The COVID-19 pandemic has been a shock like none else to systems world over. The subsequent research and creation of a successful vaccine against the disease in record time is a modern day miracle, which promises significant hope for future biomedical research, as I had written earlier. While the problems associated with the manufacturing of vaccines at substantial scale are complex, the problems associated with the rollout, distribution and actual administration of vaccines are equally, if not more complex.
In India, the COVID-19 vaccination efforts have been coordinated on the COVID-19 Vaccine Intelligence Network (“CoWIN”) platform which was developed by the Ministry of Health and Family Welfare (MoHFW) with the United Nations Development Programme (UNDP). The CoWIN platform is in fact an adapted version of the electronic Vaccine Intelligence Network (eVIN) platform that has digitized stocks in 27,000 storage centres and built a capacity of around 37,000 government personnel for vaccine and cold chain logistic management since 2015. This system’s adapted form allowed us to manage the distribution, administration and management of the COVID-19 vaccine rollout.
The CoWIN platform functions as an interface not only for end users such as us, but also for National, State and District Level administrators, and for the vaccinators as well. This is meant to enable easier planning and scheduling, reduce wastage and increase efficiency. The data regarding session sites, bulk upload of beneficiary data, self registration session management, monitoring and reporting is also stored on the cloud-based platform. As such, it is meant to be a single solution for administrators, vaccinators and for the general public to interact.
The CoWIN interface also provides an open Application Programming Interface(API), allowing anyone to programme a tool that will alert them if a slot opens up in given parameters. APIs are intermediaries that essentially allow two software to communicate with each other. For example, Google Pay and PhonePe utilises the United Payments Interface (UPI) API to enable payments.
As a result of the CoWIN APIs being open, any person could build a tool which would interact with the CoWIN platform and they or anyone using the tool can be notified when slots are opened up. Infact, an Open API titled ‘Under45.in’ was acquired by HealthifyMe, a health and wellness platform, integrating both notification and slot booking facility (which uses CoWIN).
While there have been fears that the CoWIN platform increases the digital divide and that the Open APIs would allow persons with advanced technical knowledge to game the system, such fears are quite unsubstantiated. This can be evinced from the Government of India’s affidavit in the Supreme Court, according to which on 23rd June, 2021:
19.12 crore or 59% of the 32.22 crore beneficiaries were registered on-site.
23.12 crore doses por 78% of the 29.68 crore vaccine doses were administered through on-site or walk-in vaccination.
74.45% of the vaccination sites are located in rural areas and 56.24% of the doses administered were at rural centers.
The doses per million in tribal districts have been higher than the national average.
This is indicative that the fears of digital divide and inaccessibility are likely exaggerated. The high delivery of doses in on-site and walk-in vaccination shows that while direct vaccination slots through CoWIN have been substantial, the States have focussed through outreach via PHCs and through healthcare workers. Even on April 1, 2021 walk-in registrations were four times that of online registrations.
CoWIN also provides on its dashboard information on an hourly “session by session” basis to the level of a district for the past few weeks and also for individual vaccine sites on a daily basis. This information is a goldmine to understand how well - or how worse - the country’s vaccination campaign is going. It also provides information on vaccine reactions (Adverse Events Following Immunization), Rural v. Urban dosage delivery, registration trends and more.
Overall, it should be noteworthy that such an effort is being made for transparency related to vaccine data. The same platform also generates vaccine certificates and even allows the same to be linked to passports. While privacy concerns have been raised, the CoWIN platform does not mandate the use of Aadhar Card - six other forms of identity card, ranging from a driving license to a passport can be used to register in the platform by the end user.
This however does not mean that only those with ID cards can get vaccinated either. The MoHFW has issued a Standard Operating Procedure for District Level Task Forces to identify such persons and vaccinate them through the use of facilitators for the input of information. (A facilitator for example can be a Superintendent of an Old Age Home). Around 1.5 lakh persons have been vaccinated without ID cards.
While many faced issues in the initial day when registration was opened up for all those aged above 18, the system had been remarkably resilient. The platform has doubtlessly served us well and there is no doubt that it can be utilised in the future for other immunization programmes as well.
The Government has recently announced that the technology will be made open-source, and any country can take advantage of the platform. As many nations step up their COVID-19 vaccination drives, the utility of a vaccine management platform becomes crucial as well.
Hopefully, India will resume the export of vaccines as supply improves along with the export of the CoWIN platform. India has a crucial role to play in the post-pandemic world, with the Chinese vaccines efficacy being doubted, India’s vaccines and our digital platform can prove the difference for many nations.