For Delhi's Poor, Chance of Finding Free Vaccine Shot Could Be As Low As 2%

The data suggests there is a big accessibility difference between the rich and the poor in Delhi, with significantly more paid shots and slots available than those provided free of cost.

New Delhi: The CoWIN portal is India’s principal point of entry for people to acquire vaccines against COVID-19. This has created an access gap: using it requires an internet-capable device, an internet connection and digital literacy.

The Supreme Court noticed this problem, with a bench led by Justice Chandrachud saying in early June, “It is the marginalised sections of the society who would bear the brunt of this accessibility barrier.”

The Centre opened up on-site registration and vaccination on May 24 but in the notification said that those lacking “access to internet or smartphones” will receive help to register on CoWIN. It made a provision for same-day walk-in registration and vaccination – “but only if doses meant for those who had pre-registered were left unused at the end of the day.”

Revised guidelines from the Ministry of Health as of the 8th of June, which went into effect on June 21, says, “The CoWIN platform provides every citizen the facility of conveniently and safely pre-booking vaccination appointments. All government and private vaccination centers would also provide onsite registration facility, available both for individuals as well as groups of individuals, for which detailed procedure is to be finalized and published by States/UTs, in order to minimize any inconvenience to citizens.”

CoWIN is central to vaccine distribution, and the availability of vaccines may depend on the availability of doses and slots on the portal itself.

And as such, it prejudiced Indians’ access to COVID-19 vaccines by economic class.

However, the data on vaccine availability within the app shows that this divide probably runs deeper than thought in the national capital.

The data suggests there is a big accessibility difference between the rich and the poor in Delhi, with significantly more paid shots and slots available than those provided free of cost.

On June 29, The Wire downloaded details from CoWIN of vaccine slots and doses available in Delhi city from 2 pm to 3 pm, for the period of June 29 to August 2, 2021.

The numbers on the portal change constantly: people book slots while facilities add more slots, through the day. There is also reason to believe that many vaccination centres accepted deliveries of fresh batches on a daily basis (not monthly); some Telegram channels provide real-time updates of new vaccine tranches.

As such, the data in our analysis is a snapshot of vaccine availability at this particular time of day in this period.

This said, the data is limited by some potential confounding factors. For example, manufacturers may be supplying doses to Central hospitals, state facilities and private hospitals by taking turns, and July 2021 may have been the turn for private hospitals.

Second, The Wire limited this exercise to one slot – 2-3 pm – at various centres in order to simplify analysis. There may be a different availability pattern at, say, 9-10 am – the first slot of the day, including that people would book slots to receive free doses as early as possible. 

Finally, the analysis does not say anything about the number of vaccines that can be, or have been, administered or allocated.

Every slot has two attributes: a day and a site. Within these slots are doses (with numbers in yellow and green cells), which is the quantum of vaccines available at a particular site on a given day. The doses of vaccines are visible only when they are available; they aren’t displayed for slots that have been booked out.

In Delhi, there were 1,23,039 vaccine doses available to book between June 29 and August 2. Of these, 91,183 were paid and 31,856 were free – a difference of nearly 3x.

This difference is worse in some of Delhi’s 11 revenue districts.

Of the 11, only three districts are offering more free vaccine doses than paid ones in the one-hour slot from June 29 to August 2.

Of these three, only two – North Delhi and North East Delhi – have zero paid vaccine sites available at all. In the third, Shahdara, there are 370 more free doses than paid ones, out of a total of 784 doses for the district.

Across Delhi, fully 74% of the doses available on CoWIN were for paid doses only in the period of analysis.

The gaps widen considerably in some districts.

South Delhi had the most paid doses – 23,072 – while only 451 (2%) were available for free.

Some 95% of East Delhi’s slots were for paid doses, similar to 94% in South East Delhi and 93% in South West Delhi.

West Delhi and New Delhi were marginally better – 86% and 85%, respectively – while Central and North West Delhi had the lowest number of paid doses, with 64% and 63%.

The Hindu reported in May this year that the average monthly income for a household of four members, after the economic impact of COVID-19 in 2020, was Rs 4,979. If it costs a fifth of one month’s wages to vaccinate just one individual (with one dose out of two), these prices – exacerbated by unequal access and affordability – are simply anti-poor.

In addition, Indian Express has reported that nine private hospitals have reserved half of the manufacturers’ output designated for all private hospitals. Delhi’s unequal urbanisation could accentuate this skew: areas with better access to private hospitals will be able to access more vaccines than others.

Why are there so many more paid doses available at this time?

According to the CoWIN dashboard, East Delhi inoculated 537,798 people in June 2021. Out of 112 sites conducting the vaccination, 11 were reportedly private. They administered 115,071 doses.

Private vaccine centres accounted for just around 10% of all centres, but some of these centres accounted for a disproportionately larger number of doses. For example, sites affiliated with the Max Hospital franchise administered nearly 10% of all doses in East Delhi and 12% in South Delhi in June 2021.

As such, 20% of all doses provided in East Delhi were for payment. This number is within the Centre’s decision for vaccine manufacturers to allocate 25% of their production capacity for private hospitals.

Blocked vs not applicable

Private sites ease access to vaccines by having more doses available than government sites, and in terms of the time at which they are available.

For example, if one private site has as many doses as 10 government sites put together, finding an ‘available’ paid slot is going to be easier than an ‘available’ free slot.

For many of Delhi’s free vaccine sites, slots are ‘available’ only briefly, on the day preceding their availability.

On the other hand, paid-vaccine slots are ‘available’ for days at a time, if not for weeks.

The red ‘booked’ label shows slots that were made available and have since been closed because they have run out of doses.

‘N/A’ – ‘not applicable’ – denotes slots that haven’t even been opened. Private hospitals typically have multiple ‘N/A’ slots on Sundays. But for free doses, ‘N/A’ slots are the rule instead of the exception.

Throughout July 2021, 486 slots were ‘N/A’ for paid sites versus 6,950 for free sites – a difference of nearly 14x.

This trend stayed the same for slots that were ‘booked’ – 1,065 for free doses versus 77 for paid doses.

The big picture

Between June 29 and August 2, there were 9729 slots. They are divided as ‘available’, ‘booked out’ and ‘N/A’. Of these, 8707 offer doses for free and only 1,022 offer vaccines for a fee.

Of the 8,707 free sites, only 1,384 (15.9%) had doses available. But of the 1,022 paid sites, 918 (89%) had doses available.

So while there were fewer slots to administer vaccines for a fee, the vast majority of them had doses accessible. But while there were more sites and slots for free vaccines, the vast majority of them didn’t have doses available.

Nearly three-fourths of all slots for free doses were marked ‘N/A’ – whereas only 5% of all slots for paid doses were marked ‘N/A’.

And only 9% of all slots had 74% of all available doses – all for payment.

These numbers reflect our expectations, but not good vaccination policy: slots for free doses are hard to find, and they get booked quickly.

As a result, those who can’t afford to pay are often faced with a lottery, while those who can have a buffet of options to pick from.

Update: A previous version of this article did not include the new vaccine guidelines from the Ministry of Health (8 June) and the article has been updated to reflect this.