Since January 2021, the Indian government has faced a rather daunting task: the need to vaccinate 1.3 billion people, or roughly one-sixth of the world’s population. Technology has been both enabler and barrier in this process.

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A health worker collects data before conducting a basic test on a volunteer during a day-long mock drill to check the best ways to vaccinate people against COVID-19. The drill will test the operational feasibility of CoWIN in a field environment. Photo by Sondeep Shankar/Pacific Press/LightRocket via Getty Images

All data and statistics are based on publicly available data at the time of publication. Some information may be out of date.

At 4 p.m. on April 28, 2021, the Indian government opened up registration for vaccines for those aged 18–45 years. More than 10 million people signed up in 8 hours, causing CoWIN, which is the Indian government’s vaccine booking portal, to crash.

The CoWIN portal was a part of a mobile app called Aarogya Setu, which was designed for contact tracing of people with COVID-19 from March 2020. It was supposed to help people book a vaccination center, help people register their vaccination data, and remind them of their next dose.

However, there were glitches.

When India’s vaccines rolled out for older adults and people with comorbidities, problems ranged from not getting text alerts after having a vaccine to problems with booking slots. There were also worries that it was not scalable, especially when vaccinations opened up for a larger segment of the population.

Dr. Ram Sewak Sharma, chief executive officer of India’s National Authority, said in an interview with the Economic Times that the platform existed because the government was focused on leveraging technology to boost healthcare.

“CoWIN platform is enabled with real-time monitoring of vaccine data. From registration of vaccines to delivering certificates of vaccination, our system is fully prepared and enabled with the right technologies. The system is highly scalable,” he said.

However, for many Indian people, scheduling their vaccines has been a very frustrating experience.

For security reasons, the CoWIN website automatically logs users out 15 minutes after they log in. A person needs to register with a photo ID and book their slot fairly quickly.

“While the website’s user interface was fine, (navigating) it is arduous because one has to keep refreshing the page in order to see updated (vaccine availability) information,” Ranjini Rao, a marketing communications professor at Commits College in Bengaluru, India, told Medical News Today.

In early May, the Indian government said that walk-in vaccinations would not be allowed for people aged 18–44 years, making registration on CoWIN mandatory. This was to ensure that people maintained proper physical distancing at vaccination centers, authorities said.

However, the reality was very different. When Rao managed to book a slot for herself and her husband at Bowring Hospital in Bengaluru, the slot was scheduled for 3–6 p.m. “When we got there after an hour’s drive, we were shocked. The line snaked from the first floor all the way to the sixth! It was a super-spreader event, this vaccination drive.” Afraid of exposure to the virus, the couple left.

For many people, the registration process was simple enough. However, many did not get as far as Rao did, because booking a time slot for vaccination proved impossible.

“I started calling it the Great Gamble,” said Rumela Basu, a freelance editor based in Kolkata.

She checked the CoWIN website throughout the day, but slots were always full at the centers around her home. After a week, she decided she needed expert help.

Tech startups and anonymous techies filling in CoWIN’s gaps

After India rolled out the CoWIN platform for those above 18 years old, techies and tech startups across the country sprang into action, trying to help people book slots faster.

Many of them, like Chandra (who prefers to go by one name), worked anonymously and free of charge. Chandra is at university studying computer science, but he has been home for several months on an extended break as a result of COVID-19 quarantines. So, to help people, he built a bot on Twitter called the Bangalore Vaccine Updater.

“What we’re doing is perfectly legal,” he told MNT. “Slots for vaccinations in hospitals don’t open all at once. So the bot I built keeps trawling the CoWIN website and Aarogya Setu app every 1.35 seconds, seeking out these new openings and sending out alerts to people who have signed up for them.”

With slots vanishing seconds after they open up, these notifications can give people an edge when they attempt to book vaccines.

Basu also signed up on Under45.in and getjab.in. These are popular vaccine services that also track slots and alert users of availability by sending messages via Telegram and email. However, even this did not seem to help.

Whenever she got an alert, she would immediately log into CoWIN and enter her state and district information to check for available slots. She did all of this in under a minute, she said, but the slots were already fully booked. Soon, finding a slot became an obsession.

“I have logged into CoWIN in the shower, during breakfast, leaving behind a half-eaten lunch. There have been times where I would let out a small squeal in the middle of a conversation with my family during tea-time or just when we were sitting around, surprising everyone, because there was an alert.”

– Rumela Basu

Others who have used the CoWIN website have also complained about the vanishing slots, which some have attributed to the great demand for vaccines and the shortage in supply.

However, it is not possible to rule technical difficulties out, said Basu. “Sometimes, you would see a number in yellow indicating there’s a slot, but in the 5 seconds that you put in the captcha/code to book it, it would say that the vaccination center is fully booked.”

One time, a new vaccination center in Basu’s neighborhood indicated that it had over 100 vaccines available, and yet, when she logged in, there were no slots. When she refreshed the page and went back, the number of available vaccines remained unchanged, showing that slots were still not fully booked. She found it bewildering, she said.

Even as urban, educated people struggle with the CoWIN platform, many expect the situation to deepen the country’s already skewed digital divide, making immediate access to a vaccine even more difficult for the multitude of India’s rural poor.

“While there is a need for a technological backbone like CoWIN that can help us record and keep track of vaccination data, there are some challenges that need to be overcome too,” said Dr. Anant Bhan, a researcher in bioethics and global health and a visiting professor at Yenepoya University in Mangaluru, India.

The lack of flexibility was one of the biggest hurdles to the third phase of India’s vaccination drive. “If people can get access to the vaccine only through such a digital platform, then this approach would exclude or make it very difficult for a significant part of the population. There is a gender divide as well. It is less likely for poorer women to access tech devices,” he told MNT.

However, some changes have recently taken place to help improve access. As of mid-May, CoWIN is available in 14 native Indian languages. It previously used only English.

On June 15, 2021, the Health Ministry announced that walk-in registrations would become allowed, waiving the need for bookings. Now, those above the age of 18 years can get vaccinated by showing up at vaccine centers, just as older adults did during the previous drive.

According to data released by the Health Ministry, nearly 55% of the 211.8 million doses administered up to May 29, 2021, took place during walk-ins. Authorities have now asked more than 250,000 Community Service Centers, which are India’s primary healthcare centers, to assist rural citizens with registrations.

On June 21, 2021, India recorded its highest daily vaccination rate: 8.1 million doses, which is 2.5 times the daily average. However, these numbers have not been consistent. They dipped to a little more than half, or around 5 million doses, on the very next day.

Technology limitations risk becoming ‘barrier to lifesaving vaccines’

Basu finally got vaccinated at a private drive organized at her boyfriend’s housing society on June 3, 2021, roughly a month after she tried to book her slot. There was proper physical distancing with a couple of doctors overseeing the process, and she paid for the vaccine.

The vaccine would have been free had she managed to book it at a vaccination center. Still, it was a relief to finally receive vaccination certificates, she said.

As the delta variant tears through communities in India and across the world, there is no more time for struggling with sluggish vaccination efforts, public health experts feel.

“A lack of access to technology should not become a barrier to lifesaving vaccines, especially when the intent [is] to enhance coverage and vaccinate as many people as possible now,” said Dr. Bhan.

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