India’s reliance on a vaccine app is hindering its push for herd immunity

July 14, 2021, 5:16 AM UTC

New Delhi cabdriver Arvind Kumar worries that he might catch COVID-19, but he hasn’t gotten a vaccine against it because he doesn’t know how to download the app to register for a jab.

He knows the Indian government’s app, called CoWin, exists, but he’s unsure of how to download or use it, and he admits he has little time to figure it out. He drives his cab all day to scrape together a living. 

India’s government launched the CoWin app on Jan. 16 when it started its massive vaccination program. Officials hailed the app as the technological backbone of the campaign and said it would make the management of doses easier and prevent misuse, such as ineligible people turning up for vaccines. 

India opened vaccine eligibility up to citizens in phases, prioritizing the most vulnerable populations, such as health care workers and those older than 60, first. And early on, vaccine supply was limited. But now everyone over 18 is eligible for a shot, and reliance on digital tools to educate Indians about the jab and register them for vaccine appointments is becoming an obstacle in the country’s drive to inoculate every adult by year’s end. 

Subscribe to Eastworld for weekly insight on what’s dominating business in Asia, delivered free to your inbox.

The CoWin app features a registration tool for Indians seeking a jab and information about the vaccines and their possible side effects. After inputting a national identification number, users can search for vaccination centers by location and reserve an appointment. The app provides a digital record of the reservation that Indians must show when they arrive for their shot.

Even with staggered appointments, vaccination centers were overrun during India’s second wave of COVID-19, when the disease infected millions and killed tens of thousands. But now, as the second wave eases, India’s vaccination campaign is entering a new era of targeting harder-to-reach citizens, and the CoWin app has become a point of friction. 

Just over 50% of Indians own a smartphone, according to Swedish telecom company Ericsson. An even smaller share—11%—own personal computers. Online access is especially hard to come by for marginalized groups. Just 38% of Indian women, for instance, own a smartphone. 

That digital disparity may be one factor behind the emerging gender gap in India’s COVID vaccinations. For every 1,000 men who have received their first dose of the vaccine, 846 women have gotten a jab, says Sarojini Nadimpally, a public health researcher and social scientist with the Delhi-based nonprofit organization SAMA.

2 Phase Of COVID-19 Vaccination Drive
A health care worker helps with COVID-19 vaccination registration via the CoWin app on March 25, 2021, in Noida, India.
Sunil Ghosh—Hindustan Times/Getty Images

Health officials now are looking for ways to make India’s digital-first vaccination drive more analog as the country’s daily vaccination rate plateaus at roughly 4 million a day, down from a peak of 9 million in late June. Overall, 295.1 million Indians have received at least one shot of a COVID vaccine as of July 9, or less than a quarter of the country’s 1.3 billion people. 

“We have to make the process very simple. People should be simply able to take a jab without any formalities,” says Amir Ullah Khan, an economist and former policy adviser for the Bill & Melinda Gates Foundation. “All you should have are road signs that say, ‘This way to the vaccination center.’” 

The government does allow walk-in vaccinations, but there is no guarantee that those who show up at a center will get a vaccine. Registering on CoWin is the only way to reserve a jab ahead of time. And health care workers must register walk-ins on CoWin, which can be difficult at makeshift vaccination camps that have poor network connectivity, Khan says. 

“Just remove the mobile number from the process,” he says.

India’s vaccination drive currently excludes people below 18 years of age, meaning it’s even more important that every adult takes the jab to inch the country closer to the 70% vaccination rate that’s associated with herd immunity, says Gagandeep Kang, a professor at CMC Vellore, a medical college in the southern Indian state of Tamil Nadu. Failing to reach that threshold gives the coronavirus room to mutate as it did in India earlier this year. The highly transmissible Delta variant that is now dominant in the U.S. and parts of Europe was first spotted in India in early 2021.

“We need to be thinking about how to reach the population who are difficult to reach as well as those who have been misinformed,” says Kang. Misinformation about the vaccine causing death or infertility is rampant in India, especially among populations with low literacy, Kang says. “We won’t get herd protection if we don’t make an effort to counter all of this.” 

Health care experts have said that information about vaccinations should be widely distributed via pamphlets and posters. The government has launched public health advertisements on television and radio, but health experts say it’s not doing enough to counter misinformation.

The lack of reliable information about COVID-19 vaccines is especially stark in rural regions of the country, where smartphone ownership is even lower. Rural users make up less than half of all Indian Internet users even though rural regions account for 65% of India’s population, according to a report by the Internet and Mobile Association of India.

“Many in rural areas have no access to correct information about the benefits of vaccination or possible side effects” because those resources are concentrated on the CoWin app, a “platform that requires a degree of literacy and access to the Internet,” says Nadimpally.

She adds that the government needs to do more local outreach and rely less on digital tools. 

A more targeted vaccination drive is forthcoming from the Confederation of Indian Industry (CII). Next week, the business association plans to launch an awareness campaign, created by advertising guru Piyush Pandey, to reach the unvaccinated, especially those in rural regions.

T.V. Narendran, president of CII, says that the success of the vaccination program will determine whether India’s economy grows by 9% annually to realize the nation’s ambition of a $5 trillion economy by the financial year ending in March 2026. Around half of the 250 Indian companies that participated in a CII survey said the second wave of COVID devastated their sales and production during the April–June quarter.

“I think the industry and the government need to work together, particularly as vaccines become more available, to make sure that a larger cross section of people are vaccinated,” Narendran says.

CII’s membership of more than 300,000 companies is gearing up to spread vaccine awareness among local communities close to members’ factories. The campaign will feature televised public service announcements to encourage vaccinations in India’s most remote pockets, where Internet access is spotty and traditional media still holds wide appeal. Participating companies will also partner with nonprofit organizations to send their own executives and workers to conduct face-to-face conversations with Indians living in rural communities and share accurate information about vaccines’ safety and efficacy. The program aims to get more vaccines to hospitals in remote areas and engage with influencers such as elected village representatives, teachers, and doctors to combat vaccine hesitancy and misinformation.

Some companies such as Tata Steel and Vedanta, which makes aluminum, zinc, and copper, have already launched awareness drives.

“We try to reassure people by sharing our own experience of taking the vaccine. We tell them that the vaccine will only protect you and not take your life,” says Babita Mahtato, a rural health care worker who is part of a public-private initiative coordinated by the Tata Steel Foundation in Bhalukpahari village in the eastern state of Jharkhand.

She collects people in groups of 10 or 12 from the village and escorts them in a vehicle borrowed from the village council to a nearby vaccination center. There, she and other health care workers help villagers register for jabs on the CoWin app.

London-based Vedanta says that it has conducted vaccine outreach across 500 villages. The company has repurposed 2,500 women and childcare centers, called nand ghars or “happy homes,” in villages for COVID vaccinations.

But such efforts are only just getting off the ground, while the need for clearer messaging remains stark.

As he makes a sharp turn at a traffic light, Kumar says some of his friends might be able to help him register on the CoWin app, but none have gotten around to it. 

“Who has the time these days?” he says.

Subscribe to Fortune Daily to get essential business stories straight to your inbox each morning.