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Vaccine Slot Machine: How India fell behind in the Race for COVID Immunisation

By Jhanvi Kotak and Ahilya Mehta

Artwork by Rahul V. Mathew

COVID-19 has ravaged our world and consumed our lives for nearly two years. Scientists, virologists, and other relevant experts exhausted themselves to produce a vaccine in record time. The global vaccination inoculation programme has commenced. More than 2.75BN vaccine shots have been administered across 174 countries already. Statistics around vaccine efficacy are also reassuring. There seems to be an end in sight to this pandemic.

However, as the world rejoices, India still suffers. In January 2021, we thought India would be the leader in vaccine production and distribution. Bharat Biotech was even in discussions with the US to supply 100MN doses of Covaxin. An Indian drug, approved by CDC and selling in the United States would be a major milestone. Covaxin completed trial data on 26,000 Indians and proved to be 81% effective, while Covishield proved to be 63% effective. The number looked positive. Unfortunately, as COVID-19 case numbers decreased across India, we became less vigilant. The second wave catapulted case numbers disrupted lives and supply chains and overwhelmed our healthcare system, leading to utter chaos and many deaths. The pandemic may be a black swan event, but the ramifications are our new reality.

And in the meantime, a significant number of the population are struggling to even access a vaccine. People between the ages of 18 and 44 are battling it out gladiator style to book a slot if gladiators had mobile phones and fought by “who can type the fastest”. And just when you start to think this is the end of the constant surprises and scares, a new variant comes onto the scene to remind you that it isn’t. The newest concern is over the “Delta plus” variant, detected in three states so far, which the Health Ministry says has showed increased transmissibility. The possibility of recurring strains and constant mutations leaves room for greater vulnerability and is inevitably causing a general sense of helplessness amongst the public. The fear that the worst is yet to come stymies the possibility of recovering the devastation of the hard-hitting second wave, making the need for vaccine inoculation programs even more prevalent.

The situation so far

As of right now, India has managed to produce two vaccines: Covishield and Covaxin, and the prognosis is positive. Lancet: Infectious Diseases documented that infection rates were 60% lower after 45 days among those who had one shot of the AstraZeneca vaccine. The last few days have seen an uptick in the vaccination rates, which is a positive sign. Last Monday, a record 8.6 million vaccines were given, but health experts have warned this rate may be unsustainable.

Despite small victories, India’s journey to freedom from the pandemic is far from over and riddled with dichotomies. Firstly, we are falling grossly behind. Less than 5% of India’s 1.4 billion people have been fully vaccinated. Up until last week, India was also the only major country globally that was asking its citizens to pay for vaccinations against Covid-19. If having a majority of citizens in a developing country of 1.3 billion paying out of their meagre incomes to literally stay alive isn’t bad enough, then imagine the consequences of allowing virtually unrestricted pricing by private players. The formula devised by the Indian federal government had split all available vaccines between itself, state governments, and private players in a ratio of 50:25:25. It’s the 25% of vaccines that were being sold and administered by private hospitals and players where there’s both tremendous opacity and variance.

For the purpose of simplicity, let’s talk only about the vaccine that’s being manufactured at the largest volume in India – Covishield. This is the Indian brand name of the AstraZeneca vaccine that is licensed, manufactured, and sold by the Serum Institute of India (SII), the world’s largest vaccine maker. The price at which Covishield is sold by SII to private hospitals or players is Rs 600 per dose, which, including taxes and transportation, comes to around Rs 650. Once hospitals or procurers add in their own costs and profit margins, that ends up costing citizens anywhere from Rs 850 to Rs 1800. Not only is that a huge variation, but it is also largely opaque. Prices are fixed between hospitals and bulk buyers like companies (who want to vaccinate their employees) or resident welfare associations (who want to vaccinate residents in their communities).

Since the policy reversal last week, now the government takes 75% of the stocks from manufacturers and allocates it to states, leaving the other 25% for purchase by private hospitals to then be paid for by someone who can afford to. The fact that this cost burden was on us as citizens up until very recently is astonishing, and in no doubt contributed to the chaos that has been the vaccine rollout. India has disappointed like a Desi kid going home to their parents to tell them they got a B on a test instead of an A. Except in the case of managing Covid and vaccines, it’s had grave consequences, and now state’s are trying to play catch up to fix the mess.

Battle for the slots

With states now able to distribute the vaccine for free, accessing a slot will likely become even harder. Huge one-day drives mean that some states use up all of their vaccine stocks in a short period. A significant number of people are desperately trying to book a slot for a vaccine to no avail. The age groups between 18 and 44 are at war with each other to book slots for vaccination. Conditions are such that 100+ doses are getting booked in the span of a few minutes, as people are constantly refreshing the portal. All slots are booked and when they do open up, it’s already too late by the time you select the time slot and enter the captcha code. The slot is booked, your chance is gone because there is always someone faster than you in this game of “fastest finger first”.

Concern also arises for those who do not have access to smartphones, laptops, and high-speed internet.

Considering the traffic on the portal, it is extremely tough for people to get the vaccine slots without access to these facilities. Since walk-in registrations were not available for people between 18 and 45 at the beginning, online booking was the only option. This was done to prevent overcrowding at the site, but in a recent move, the government allowed walk-in registrations to minimise vaccine wastage. Additionally, language serves as another barrier, since the co-win portal is available only in English, spoken by very few people in the country. The condition is much worse in remote and rural areas.

Bots to the rescue?

Nevertheless, manoeuvring a flawed system is simply part of the respite that comes with tackling the vaccine. But to make the process easier, many people came forward with bots that can access the Co-WIN API to find out the availability of slots and notify users when a slot near them is available. Even though these bots benefit the already privileged, they helped a lot of people find available slots.

Speaking to Rahil Ranka, the brain behind on how the bot works, he said, “We use public API provided by the government to get information about the slots and availability. The data is provided by Cowin.” API stands for Application Programming Interface and works as an intermediary that allows two apps to talk to each other. In other words, it plays the role of a middleman between two machines that want to connect for a specified task. Ranka said, “This is just a tool to help people and in no way am I or the bot is guaranteeing any slot confirmation.”

However, by the end of the first week of May, the government of India put a restriction on access to these APIs. The APIs were made public with the aim of enabling private hospitals to get real-time information and facilitate faster vaccination. But, this was also used by many people to send alerts for vaccine slots opening, which gave birth to websites and telegram groups dedicated to these slots. Due to this, hundreds of slots get booked within minutes.

In a note to developers, API Setu said, “These APIs are subject to a rate limit of 100 API calls per 5 minutes per IP.” The government wanted to ensure that slots get booked only through the Cowin portal, and not through these bots since it will be unfair for those who don’t use these alerts. Ranka added, “The govt has issued an update in which they have said that the data provided by the API could be cached and delayed by up to 30 minutes, we are still trying hard to issue timely updates through our bot, and are not misusing the data, we are just providing free public service so that people can book their vaccine slots easily. The information is displayed as is and not modified.”

To mitigate the concern over the privacy of the thousands of people who subscribe to get bot alerts, Ranka assured that the data of people remain safe. “We use (an) SSL layer on our websites and we only capture the data of the people so as to notify them about the slot availability. With VaccineBot you can be assured that the data is safe. We have 5600+ registered users as of now and many many users have got their slots booked due to our timely updates.”

Let’s not forget, vaccine or not, there is no one or simple solution to the Herculean task of eliminating Covid-19. We’ve got bots to the rescue for vaccine access, but there’s still a long way to go in providing a sustained vaccine effort and tackling the hurdles, particularly in rural areas. The virus is definitely here to stay, as per experts and could very well be something that we have to fight against every flu season. However, the key thing to understand, even for naysayers, is that the vaccine is our best shot at ending the pandemic and potentially saving millions of lives all across the globe. The only way to contain transmission and avoid future mutations is if we can achieve herd immunity via the vaccine. There is enough data to prove that vaccines protect against severe illness and mortality.

No matter how tedious the scheduling process may be, the need is unparalleled. The journey to combat COVID-19 requires patience, vigilance, and discipline. Until then, the actions of each person and community count. Remember, it all started with one person being infected in some part of the world, to begin with. It was a human movement that led to the pandemic and it is ultimately, human action and effort that will put an end to it. Until then, we must prioritize vaccinations and keeping our masks on!


About the authors:

Ahilya Mehta is a Women's Health and Empowerment enthusiast. Founder of Aara Health, Dealflow Analyst at Stanford Angels & Entrepreneurs, and Learning Chair YNG Mumbai.e

Jhanvi Khotak is an economics student at the University of Delhi. She is currently working with Dost Education as a primary researcher. She loves to eat, write and read books.



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