It’s 9.40 am and the Vaccination Officer-2 (VO-2) at Niloufer Hospital is sweating profusely, under pressure. She is unable to verify a COVID-19 vaccine beneficiary on the government’s Co-WIN portal. The browser with the portal open says, “Something went wrong, please try again”. From her counter alone, she is supposed to authenticate as many as 67 beneficiaries and send them for vaccination. Instead, a queue is building.
The VO-2, who did not wish to be identified, is an Auxiliary Nurse Midwife (ANM) from a city Urban Public Health Centre (UPHC) facility. She had only received verbal instructions on how to operate the portal from the District Medical and Health Office (DMHO) in December. Her task is to verify the details mentioned in the list of vaccine beneficiaries due for that day. Once verified, she has to then authenticate them on the Co-WIN portal. But the portal refuses to respond fast and a queue of anxious vaccine beneficiaries piles up behind her. The portal finally responds after several attempts and the line finally moves forward.
However, her struggles do not end there. The name and phone number of R Laxmi, a contract staff member on security duty, who was scheduled to receive the vaccine on Thursday does not reflect on the beneficiary list on the portal. The Niloufer Hospital administration had sent details of all hospital staff, including doctors, nurses, security guards and sanitation staff, to the DMHO to get them registered on the Co-WIN portal.
The Union government hopes to vaccinate as many as 3 crore healthcare workers in the first phase of vaccination. As on January 22, 2021, till 7 am, nearly 10.5 lakh (10,43,534) health and other frontline workers have received the vaccination. For the general public, the vaccine will be provided only on pre-registration on the Co-WIN portal. However, the registration is not yet open. A close look at the portal’s operation on the ground shows India’s COVID-19 vaccination app is still a work-in-progress.
“Yesterday an option was added by which walk-ins can be accepted if they are in the register,” the VO2 explains, as she tries to add Laxmi to the beneficiary list, but the portal doesn’t show any details about Laxmi.
“I don’t know what to do now,” the VO2 tells this reporter, while asking Laxmi to wait. She then tries to authenticate the next vaccine beneficiary, but the problem recurs. Of the 10 subsequent vaccine beneficiaries, only two were authenticated and able to receive their vaccine shots. As the other eight beneficiaries wait, more people arrive to receive their shot.
It is not just the VO-2 who is struggling. The on-duty Resident Medical Officer (RMO) in charge of managing the crowd, too gets anxious as the crowd grows. He urges the officer to quicken the process. “If the system isn’t working, why don’t you manually verify by looking at the register and then authenticate on the Co-WIN portal later?” he asks.
But the VO-2 was instructed to authenticate a beneficiary only if their name is registered with the portal.
The delay now begins to irritate the doctor, who dials the DMHO seeking instructions. Finally, an officer from the DMHO instructs the VO2 to authenticate beneficiaries manually and update the Co-WIN portal later.
The VO2 proceeds to manually record the details of the beneficiaries who did not show up in the system.
A data entry officer in the DMHO accounts department attached to the vaccination programme tells TNM that the problems at Niloufer were due to the errors made while uploading the Excel sheet in bulk at the back-end. “We collected all the data for registration from hospitals and bulk-upload it into the Co-WIN portal. Even if there’s a mistake in a full-stop or comma, the name gets rejected and doesn’t get uploaded. We have to collect the names and phone numbers of these people and upload them again for it to reflect in the Co-WIN system,” he explains.
The work is tedious, says the DEO, as there are not enough people to do the data entry work. “We had to rope in Auxiliary Nurse Midwives to do the job. The data entry can be done on an Excel sheet and the process can be faster, but there is scope for errors. Also, the data can be fudged in an Excel sheet. Those who are not in line for the vaccine may get it and the original beneficiary may miss out,” he adds.
On January 16, the day of the vaccine rollout, most states faced trouble with the Co-WIN portal. Maharashtra reportedly stalled its vaccination drive for two days due to glitches in the portal, while Telangana and Karnataka too reported issues with using the portal.
Dr Giridhar Babu, a member of the Epidemiology, Surveillance and Research group constituted by the ICMR National Task Force for COVID-19, opines that India should have stuck to its time-tested and perfected Universal Immunisation Programme (UIP) adopted for polio and measles. “When we can do mass vaccination with paper, pen, and micro-planning, why do we have to implement something that has not been tested yet on a large scale. Co-WIN has not really been helpful so far,” he adds.
Acknowledge the technical glitches and fix it by next phase.
— GRB (@epigiri) January 9, 2021
There is still time. Pen-Paper-excel has worked for vaccination programs. Use it for first please.
My two cents
Dr Giridhar is of the view that the COVID-19 vaccination process should have adopted a bottom-up approach where all details of the vaccine beneficiaries are captured in the field and collated at the district and state level. “But Co-WIN is a top-down approach where there is a bulk upload of data in real-time. In this approach, we ask people to come to a particular spot for vaccination. Unless the vaccine beneficiary gets the message about the schedule, they will not know,” he adds.
The doctor says the present approach to mass vaccination makes it difficult to detect previously undetected comorbidities in the vaccine beneficiaries. “In a bottom-up approach, the micro-planning is done at the individual and household level. Citizens are called for a session where they are asked about their health, and then told where to go get vaccinated. The problem now is we don’t know how many people have comorbidities. Without doing proper assessment, how do you invite people for vaccination?” he asks.
To register employees with the portal, the management of a government hospital in Telangana have shared either their Aadhaar or PAN card details. This data is then uploaded to the portal in the back-end at the DMHO. TNM checked with the hospital administrations of Hyderabad’s Osmania General Hospital and Sarojini Devi Eye Hospital. Both administrations had used identification documents already available with them for salary purposes to register their hospital staff, but no consent was taken,
“They gave my Aadhaar details without my consent,” says one of Sarojini Devi Eye Hospital’s Resident Medical Officers (RMO), who did not wish to be identified. “The Aadhaar has my iris scan and fingerprint details, it’s my personal information. But the hospital gave the details sometime in December and they didn’t seek any permission. For most doctors, they have shared PAN numbers, it’s mostly the contract staff members whose Aadhaar details were shared,” the doctor adds.
The duty RMO says the Co-WIN portal accepts any type of identification document for registration, but Aadhaar and PAN were chosen for practical reasons. “You can give your driver’s licence or voter ID. But we chose Aadhaar and PAN as it’s readily available with us. It’s collected for salary reasons,” he says.
The Co-WIN portal provides an option to authenticate using Aadhaar. One can provide biometric details or receive an OTP or provide demographic details to authenticate. “But we’re not using the Aadhaar option to authenticate as of now,” says the DMHO data entry officer, adding, “The OTP takes ages to arrive and many people have issues as their Aadhaar is linked to some other number.”
The Supreme Court, in March 2014, while ruling that Aadhaar cannot be made mandatory for any government service had also ruled that government organisations cannot share with each other Aadhaar details of any individual without consent from the person.
A senior doctor overseeing the vaccine rollout, who did not wish to be identified, admitted that not everyone’s consent was taken. He, however, says that the portal is helping his hospital prevent unauthorised access to the vaccine by identifying beneficiaries. “Many people are coming to me and pressing me to give them the vaccine, because they are worried. We realised that even retired hospital employees are asking for the shot. But only those registered with the portal will get the vaccine,” says the doctor, who even faced employees bringing their relatives and friends to get the shot. “The Co-WIN app helps prevent that,” he adds.
“We were never asked to collect consent because we never got any such instructions from our superiors. We entrusted the work to patient care workers, class 4 workers and health workers,” the doctor says.
L Srikanth, a technology researcher points out that on the Google Play Store, the privacy certificate for the Co-WIN app takes the user to India’s ‘National Digital Health Mission: Health Data Management Policy’. He wonders how the privacy policy of the vaccination app can be linked to broad national health data management policy.
So #COVID19Vaccination has its own app - tech infra management - #CoWIN.#Thread to keep a watch on this. It is *as* important or even more important than @SetuAarogya app Page 45 of https://t.co/SkjQC1POQ7 CoVID-19 Vaccine Intelligence Network (Co-WIN): The Digital Platform
— Srikanth ஸ்ரீகாந்த் (@logic) January 17, 2021
A project of the Ministry of Health and Family Welfare (MoHFW), the National Health Policy, 2017 intends to digitise the entire healthcare ecosystem of India. The objective is to create a system of digital health records that is easily accessible to individuals and health service providers alike. For this purpose, each individual will be assigned a Health ID number linked to their Aadhaar for authentication. The policy claims that the generation of the Health ID and its linking to Aadhaar is voluntary and that services will not be denied if both are not linked.
Srikanth points out obtaining a single consent on using Aadhaar as ID proof for vaccination without a choice to opt-out of Health ID poses dangerous risks. The Health ID is created automatically. It creates seeds for lifelong electronic health records digitization, even as we don't have a data protection law.