Vaccination Experience, can do better?

Reminds me of my reports during school, it was always 'smart boy - can do better'. Same can be said about vaccination experience rolled out by the Government of India.

Building Cowin as a platform for vaccination management was a very smart approach, we saw the famous quote by Nandan Nilekani on Twitter that he got a digital certificate whereas his friend in Seattle got a paper certificate.

Undoubtedly, getting a digital certificate on the Cowin platform was a great experience for all of us. Proudly, I had taken selfies of myself after getting the shot at the vaccination center and was delighted when my certificate got downloaded on the phone.

However, it had taken me around 2 hrs to get the entire process done at the vaccination center. First I had to queue up for 30 mins and provide my identification for verification in Cowin to confirm my appointment at the center. Then it took another 30 mins to register myself and make the payment required for a private center. Another 30 mins of waiting for my turn and then 30 mins mandatory period for my safety. Add another 2 mins for selfie and certificate :-)

"can be better"

Surely, the hospital could have received the appointments using an API from CoWin and converted that into a payment link to avoid registration and payment at the counter. It would have saved time and been less scary due to risk of contracting Covid, the crowded bull pen where we were all seated within 'kissing' distance was completely avoidable. All it would have taken is designated slots for each patient visiting the hospital. Instead, all of us were in the Post Noon appointment and went through a batch process with those arriving early finishing in 2 hrs and others took even longer.

Now, you may say that the important thing was getting the slot and jab. It doesn't matter what inconvenience you had to suffer or the risk you had to take in the process of vaccination as the benefit far outweighs the cost. And truly, that is probably reasonable for an individual. Truly, one must thank the government for the vaccination and certificate.

Then we started hearing reports about several things going wrong with the vaccination program, what we started to see was:

• Wasted Vaccinations - not everyone could use Cowin app in the 60+ category, this led to wasted vaccinations when enough people did not turn up at the center.
• Chaos due to walk-ins - more than 60% who came did not take appointments, this should have been expected given the trends in Indian hospitals.
• Fewer vaccinated - many older people did not have the capability to endure this long a process and shied away, those who were working in 45+ were not able to take the time off required during a weekday.
• Nobody reported the infections at the centers, what we do know is that many who did get a jab were infected perhaps at the only crowded place they visited after an year.

What could have been done better and how would it benefit the patient everyone? Just give it a thought and see what it could have been if done better:

• Minimal waiting time from 45 mins to an hour, reducing the burden on both staff and patients.
• Lower risk of infections for older people due to shorter waiting time, no queues and sitting in crowded areas with others.
• More people vaccinated if they could call and fix an appointment with the nearest center, being the way most older people fix appointments currently at hospitals.
• Planned handling of walk-ins by offering them on spot registration provided vaccination is available or allowing them to come in and register for next available option.

Can we do better for the large 18+ category, rather than a chaotic way to check slots available by using python scripts on an open API? Is it possible to decentralize the process and make it more accessible and convenient for both the patient and vaccination center?

Yes, it is possible. All we need to make happen is:

• Decentralized process for appointment booking after registration on Cowin, patients can choose one of their nearest centers or 3 preferred options in their area.
• Hospital can get the list of patients who have chosen their center through an API or Excel download and invite the patients to fix appointments based on availability
• Registration and payment can be done before visit to private centers, free centers can call patients using IVR or call center and get them to fix an appointment.
• Self service check-ins using Aadhar card can be used for walk in patients, typically the walk ins get the dropped appointments by others.
• Reminders and alerts for patients who have booked appointments, and even for second jab.
• Feedback from patients about their experience and any adverse events observed after the vaccination

Finally, what we want to achieve is better planning and execution of vaccination program measured by:

• Higher coverage in each area of vaccinated population by convenient process for scheduling
• Minimal wastage of vaccinations
• Nudging and persuasion of those with vaccine hesitancy
• Lowest risk of infection during vaccination process