As the COVID-19 pandemic spread across from big cities into smaller towns and villages, it has impacted hugely the pace of vaccination across the country. The government-mandated online registration process for COVID-19 vaccination has posed quite a bit of challenges not only to the rural population but also to the urban population residing in resource poor settings. The internet savvy urbans cornered access while the marginalised sections and less aware urban people are being left out. As every city’s urban educated were in a mad rush to book slots for vaccination for those in the 18-44 age group, this process was yet to find any legs in the slums/ resource poor settings that accommodate the city’s working-class population. This tier of the society who are at the bottom of the pyramid either do not possess the smartphones needed to do online registration or those few who may possess it do not know how to navigate the registration process and many do not know about the Co-WIN portal.
The rural scene is somewhat similar to the challenges faced by the urban poor. The rural populations who do not have much access to smartphones and lack the digital skills (for those who possess the smartphones) needed to book slots are left out of the circle of safety. There are several people who have little or no knowledge of operating even the key pad-based normal phones. Registering through a portal seems a dream ride to them.
These factors prohibited many to avail the vaccine and they gradually turned into vaccine hesitant groups in the process. The national and local media left no stone unturned to bring up this digital divide that has its presence strongly rooted in the urban resource poor settings and in villages (both tribal and non-tribal).
Recently, the Honorable Supreme Court has flagged off this issue of digital divide and how it is affecting and exasperating the registration process on Co-WIN portal. It further added that this digital divide that is a manifestation of accessibility barrier will have serious implications on the right to equality and the right to health. The data suggests that 63% in rural areas and 43% in smaller towns do not know how to register on Co-WIN for vaccination; 60% of rural population and 40% of those in smaller towns did not even know how to enrol for vaccination. (BCG India’s survey was carried out from May 23rd, 2021 to May 28th 2021 covering nearly 4000 respondents across metros, smaller towns and cities in rural India).
In India, where the COVID-19 vaccination is in its full swing, the digital divide, if unaddressed, has a high risk of widening the vaccine divide, potentially leading to negative health outcomes. According to the International Telecommunications Union (ITU), only 28% of the rural households in developing countries had access to the internet in 2019 (65% in urban areas) compared with 81% in developed countries (87% in urban areas). It is not only important to address the issues of availability and accessibility to high-speed internet and devices such as computers and smartphones and enhancing one’s digital skills to navigate the online registration process but also to ideate and implement solutions for closing this digital gap, accelerating COVID-19 vaccine delivery, thereby getting more people vaccinated.
A special vaccination camp for the priority groups has been organised by Bankura District Administration. The priority groups are the differently abled citizens who not only find it difficult to go to the vaccination centres due to limited mobility but also face challenges in accessing the phone- based registration process. A decorated tableau, `Duare Vaccine’ was launched at the DM office, Bankura on June, 1st, 2021 to vaccinate the 18+ cohort. This followed a community-based, flexible and people-centric approach, bringing the vaccination services at the door step (the literal meaning of the word, Duare Vaccine initiative) of the vaccinees while maintaining all necessary precautions and safety measures in accordance with the operational guidelines and advisories. In the areas where mobility and competency (of the vaccinees) and access (to computers and smartphone) issues could have contributed largely to the already existing digital divide, the government and local authorities addressed the potholes immediately and formulated this community-friendly approach.
Apart from this, many special camps were held; at Barjora Super Speciality Hospital (May, 28th, 2021) for the differently abled. Sixty-six citizens of 18-44yrs cohort were vaccinated; at Kenduadihi Bikash Society (a special school), 108 people were vaccinated. The composition of the vaccinating team was as per the guidelines issued by the Ministry of Health and Family Welfare.
The initiative, `Duare Vaccine’ adhered to the guidelines that included details regarding registration and appointment of beneficiaries — either in advance, on-site or Facilitated Cohort Registration process on Co-WIN/BENVAX, line listing of beneficiaries, thereby making the vaccination process accessible, approachable and friendly to the persons with special needs.
The state has adopted a connectivity solution that has resulted into a central hub for vaccine delivery in both urban and rural areas. The state has launched the Telangana State Vaccine App through which the beneficiaries are registered. All the concerned Line Departments (Municipal Corporation, Panchayat) have the details of the beneficiaries; age and sex wise. (Data of the registered beneficiaries is available at the PHC level and certificate of vaccination is issued after the vaccine is administered). The beneficiaries are the Super Spreaders and Vulnerable groups who have already been prioritised, identified and line-listed. This move has saved the prioritised groups from the hassles of online registration.
As soon as the state sensed the teething issues of digital divide, no time was wasted in addressing the same. A Group of Ministers was formed at the state level that decided that the spot registration should be initiated immediately across the state to mitigate the challenges posed by online registration in Co-WIN portal. Realising the severity of the situation and the negative impact it could have on the vaccination coverage, a rapid assessment was carried out under the umbrage of Madhya Pradesh SEPIO. A total of 10 Tele-callers were hired and stationed in COVID-19 Control Command Room. Each Tele-caller was given a list of 50-100 vaccinators’ name and contact details. Their task was to call the vaccinators and ask them the questions on whether the people possess smartphones/computers or not, on their digital skills, the awareness of the people about Co-WIN registration process, knowledge level of how to register in Co-WIN, the challenges they faced, internet connectivity issues etc.
Unable to find online slots, several urban residents were zeroing-in-on the rural areas, where slots were easily available for vaccination. They were travelling to Phanda Kala village (25kms from Bhopal) and Ratibad village (17kms from Bhopal) to get the vaccination services. The outcome was that the nondescript Sub-centres/CVCs were lined with urbanites swooping on its rural hinterlands that resulted into clashes between the rural masses and the urban people. The findings and feedback of this rapid assessment and the information collected through field monitoring in these villages, urged the state functionaries to go for spot registration. Various awards like Panchayat Puraskar, Nagar Nigam awards were announced as an incentive to boost the vaccination uptake and keep the momentum going steadily.
Other states like Tripura started registrations at Common Service Centres (CSCs) across districts. These CSCs assist the people in registering in the Co-WIN app and eventually provide the vaccination services without any hassle to the less aware, less read, less informed sections of the community.
Uttar Pradesh has started the Cluster Approach strategy so that maximum beneficiaries in the target groups are covered. The community mobilisation and vaccine facilitation activity will be intensified in a small geographical region (10-12 villages) so that no one is missed out. It will be carried out in phased manner.
Gujarat, reported to have no digital divide issues.
Connectivity is key to ensure that no one is left behind. The state governments, in partnership with local and private sector machineries, development partners, NGOs, CSOs, and CBOs should consider a range of options to expand the access to the services and address connectivity gaps particularly in rural communities.