India’s deadly coronavirus second wave has underscored a stark digital divide determining who has better access to vaccines and healthcare, as surging caseloads expose shortfalls and overwhelm hospitals.
Onerous online procedures have turned vaccine access into an exclusionary, often lottery-like process in a country where about half the population lacks internet access.
When India opened up vaccines to all adults on 1 May, those in the 18 to 44 age group had to register through the Cowin platform – a centralised system – before they could book an appointment. For this, they need identity documents and access to a smartphone or computer with a strong internet connection. As states grapple with vaccine shortages, the online system has privileged a small fraction of elite, tech-literate city dwellers.
“The government has never looked out for people like us, and now is no different,” said Sarfaraz Ahmed, a driver in Mumbai.
Although he lives on a footpath just steps away from a club being used as a vaccine centre, he didn’t know the temporary clinic even existed. “We want to get vaccinated, but we have no idea how to go about it. No one has reached out to us,” said Ahmed, who owns a mobile phone, though not a smartphone.
This week, India’s health ministry announced that states can offer on-site registration in government-run clinics for all adults, acknowledging that people without internet or smartphones had “limited access for vaccinations”. But activists say more must be done to ensure doses are available to all.
India’s second-wave surge is setting global records for new daily infections and death tolls, while exposing long-standing inequalities between cities and rural centres, and across class and caste lines.
Healthcare and vaccine shortages have hit everyone. But internet access has proven to be a lifeline for some and a barrier for others – from getting vaccines or emergency help, to a wide information gap. As the virus overwhelmed hospitals in urban centres like Bangalore and Delhi in April and May, tech-savvy urban users leveraged social media to find leads for beds, oxygen, and medicine.
“We want to get vaccinated, but we have no idea how to go about it.”
India’s second wave is starting to stabilise in cities like Delhi, but activists fear the divides could grow even more acute as the pandemic swells in rural areas – where health systems and resources are more fragile, and internet connectivity more sporadic.
Reports from states like Bihar, Jharkhand, Gujarat, and Uttar Pradesh are grim. Bodies have been washing up in the Ganges, crematoria are overflowing, and graveyards are packed to capacity. “The situation is very bad. The entire village is suffering from COVID-like symptoms,” said Nizamuddin Khan, a physiotherapist and resident of a village in Uttar Pradesh.
In Mumbai, vaccine availability announcements were made on Twitter – a platform used by only a fraction of India’s population. Available slots are often snatched up within seconds.
Language is another barrier. So far, the Cowin app has only been available in English, spoken by about 10 percent of the country.
“How do I know where to check or what to do? I am not that educated,” Shivcharan Yadav, a migrant worker in Mumbai, said in Hindi.
Activists, researchers, and civil society groups have condemned what they see as needless and discriminatory policies that are widening the gap in access to vaccines. They’re demanding that mandatory steps like proof of identity also be removed.
“People are forgetting a basic fact that vaccination is to be carried out by healthcare workers, not by IT engineers. It is a highly logistics-driven process,” said Srinivas Kodali, a researcher with the Free Software Movement of India. “Tech utopian ideas don't factor realities on the ground.”
The urban poor like Ahmed and Yadav, who number more than 80 million, have been particularly hit.
“Even the few that have smartphones aren’t able to manage,” said Subodh Bind, a street seller in Delhi. “If the government reaches people through local leaders or elected officials, that would instil confidence and awareness in people.”
He said he has seen many people struggle: “Rich people may be able to manage, but what about us?”
Faster internet, better access
India has about 749 million internet subscribers in a population of about 1.3 billion people, according to the government’s telecoms regulator, though a 2019 survey suggested only 36 percent of the population had access. Mobile plans are cheap, and connectivity is constantly growing, but large parts of India are still offline.
“Forget 4G. You don’t even get 2G internet in some areas; you can’t even make calls,” said Dr Sarika Kulkarni, founder of the Mumbai-based Raah Foundation, which works with Indigenous communities in remote parts of Palghar district, north of the city.
The foundation is urging local authorities to take the healthcare registration process offline, or “the bulk of this population will not be vaccinated”, she said.
Vaccine shortages have compounded problems. India is the world’s leading vaccine manufacturer, but it blocked exports in March as its second wave began.
As of 23 May, roughly 11 percent of Indians had received at least one dose, while the fully vaccinated population was just 3 percent. India is averaging about two million daily doses; at this rate, it would take more than two years to fully vaccinate three quarters of the country.
With vaccines limited and access dependent on the app, coders and the tech-savvy have created workarounds – social messaging groups and other hacks – to track when slots open.
“It’s luck and immense technical skill that gets you a slot today,” said Karan Rajpal, a Delhi-based digital marketing professional who has been helping people in his circle in Bihar and Uttar Pradesh states. “Despite all the wherewithal I have, it is like a daily roulette.”
The faster your internet, the better your chances. In remote Leh, on India’s northern border, where the network is patchy, those with better connectivity succeed, said Konchok Stanzin, a district-level official.
In rural Thane, a few hours’ drive outside Mumbai, out-of-town city dwellers scooped up most of the available slots as vaccines became available for 18- to 44-year-olds.
“The internet here is slow and within two or three minutes of opening, the slots would get booked with city folks coming here,” said Subhash Pawar, head of the local governing body. “But after the first few days, [their numbers] came down.”
“It’s luck and immense technical skill that gets you a slot today. Despite all the wherewithal I have, it is like a daily roulette.”
Often, senior citizens must rely on younger family members. In Jammu, in India’s north, activist Sanam Sutirath Wazir registered an elderly couple using his own phone. But the couple were turned away from the vaccination centre since they were not carrying the phone used to register them.
Vaccine hesitancy is another pressing issue. Misinformation is rife; dubious videos and rumours spread online, but there is not enough outreach to counter it with solid information, activists say.
“Many slum residents are afraid of the vaccine, but even those who want to take it don’t know how to register,” said Dev Pal, a field researcher with the Housing and Land Rights Network in Delhi.
The pandemic spreads in rural areas
Government officials say online vaccine registration is necessary to avoid “chaos” and overcrowding. Ram Sewak Sharma, CEO at the National Health Authority of India and head of the panel that created Cowin, defended the app in an interview with the Times of India, saying most problems were related to vaccine shortages rather than registration, and young people should be helping the less tech-savvy secure vaccination slots. The government has promised to roll out the Cowin app in Hindi and 14 other languages this month.
But as infections rise and health shortages worsen in rural areas, India’s digital divide continues to widen.
Ruben Mascarenhas, joint secretary of the Aam Aadmi Party, a political party, said he has fielded hundreds of requests for oxygen and hospital beds in recent days – including from people turning to social media for the first time.
“I have had people message me who have never really used Twitter,” Mascarenhas said. “The situation is very bad in the countryside.”
A month ago, Twitter timelines were filled with desperate messages from urban internet users broadcasting SOS calls. There are fewer of these calls for help now because rural India is not on Twitter, he said. And with poorer connectivity and health infrastructure, there’s often little help available.
“We haven’t even seen the tip of the tip of the iceberg.”
Nizamuddin Khan, the physiotherapist in Uttar Pradesh, said he managed to get a friend to put out a Twitter SOS call for his father, but network coverage is poor in his area. Similarly, Shaurya Shukla, who was desperately searching for oxygen for his father in another Uttar Pradesh village, made a Twitter account thinking it could help. No leads materialised.
Local organisations and authorities are trying to streamline the vaccine registration process, particularly for people lacking digital literacy. In Mumbai, the non-profit Aajeevika Bureau is trying to help migrant workers. Spice India, a rural financial services outfit, is helping people register for vaccines. The Raah Foundation is collecting data offline, then uploading it.
Individuals, civil society groups, and local administrations are also trying to bridge the digital divide in underserved areas. This includes a Twitter account tracking more than 300 rural relief initiatives; an alumni group raising money for the coal-mining town of Dhanbad, Jharkhand; and a government bureaucrat who set up an online fundraiser.
But Mascarenhas worries such efforts can only help a portion of those struggling to get healthcare in rural India.
“We haven't even seen the tip of the tip of the iceberg,” he said. “At the end of the day, we have a broken system.”