Arjun Kumar, Ritika Gupta, Chhavi Kapoor, Kashish Babbar, Rohit Mehta
With the rolling out of vaccinations early in the year 2021, there was a need for an efficient vaccination drive to dose about 1.39 billion Indians. To pave the way for a universal and citizen-centric structure of vaccination drive, Honourable Prime Minster unveiled a digital vaccination management system called CoWIN, a cloud-based IT solution for planning, implementation, monitoring, and evaluation of COVID-19 vaccination in India. Launched by Ministry of Health and Family Welfare, the platform that facilitates the management of registration, appointment scheduling, vaccination and certification.
Pro Administration and Citizen Platform
India has 1.10 billion mobile users in the country with about 600 million people using smartphones and 622 million users with internet connections. On an average, every second person have access to smartphone and internet connection. Thus, the very thought of platform being people centric is depicted the easy registration with mobile number, thereafter providing OTP for verification. It also enables scheduling an appointment to nearby district/city based on pincode enabling users to get vaccinated in nearby their homes without travelling to far off places.
Finally, once a centre is selected, a confirmation is received, and the details can be downloaded. After getting vaccinated, the digital certificate can be downloaded within few minutes containing details of the dose, center, doctor and even the date of next vaccination, eliminating the asymmetry of information.
Presentation by IMPRI Team:
The platform is designed to assist all administrators across various levels through automated session allocations for pre-registered beneficiaries, their verification, and the generation of a digital certificate. In addition, the system is intended to keep the process of vaccination transparent, to ensure there is an equitable distribution of the vaccines among all citizens so that the principle of equality of opportunity can be honoured.
The platform provides an end-to-end solution for the public health system right from the national up to the vaccinator level.
Under User Management, the system allows for user creation, which includes admins, supervisors, and vaccinators. Under Inventory Management and Temperature Monitoring, the platform facilitates real-time tracking and monitoring of utilisation, wastage, and coverage at all levels, including National, State, District, and Sub-District. With regards to beneficiary registration, there are two components: bulk upload and individual registration.
The primary task is planning and scheduling sessions and implementing the entire vaccine process: Beneficiary registration, vaccination, and Adverse Effects following immunisation (AEFI) reporting.
The dashboard provides invaluable data on the total sites for registration, the number of registration and most importantly, the number of doses administered. It also categorises data according to gender, age and geographic location.
International Vaccination Management Platforms
While India is at the forefront of leveraging technology in dealing with vaccine management, other countries have some vaccine management systems in place too. Here is an overview of what other countries are doing :
Dubai in UAE has a similar application; it is termed SEHA. It also provides its users with the ability to book appointments. Vaccine Guard is the product of a joint collaboration between the World Health Organisation and Estonia to develop an international vaccination certificate. Like CoWIN, healthcare workers are mandated to generate QR codes that serve as digital certificates for their citizens. Like many other countries, Israel has a mandatory public health system that is integrated with the country’s digital network. The organisation responsible for the maintenance of health are mandated to maintain digital records of all patients. Any authorised entity then has access to the data. In Sweden, Svevac serves as a vaccination register for the authorities, healthcare system, and patients who need to obtain information on vaccines.
Issues and Challenges
The presenters then spoke about some issues and challenges pertaining to the CoWIN platform.
The most glaring issue is of the scale of our vaccination program. The main question that arises here is how does the government plan to vaccinate the entire population by December 2021 if only 15.2% of our population has received the first dose and only 3.5 % has been fully vaccinated till now?
With the anticipated introduction of new vaccines, there exists the challenge of constantly reconfiguring the platform to add the latest vaccines. With the addition of these new vaccines, the issues of administering the second dose also comes up.
Another important issue would be of the digital divide. Digital illiteracy in the rural population prevents them from registering and booking a slot on CoWIN. Recently even the Supreme Court asked the government to “wake up and smell the coffee”, stressing a ‘digital divide’ is causing unequal access to Covid-19 vaccines in India.
There are also some cybersecurity risks associated with the platform. Many people face issues in booking slots due to shortage in vaccines. Seeing their anxiety, cybercriminals have begun to lure them with fake offers.
Some residents who got their first vaccine doses claimed to not have received an SMS confirming that the vaccine had been administered. Similarly, there have been other complaints of technical glitches, such as inconsistent dates, which causes discrepancies in records. The duplication of accounts is also a concern. Some people create another account using a different mobile number and/or identification since one can use multiple documents for registration. So, some get their first dose on one account and the second one on another account. But the portal does not recognise that as the second dose and thus, such people end up with two first dose certificates.
Lack of regulation for safeguarding sensitive information is an issue that many citizens are concerned about. There are questions regarding information regulation and the collection of personal data.
The government has acknowledged these fallacies and steps have been taken recently to address some of the aforementioned concerns.
- On-site registration has been enabled. Recently, The Ministry announced that anyone over the age of 18 could directly go to their nearest vaccination centre where on-site registration is available and get the doses.
- The Toll-free number has been made operational. People can call on the helpline number ‘1075’ and book their COVID vaccine slot.
- The CoWIN portal is now available in multiple regional languages. This addresses the criticism about inaccessibility by non-English speakers.
- According to the new guidelines, there are restrictions on the number of Application Programming Interface (API) calls per third party. The guidelines state that “the appointment availability data is cached and may be up to 30 minutes old”. “Further, APIs are subject to a rate limit of 100 API calls per 5 minutes per IP.”
- Users can also edit their vaccination certificates in case of discrepancies. In addition, the government has announced a new update that enables an applicant to correct any errors in name, year of birth and gender printed on the CoWIN vaccination certificate.
- In addition to that, vaccine certificates from CoWIN will now be linked to passports for people planning international travel for education, work opportunities or as part of the Indian contingent for the Tokyo Olympics.
The Way Forward
It’s essential we deliberate upon how the government plans on vaccinating about 1.5 billion people with both doses, how existing functionalities can be expanded, on-site registration and Common Service Centres can be strengthened, information can be disseminated to every pocket of our country and how the data from CoWIN can help achieve the National Digital Health Missio. There is a need to discuss India’s potential to help and enable other countries with our technical know-how, for eg CoWIN and MOSIP (Modular Open Source Identity Platform).
CoWIN Vaccination Data Potential
With this new platform and technology, we now have the opportunity to work towards a Digital #NewIndia, envisaged by our Prime Minister Narendra Modi for India 2047. The CoWIN vaccination data and Aarogya Setu data lay the foundation for a new Digital India. As we all know, due to the pandemic, the Census 2021 has been postponed. We need to have a discussion about how we can use this data towards the National Digital Health Mission, for the good health and prosperity of every Indian.
The article is based on the presentation by IMPRI team in a webinar on Strengthening CoWIN App towards Universal Vaccination organized by Center for ICT for Development (CICTD), IMPRI Impact and Policy Research Institute, New Delhi and The Dialogue. The panelists for the event included Dr Ram Sewak Sharma, CEO, National Health Authority (NHA), Ministry of Health and Family Welfare, GoI; Shri Abhishek Singh, President & CEO, National e-Governance Division (NeGD), Ministry of Electronics and Information Technology (MeitY), GoI; Shri Amit Dubey, Founder, India Future Foundation; National Cyber Security Expert and Mr John Santosh, Entrepreneur and Technocrat.
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