India is betting on glitchy, unproven software to help vaccinate 300 million people by August.

But experts suggest India may need to fall back on the old, proven methods if it is to deliver 600 million doses of the covid-19 vaccine in less than seven months.

Giridhar Babu, epidemiologist and member of the Covid-19 technical working group in India, believes that achieving the country’s goals will require creating a comprehensive list of people to be vaccinated – the method used in previous campaigns. “From now on, health workers and frontline workers [are being vaccinated]: they are the easiest to capture, ”says Babu. “But once we start to go beyond that to population, there isn’t a single list that has people with all the comorbidities, the elderly. [medical] the story.”

He says this list should be created by officials going door-to-door and registering people. Babu believes that self-registration through Co-WIN can only work for city dwellers and educated people and not for those living in rural areas, and that “incomplete registration will then lead to incomplete vaccination”. He acknowledges, however, that putting together a list of people to immunize “is an exercise of phenomenal magnitude that requires a lot of planning.”

“It is dangerous to have it only on one application”

Experts are concerned not only that the campaign will fail to meet its goals, but that it will be used as a way to collect private health data from citizens. In August, Prime Minister Narendra Modi announced the launch of a National Health Identity Card, a means of centralizing data on Indian health care. The health ministry later said that vaccinated citizens would have the option to create a unique health identifier through their Aadhaar number – that of India controversial 12-digit national ID, which is linked to people’s fingerprints and iris scans.

“When a beneficiary shares their Aadhaar details to the vaccination center for identity verification purposes, the Aadhaar data is shared with Co-WIN on the back, which is then used to create a health identifier for that person.” says Srikanth Lakshmanan, a technology researcher who has studied the documents around Co-WIN. “Although the government says it’s voluntary, not many people even know it’s being created.

There are also privacy concerns. The Co-WIN app, which so far has more than 100,000 downloads from the Google Play Store, does not have an appropriate privacy policy and no data protection law would adequately cover this data. Lakshmanan says, “My biggest concern is that although the government is building a digital health infrastructure to share health data with the insurance and pharmacy industry, there is no investment of the government’s part in expanding the real health infrastructure we need.

“Although the government says it’s voluntary, not many people even know it’s being created.

Digital policy experts say that using an app for the vaccination campaign reflects India’s love for tech-solutionism, but is fraught with potential pitfalls. “It’s not easy to create an app-only solution when the infrastructure isn’t good – people not only need cellphones, they need connectivity, they need the Internet, they need to be able to use the phone. Says Shweta Mohandas, policy manager at the Center for Internet and Society, a think tank. “Especially when it comes to medical services, it’s dangerous to have it only on one app … it limits the number of people who can use it.”

Meanwhile, the doctor who received the misdirected vaccine invitation was able to get the first dose when he went to the hospital to inquire. He feels grateful, he says, because if it hadn’t been for this text message to a stranger, he wouldn’t have gotten the vaccine so soon.

But the Co-WIN snags continued.

A few days after receiving the first injection, he received two more text messages to two other people, with details of when and where their first doses were. “I wonder,” he said, “if these people got this message or missed their first dose.”

This story is part of the Pandemic technology project, supported by the Rockefeller Foundation.

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