Delhi: In a 10X10 room located in Delhi's Uttamnagar area, Priti sits across a laptop with a phone in hand. "Did you get the OTP? Tell me your OTP," she asks the caller thrice before the phone disconnects. "Bad network," she says. Priti has been trying to register Prince, a 26-year-old who lives in a slum in Vikas Nagar, in West Delhi for the Covid-19 vaccination.
The residential area of the capital city that is largely occupied by middle-class families has 15 vaccination centres within the same pincode. Only four have, so far, opened up for vaccinating 18-44 age groups. "More than eighty percent of those who live in this slum have not been vaccinated," said Priti, a staff of NGO Protsahan. "We are helping them register, but there are no slots available."
In 48 slums of West Delhi-- Dwarka, Uttam Nagar, Vikas Nagar, Hastal-- Protsahan found 41 children who have lost their father in the second wave of the Coronavirus pandemic. In most of these cases, the father was the sole breadwinner in the family.
Payal, Child Protection Officer at the NGO said that every day they learn of 'heartbreaking' realities on the ground-- cases of familial sexual abuse with children, pregnant women not getting a single meal in a day, infants on breast milk losing their mothers-- are some of them. "The situation is more horrifying than last year. If we don't do anything right now, we will see more losses and grief," she said.
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Scientists, doctors and health experts across the world have said that vaccines are effective at preventing COVID-19. As the young population of urban India queues up to get the vaccination, a large number of pockets have no clue about the need for vaccination or even the process to get it. "How accessible is the government's CoWin app? How inclusive is it?" Sonal Kapoor, founder-director of Protsahan asked pointing out that English is the only language that the vaccine registration platforms have. "It should not have been that difficult to set it up in different languages," she said.
Priti sits across a laptop with a phone in hand. "did you get the otp?" she asks as tries to register a resident for covid-19 vaccination.
Sonal listed out some of the 'basic problems' with the vaccine registration process: Digital accessibility, language, font is small, trouble getting OTP, misinformation, rather, no information. "There is an expected digital literacy. Unfortunately, a lot of people will be left out of the vaccination process if that's the condition," she said. "India won't become digital just by saying it."
Why Is There So Much Misinformation?
"Vaccination causes deaths, we have heard," said Saraswati, a 38-year-old woman daily wage laborer. Priti said that without information on the virus and the vaccine, most slum-dwellers want a 'guarantee' that no one will die of the vaccine. Many fear that the government is supplying 'fake vaccines'. "It is just saline water," one of them told Priti.
The founder of Protsahan said that lack of communication from the top is what is creating vaccine hesitancy. "When Amitabh Bacchan gave a message for 10 years, only then polio vaccination became a reality for all. With Covid-19 too, the government needs to have the right kind of messaging."
The misinformation is strong with the Covid-19 vaccination. "If one gets vaccinated while menstruating then she can't become a mother; I have seen a video on WhatsApp," said a 15-year-old, resident of a slum in Dwarka. "Pregnant women will give birth to disabled children if they take the vaccination," another woman said.
Jayashree Velankar, Director, Jagori, believes that bureaucrats need to think from the perspective of a poor woman in this crisis. "They should provide eggs and milk to lactating mothers. If the country wants to stop infant mortality rate and maternal mortality rate to not spike -- they need to do this," she said.
The National Technical Advisory Group on Immunisation (NTAGI) has recommended that pregnant women may be offered the choice to take any Covid-19 vaccine and that lactating women can be inoculated any time after delivery. The Ministry of health is likely to accept the suggestion and come up with an announcement this week.
The misinformation aside, most residents without a TV connection or internet do not know how to get the vaccine. "I have no idea about where and how to get the vaccine. I have been told I will need to provide Aadhaar card details. I don't have one," said Hemant, a local tea-seller.
What Stops Them From Vaccine Registration?
The lack of information is the reason for the hesitancy. That, combined with a lack of digital literacy and limited access to smartphones and data packs has prevented many from taking the first step towards vaccination: Registration.
It has been more than two weeks since the Central government rolled out the fourth phase of vaccinations for those between 18 and 45 years. Moments after the registrations opened, the site crashed. As the tech-savvy urban India tried to play 'fastest finger first' overnight, techies came up with Telegram groups to provide constant updates on new slots. But, in urban slums, there's a hope for the virus to simply disappear.
"We can't forget that many children had to drop out of schools due to lack of smartphones and internet in the pandemic. We know what the digital penetration in India is through those cases," said Sonal.
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Smartphones are not the problem. India's smartphone base is estimated to reach 820 million in the next two years. According to a report jointly released by Indian Cellular and Electronics Association and consulting firm KPMG, rural India witnessed a year-on-year growth of 35% in 2018 as opposed to 7% growth in urban India in the same period in terms of internet users. Smartphone penetration in rural India has risen from 9% in 2015 to 25% in 2018. "Yes many people have smartphones now, but where is the internet connection? They don't have the money for it," Velankar said.
For women, it is worse. Only 38% of women in India own mobiles; many of them may not even have access to them despite owning one.
The director of Jagori, one of the oldest NGOs in Delhi that works towards women empowerment said that a lot of messaging from the government is through television channels. "Many families have had to discontinue their television connection after they lost jobs in the pandemic. They are unable to get any sort of information."
While many state governments have announced free vaccination at public centres, Velankar said that most people don't even have the money to afford an auto ride to the hospital.
How To Make Vaccines Accessible?
Preeti said that Protsahan workers who have been going from door-to-door to provide ration are also trying to provide information on the vaccination. They are holding conference phone calls inviting the residents to ask their questions and they have plans to install loudspeakers in rickshaws.
Sonal suggested that the government looks to train and empower Asha workers and engage in door-to-door communication. Community health workers in rural parts of the country have been tasked with surveillance and monitoring of Covid-19. "They can be trained to provide vaccinations too," she said.
Last week, Chief Minister Uddhav Thackeray urged the Central Government to consider letting states develop their own apps for Covid-19 vaccination. In a letter to Prime Minister Narendra Modi, he has suggested developing state-level apps registration of citizens for Covid-19 vaccination. "It's a good idea but it's an afterthought," Sonal said.
Besides communication on vaccination, Sonal believes there should be digital camps set up for adolescent girls. "Where is the digital empowerment to speak?" Sonal asked, pointing out that there is an increase in the number of sexual abuse and trafficking cases in the second wave of the pandemic.
The NGO founder said that the government has to foster relationships with NGOs working on the ground. "We were asked to distribute ration, we are still doing it. But we are struggling to breathe now, we don't have money to pay salaries to our staff," she said. Sonal said that the mistrust of central agencies towards NGOs is unproductive for the common citizens. "If you want to empower locals, you need to trust the people who are doing the groundwork," she said.
The use of government schools for vaccination is also a 'good idea', said Velankar. "Prioritising", she said, is most important. "The government needs to formulate a policy to find out who is more vulnerable and vaccinate them first," she said. The sanitation workers and domestic workers, who largely inhabit slums of urban cities, should be considered as frontline workers. She said that the data on lactating and pregnant mothers are already with Asha workers. "Use that data and give vaccines priority," she added.
Velankar also raised a point in the NITI Ayog meet where she suggested that mobile vans be used for vaccination. "When everyone is falling sick we need to ensure that hospitals don't become the super spreader. The vaccine has to come to people, not the other way," she said.
On the subject of how to disseminate the misinformation, Velankar said that if the government has decided to provide information through apps and websites they need to start providing data packs to people who can't afford it. "The smartphones are useless without data and they don't have jobs or money to buy them. They can't even talk to their families who live away," she said. Velankar believes that it is time for some 'out of the box' thinking on the part of the administrators to make Covid-19 vaccines accessible.
This story is a part of a series that BOOM is doing to understand what can be done to fix the problem of the inaccessibility of the Covid-19 vaccination.