Balancing Digital India and Vaccine Equity

By Aryan D’Rozario
With 800 million voters spread out across 1.26 million square miles, Indian politicians have often found innovative ways to campaign. In 2014, Narendra Modi made his presence felt everywhere, using social media and virtual meetings via holograms. India’s vaccination drive needs the same innovative ideas to help immunize one of the world’s largest countries. And the solutions may not always lie in technology which is not equally accessible to all Indians.
Digital India” has led the way in creating online applications to bring vaccines to India’s citizens. It started last April with the Aarogya Setu application (app), a “contact tracing” app with over 100 million users. This was followed by another app, “Co-WIN” which was developed for booking vaccination appointments. The creation of these apps by the government in a short span of time is a testament to its digital direction. The problem? Not everyone can download an app. Only one in four Indians own a smartphone. Therefore, access and equity are real impediments for many Indians, especially those who have lived their lives without knowing how to use a smartphone. A survey in May 2021 found that 63 percent of Indians in rural areas did not know how to use the Co-WIN app. 
India saw the consequences of only using technology when many people were unable to book a vaccination appointment. Those who could download the Co-WIN app are mostly urban Indians for whom using a smartphone is a daily occurrence. India’s rural population, however, was left scrambling to understand the process. In May, theHindustan Times’ analyzed data from Co-WIN and found that urban Indians were more likely to get vaccinated. Vaccines administered in urban districts were 1.7 times more than those administered in rural districts. This divide is distressing, especially since many rural areas often lack access to quality healthcare. 
India’s need to digitize is urgent. However, “digital India” cannot be the only norm. India’s goal must be to vaccinate as many people as fast as possible, and the apps, however well-intentioned, cannot accomplish it all. The Indian government should consider alternative methods:
  1. Utilize its large network of bureaucrats to organize camps in rural areas without the need for an appointment. China has followed a similar framework – using a vast network of well-trained bureaucrats to get the vaccine distributed. India has done it before too. The smallpox eradication effort in 1973 involved the deployment of health workers to villages and towns to knock on doors and vaccinate. Similar efforts were used to eradicate polio in 2011.
  2. Look at innovative ideas being adopted at the sub-national levelChhattisgarh has allowed tribal communities, a large and often uneducated group in the state, to receive vaccinations without needing an appointment. Chhattisgarh has shown success in vaccinating quickly and efficiently.  State governments should disseminate information about vaccine availability and registration processes, especially in rural regions.
  3. Co-opting local leadership is an effective way to mobilize communities in favor of vaccinations. Local leaders can include panchayat leaders, religious leaders, and media influencers. There has been a fair share of vaccine hesitancy in India, but the government has the capacity to positively influence change. In 2011, imams (Muslim religious leaders) were used to urge their congregations to vaccinate against polio.  
While India must continue to develop its technological capacity and promote digital India, it must not forget its most vulnerable communities. India has an estimated 433 million active monthly internet users and the lowest cost of data in the world. Internet penetration is 36 percent for all Indians age 12 and above. Digital India is slowly inching towards reality, but we have not reached numbers high enough to justify only using apps. 
The disparities are clear. Using the internet remains a privilege. And government policy should accommodate rather than discriminate. India must embrace innovate ideas, many of which have been used in the past, to successfully vaccinate its large population. 
Aryan D’Rozario is an intern with the Wadhwani Chair in U.S.-India Policy Studies