Home / Opinion / Views /  Adopt a mix-and-match approach to vaccination

In January this year, India embarked on one of the world’s most ambitious mass immunization programmes ever undertaken. Over 70,000 vaccination centres are working hard to inoculate more than 800 million adults, at a pace that needs to be much faster than earlier such campaigns.

At the heart of the roll-out is the CoWin platform, which is a single window for citizens to schedule appointments, and for administrators to manage the process. CoWin aims to leverage India’s technological prowess to meet its biggest challenge. The user interface is simple, it accepts multiple types of ID proof, and provides application programming interfaces that let innovators create citizen-friendly apps. At the same time, it has come under criticism for being difficult to book appointments on and unmindful of the digital divide in a country where nearly half the people (bit.ly/3hPLyKB) do not have internet access. This approach advantages those who are tech-savvy, can stay online for hours at end, and type fast.

CoWin seeks to circumvent the problem by allowing four registrations for each phone number, thus letting digitally-excluded citizens seek help from their family and friends. The government has also rightly enlisted its network of 240,000 common service centres (CSCs), which are one-stop shops for e-government services, to help enrol citizens for vaccination.

More efforts are needed. To bridge the gap, India can combine its impressive record of immunization and eradication of infectious diseases with the tech infrastructure it has developed. India needs a ‘phygital’ (physical+digital) approach to vaccination. Once the government is able to procure the right level of supply, here are four specific recommendations that can be considered.

First, India can supplement its ‘pull’ model, where those seeking vaccination must come to the government, with a ‘push’ model. India’s district administrations have shown remarkable success in undertaking large-scale logistical tasks where goals are clear and outputs are visible: from job creation targets under the rural jobs guarantee scheme to enrolment under Aadhaar to toilet construction under Swachh Bharat. Local administrations need to be galvanized fully to pursue a ‘vaccination camp’-based saturation model. Clear data-based, time-bound targets for each district can be set, in keeping with vaccine supply.

The ‘push’ model is particularly important to reach those most likely to be excluded. In a country of India’s size, the exclusion of even a few percentage points affects tens of millions of people, often the most vulnerable. In its battle against polio, India used house-to-house vaccination drives to reach those children not covered by fixed vaccination sites. In 2003, over 1.3 million workers, equipped with nearly 200 million doses, took polio drops to doorsteps (uni.cf/3uqzguK). In the most recent drive, 17% of all polio vaccines (bit.ly/3wsEV4S) were delivered through such means. While operational challenges may make a door-to-door campaign infeasible for covid vaccinations, a camp model could still immunize hardest-to-reach communities.

Second, India can double down on engaging local NGOs as well as Asha and anganwadi workers, among others. Research, including a recent paper by Bangalore-based think-tank Aapti Institute, shows that such trusted intermediaries enjoy ‘social capital’ with local communities, and play an important role in facilitating access to e-governance services for those who are not digitally savvy. These groups can be equipped with enrolment software that feeds into the CoWin workflow. For this to work, they need to be suitably incentivised. Aadhaar was able to enrol millions of people in a short span because there was a reasonable compensation for enrolment agencies, based on the number of people they enrolled. India can similarly incentivise frontline workers through a nominal honorarium per vaccination of 10, say, which gets credited to their bank account after the vaccine is received.

Third, a special emphasis should be placed on vaccinating migrant populations. Not only have they been the economically worst-hit, they also lack deep local networks often required to navigate the health system. In 2004, India introduced ‘transit immunization’ of migrants at street intersections, bus stands and railway stations to combat polio; as many as 40% of cases outside Bihar and Uttar Pradesh (bit.ly/3fOS2qi) were among such groups. ‘Walk-in’ covid vaccination camps at migrant convergence points like railway and bus stations could be considered.

Finally, India should address vaccine hesitancy in mission-mode, especially in rural India. During the polio drive, India leveraged community leaders and influencers to spread the message among people who were sceptical or had misconceptions about taking polio drops. A similar approach should be adopted for covid vaccination. Other proven methods of influencing behaviour change, such as mass-media storytelling, should also be deployed. In the recent past, programmes such as Main Kuch Bhi Kar Sakti Hoon, a multimedia show broadcast on Doordarshan and All India Radio, reached millions of Indian and influenced attitudes on a range of issues related to women’s empowerment and maternal health.

India has no option today but to achieve its audacious vaccination goal. A ‘phygital’ approach that combines the best of a digital interface with a human outreach, learning from past efforts, would offer the country a reasonable chance of getting there.

Subhashish Bhadra and Varad Pande work at Omidyar Network India.

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