Why this divide in vaccination drive?

The inequity begins with the central government’s policy and spills across all stages from procurement, supply, pricing and the access to the vaccine itself.

As of February, India had ordered vaccines sufficient for just 4% of its population, whereas many other countries had placed sufficient orders to vaccinate their citizens many times over.

The central government, which had been handling procurement and supply of vaccines, adopted a “liberalized” vaccination policy on April 23. States could procure their own supplies, and were given just over a week’s notice to make arrangements.

“States were told: Go forth, multiply, procure, compete with each other and get your own vaccines,”. Most states later announced free vaccination drives, but the taxpayers are still paying for it. The central government continues to set the prices for vaccines even as it purchases them from manufacturers for a lower rate than the states, some of whom will have to spend over 30% of their health care budget on vaccines alone.

Taneja compared this with the early days of the pandemic when American states were in a bidding war to access critical medical resources: “It was a lesson that procurement has to be centralized. India went about the whole thing in reverse.

Vaccines from Serum Institute of India and Bharat Biotech, which produce Covishield and Covaxin respectively, are currently priced between $2 and $20 for a single dose, depending on who procures it and where a citizen gets the jab. The Russian vaccine Sputnik V was rolled out last week at $13. Some states offer free vaccines at government facilities, but private hospitals can charge from $8 to $18 for a single shot.

This is unaffordable for most Indians, over 134 million of whom live on an income of less than $2 a day. At least half of these were pushed into poverty by the pandemic, according to Pew Research Center. The current policy doesn’t deliver on socioeconomic justice.

When these challenges can be filled up for vaccine hesitancy?

The devastating effects of the second wave in rural areas have prompted fintech startups to enable vaccine registration.

PayNearby has helped over 8 lakh citizens register through its network of agents called “digital pradhans”, who are present in kirana, ration, mobile and hardware stores, frequented regularly by rural users.

• A toll-free helpline number 1075has been activated for those without internet.
• Similarly, districts can explore missed-call campaigns,which could ensure that minimal infrastructure is being optimised for processing high-volume user requests.
• Even though the reportedadverse events following immunisation stands at only 012 per cent, dedicated representatives can provide vaccine-related pre- and post-counselling to individuals.
• Almost 81 crore beneficiaries, 75 per cent of whom are in rural areas, procure ration from 5,46,165 fair price shops across India.
• There are over 11 lakh business correspondent outlets in India working mostly in rural areas to advance the mission of financial inclusion.
• A network of around 1,54,965 post offices (as on March 2017) exists in India of which 1,39,067 are in the rural areas.
• Such points of contact can be leveraged as dedicated units for publicising the benefits of Covid vaccines and as physical locations for vaccine registration
• The Prime Minister recently described district officials as “field commanders” in our efforts against Covid.
• This ambit should move beyond just the district bureaucracy to the extensive network of public services.
• A stellar example of direct engagement also stems from the success of the Swachh Bharat Abhiyan.
• Direct engagement with citizens contributed greatly to the operational success of previous immunisation campaigns like the pulse polio programme.

Where vaccines don’t reach?

The virus has reached remote parts of the country such as Tamil Nadu’s Sittilingi Valley. Dr. Regi George, a community doctor who runs the Tribal Health Initiative, attends to 20,000 Indigenous residents spread over 25 remote villages. Cases have been spiking and health care is often inaccessible, George said.

He feared the community would be left out of the new vaccination drive; with the digital dependency exacerbating problems caused by lack of access, vaccine shortages, and hesitancy on the part of the elder population.

“We have such poor network signal here. People still use feature phones, and the phone numbers they need are set on speed dial,” explained George. “How do you expect them to use Co-WIN?”

Around 550 million Indians continue to use feature phones, which means they cannot access digital apps. While India had 450 million smartphone users as of 2019, only 25% of its rural citizens had a device. Only 4% of Indians in rural areas and 23% urban areas had access to computers. Internet connections aren’t universal either — just over 34% of Indians have one.

The disconnect between India’s reality and the government's scheme has prompted criticism over the Co-WIN app’s efficacy. George said: “They make policies in the cities and think the entire country runs on apps.”

As pointed out by Oxfam India, India’s vaccination plans are missing detailed district plans and social mobilization strategies to reach vulnerable communities.

Who all stand at the risk of exclusion?

Unsurprisingly, the urban, the rich, the upper castes, the rich, the educated and men are more likely to own Internet-enabled smartphones, while the rest stand at a risk of exclusion from accessing vaccines.

Women, for instance, are far less likely to own smartphones, with a gap of 22 percentage points among 18-44s. Further, the digital divide accentuates through caste and class — the rich (18-44 years) are three times more likely than the poor, while the upper castes are more than 1.5 times likely than SCs/STs (Table 1) to have a smartphone. What’s more, even among those between 18-44, the divide is quite significant with the youngest chunk of 18-25 twice as likely to own a smartphone as 36-44s.

Backing up the Supreme Court’s observation, the data highlights the “farfetchedness of an illiterate villager from rural India crossing the ‘digital divide’ to register for Covid-19 vaccine on the CoWin portal”. Among 18-44, merely 8% of non-literates, 17% of those who studied up to the primary, and 40% of those educated up to matric own smartphones, as against three in four (74%) of college-educated. The urban-rural divide too is colossal, as highlighted in Table 1, with more than three-fifths of the 18-44 urban population owning smartphones, as against less than two-fifth in rural spaces. Even among urban dwellers, 72% of 18-44s in cities own smartphones, as against 56% in towns. With the second wave of Covid-19 spreading into the interiors, which had largely remained unaffected during the first wave, the rural-urban asymmetry in the vaccination coverage needs to be addressed.

How wide is the digital divide?

In the Lokniti-CSDS National Election Study 2019, only 1 in every 3 were found to be using smartphones (approximately 90% of the smartphone users had Internet in their phones), and merely 16% and 10% households had access to a computer/laptop and an Internet connection at home, respectively. Even though 18-44-year-olds were more likely to own smartphones (nearly half), the proportion is still dismal, with the majority of the chunk likely to get the jab later than their privileged counterparts.

In 2017, 24% Indians (and 35% among 18-44s) owned smartphones. Going by our most recent data of late 2020 and early 2021, in the five states that went to polls most recently — Bihar, Assam, West Bengal, Tamil Nadu, and Kerala — smartphone users have grown by 12%, from 33% in 2019 to 45% in 2020-21. Among 18-44s, this proportion improved from 47% to 56%. Since we also find that these five states taken together mirrored the national average for smartphone ownership both in 2017 and 2019, we assume a similar growth nationally as well. This would mean that a majority of the population in India still finds itself at the wrong side of the digital divide.