A voice from India: correct tracking systems are needed to prevent the virus (Shashidhar K.J., Marco Emanuele, The Science of Where Magazine)

The Science of Where Magazine meets Shashidhar K.J., Associate Fellow at Observer Research Foundation (India)

India shows the power and invasiveness of a virus that has not yet been defeated. What are the major problems, seen from the inside, that the country presents?

In the second wave of the COVID-19 pandemic in India, it is very important to not understate the seriousness of the situation. Response to the crisis is being hampered by inaccurate data about the number of infections and deaths. Testing rates are not uniform across different states in the country which gives opportunity for local governments to suppress infection rates. This has a domino effect where hospitals are not able to gauge the actual need of medical supplies like oxygen, medicine, and oxygen concentrators etc. There is lack of coordination between the central federal government and local state governments in the response to the crisis. For example, oxygen supply distribution is managed by the central federal government which allocates them to states but there is a mismatch on what is sent by the central government and actual need presented by the state government. Various court cases have been filed by state governments on the oxygen crisis asking the Centre to respond to the needs of the people adding more to the tug of war between them.

As we have seen in countries like the United States and Brazil which have seen the most number of COVID-19 cases, there is an anti-science sentiment that permeates Indian society. They range from the Union health minister endorsing “alternative” medicine from a god man to “boost immunity” against COVID-19 to inaccurate posts on social media directing people not to get themselves tested due to mistrust of the medical system. The social media landscape in India is flooded with messages and posts offering home made remedies against the virus or religious rituals to ward off the virus. Vaccination drive in the country is experiencing inertia due to several macro and micro factors. These include vaccine shortage, tiered pricing of the vaccine for state governments and private sector hospitals, blocks on vaccine intellectual property from global pharma companies and governments at the World Trade Organisation, misinformation on social media, issues with securing vaccine appointments on the Co-Win application etc.

You have underlined the very interesting theme of a distance between the use of technologies and a reality “on the ground” that shows complex needs. Can you tell our readers about the experience of the CoWIN app? 

Vaccination for people below the age 45 years requires people to register and book an appointment on the Co-WIN application or website. However, this is creating a digital divide for the inoculation programme where digitally literate people can access the application and the website. Without the appointment details from the app, people cannot get vaccinated.

Much has been said about the success of the telecom story in India, but there are finer details missing which are crucial to understand the digital divide. India has a culture of using multi-SIMs which means that one person will have multiple connections. And therefore, the total number of mobile subscribers is not equal to the number of unique subscribers. Teledensity is sharply skewed towards urban areas with 55.2% of all telecom subscribers (wireless and wired) residing in cities. Rural subscribers are a different mix and prefer 2G handsets which are primarily used for calling and SMS. These handsets are not connected to the major app stores and can access the Internet in a limited manner.

A point that is overlooked about the “digital leapfrog” in India is that even with access to cheaper smartphone handsets, proportionate digital literacy is missing and many first time Internet users are limited to using a few applications that they understand. The Co-WIN application also doesn’t take into account the multi-lingual and diversity of Indian society and the user interface is in English, a language that isn’t accessible to a majority of the population. The digital divide is further exacerbated when the application’s code was made open-source and software engineers wrote scripts to automatically scan the website for available slots and alert them. Those who can code or access these other digital tools have a better chance to get themselves vaccinated. Those who cannot, will be left scrambling. All these factors combined is leading to a lower vaccination rate. The Co-WIN application might be useful to gauge vaccine demand in a particular area from registrations, but it would be far better for India to allow walk-in vaccinations at centres and take registration information at the site rather than force citizens to book an appointment on these tools which are inaccessible to the majority. More resources should be put in follow ups through phone calls and on-ground teams. There are lessons to be learnt from earlier successful vaccination programmes for polio and smallpox which have been eradicated from India.

We deal with “science of where”, geolocation, tracking (especially in this phase of the pandemic). Don’t you think that, in a situation like the Indian one, a thorough work of analyzing the territory and tracing the infection is a priority – with mass vaccination?

Contact tracing is a useful tool for early detection and containment of the virus. However, with the level of community spread in India, contact tracing might not be the best use of resources to fight the pandemic. Applications which use GPS location and Bluetooth technology (like Aarogya Setu and the apps by Google and Apple) have largely been unsuccessful since they require users to be forthcoming about their symptoms and update it constantly. Further, there are significant privacy issues as these applications turn on location and Bluetooth access at all times leading to a trust deficit. State surveillance of COVID-19 has primarily relied on RT-PCR tests and the results go to local government bodies first. This has been much more effective in finding more cases and conducting contact tracing on all the people the afflicted have been in touch with. Thus, it is very important to get testing systems correct to serve as early warning systems.