In rural Maharashtra, how lack of internet, awareness, healthcare facilities impact access to COVID-19 vaccine

Archana Kamble awaits an electricity connection for 14 years. “Forget registering for the COVID-19 vaccination online. How are we supposed to charge the phone?” she asks.

Archana has now lost count of the number of applications and letters she wrote to the Chandoli Gram Panchayat in Maharashtra’s Kolhapur district and the state electricity board. “They just give false hopes that a connection will be issued soon. For the past one year, they are saying it’s corona time, and it will be done after corona restrictions go away.”

36-year-old Archana is forced to use a candle every day, while the darkness of inequality prevails. Hers is one of the two houses in Chandoli village devoid of electricity.

Board outside the Bhuye PHC that reads the second dose of COVID Vaccination is going on.

In the fourth phase of vaccination, the central government launched the CoWIN website on 28 April, where citizens from the age group of 18-44 have to mandatorily register themselves on the portal, and book slots to get vaccinated. Within minutes of launching, the portal crashed. Archana was neither aware of CoWIN nor did she have access to a smartphone or any device with the internet. Three weeks after its launch, Archana says, “Even today, no one in the village knows they have to first register online. The ASHA workers have informed us that the doses for 18-44 aren’t available yet.”

For the residents of Chandoli, the nearest vaccination centre is Amba Public Health Centre (PHC) – seven kilometres away. Maharashtra is reeling under a state-wide lockdown from 15 April 2021, with strict curbs on public transport as well. “Senior citizens had to walk 14 kilometres back and forth to get the vaccine,” says Archana.

The Amba PHC has been tasked to vaccinate people above the age of 45. For the 18-44 age group, the nearest centre is Bhedasgaon village in Shahuwadi taluka which is 30 kilometres away.

How difficult is it to travel 30 kilometres during a strict lockdown?

Chaos outside the Bhuye PHC which remains a single vaccination centre for 15 villages.

To answer this, Archana shares the story of her husband, Dilip, 37, who works at a bamboo farm in Amba. “The police vigilance is so strict that he has to walk eight kilometres on a desolate kutcha road to reach the farm. There’s a risk (of being attacked) by bison and leopards too.” However, Dilip cannot afford to skip work. “Last year, because of the lockdown, we didn’t get any money for four months,” she says.

Reaching Amba by feet takes two hours, and spending four hours back and forth, and another five hours waiting in the vaccination queue translates to losing a day’s income for many. However, getting to the Amba PHC isn’t enough as a limited supply of vaccines often means people are to make multiple visits before they get lucky. Lack of a vaccination centre in the vicinity means losing a day's worth of wages for the residents of Chandoli, most of whom work as agricultural labourers.

What adds more burden to getting vaccinated is the rampant spread of misinformation. “Lots of young people say that vaccines cause fever and death,” she says. Ankush Kamble, who stays in the Dhakale hamlet of Kolhapur’s Bhadole village, has encountered similar cases of misinformation. “People say there will be a third and fourth dose as well. Every time we can’t afford losing the day’s work and so they talk of not taking the vaccine,” he adds.

27-year-old Ankush has been dialling the numbers of all the vaccination centres within a radius of 10 kilometres for over a week now. “My parents’ second dose was due 10 days back.” Frustrated, he says: “When there’s no availability of the second dose, how did they [the central government] announce the vaccination for people in the age group of 18-44? It’s a mockery of poor people.”

Dr Sachin Salave, CHO at Bhuye PHC, checking the blood pressure of people with comorbidities before they get vaccinated.

He remains worried because his displaced community Dhakale, with a population of just over 600 people, registered 35 COVID-19 cases in the past 15 days. “With such rampant rise, everyone should be vaccinated quickly,” he says.

Ankush, who works as a lathe machine operator in an industry, owns a smartphone but has run out of an internet recharge. “For 45 days now, the industry is shut, and I am unable to find work. What’s the point of registering when there’s no vaccine for the poor?” he asks. “Even if I had the money to recharge, it wouldn’t have been possible because all the shops remain shut in the lockdown.” To recharge his phone, he has to travel at least three kilometres to Bhadole village. With a livelihood lost, he now relies on the free ration announced by the state government. “As the cases kept increasing, they shut down the ration shops. We have run both out of food and patience now.”

Kolhapur district, which reported over 96,000 COVID-19 cases, with over 3,000 deceased by 21 May, has eight centres dedicated for vaccination for the age group of 18-44. “For us, the nearest vaccination centre is the Hatkanangle PHC which is at least 22 kilometres away.” With public transports shut, this journey can cost at least Rs 1,000.

Meanwhile, several tech-savvy urban folks in the Kolhapur district managed to book a slot in the same PHC using alerts on telegram groups and third-party resources. The slots are filled within seconds of opening. As per a 2019 report by the Internet and Mobile Association of India, roughly 70 percent of the rural population has no access to the internet. This points towards how the digital divide is further leading to massive inequality and affecting the rural population, which is witnessing a severe surge in COVID-19 cases in the second wave of the pandemic.

Even the citizens above the age of 45, who can walk in without online registration, are facing tremendous challenges. In May’s second week, a local politician stopped the vaccination drive in Karvir taluka’s Bhuye PHC for an hour. “I want eight of my party members to be vaccinated immediately. If this doesn’t happen, we will shut down this centre,” he roared. During that time, there were over 500 people from 15 villages waiting in the queue, while the centre had received a mere 150 vials.

“These instances are happening across all vaccination centres. Poor people are suffering because of this,” says ASHA supervisor Shobha Patil. Namdev Sonawane from Dhakale hamlet, who is in his early 70s, was a victim of the same. An asthmatic patient with hearing impairment, Namdev reached the Bhadole PHC at nine in the morning in April’s last week. He was waiting till 5 pm to get vaccinated. That’s when one of his neighbours, Maruti Sonawane, enquired if Namdev had returned home. “Immediately, we phoned the auto-rickshaw driver, who then went to the PHC and found the vials for the day were over,” says Maruti. “The PHC authorities didn’t even inform that the vaccine was over,” he told Firstpost.

Frontline healthcare workers in Tardal village surveying the community and helping people register on CoWIN

The auto-rickshaw drivers charge Rs 200 from Dhakale to Bhadole PHC. Only after five days did Namdev go again. He ended up spending Rs 400 and over 12 hours to get his first dose. His family is scared to send him again for the second dose. “Like the polio dose, they should have taken the COVID-19 vaccination to every village. Young people from the village can volunteer and help the government run the vaccination drives smoothly. How difficult is that? Instead, we are left waiting for days and losing out on bare minimum income,” says an angst Ankush.

Subodh Kamble, a 20-year-old engineering student from Kerle village in Kolhapur, talks of another major hindrance to registration, “The CoWIN website is only in English, and a lot of people in villages don’t understand it. How will they register?” he asks. According to Census 2011, English is the "mother tongue" of only 2,59,678 people in India.

The frontline healthcare workers that include the community health officers (CHO) and ASHA workers, are now overburdened with helping people register. Dr Sachin Salave, who is the CHO at Bhuye PHC, says, “With the help of ASHA workers, we ran a door-to-door campaign and helped 1,500 people from Kerli village register on CoWIN. The registration percentage is very less in the villages because people don’t have access to technology and they are unaware of the process.”

Whenever ASHA workers survey the community to find suspected COVID-19 cases, a common question they hear is, “When will we get vaccinated?” says Kavita Phadtare, an ASHA worker from Shiye. By 21 May, Maharashtra had vaccinated more than 20 million people, while India reached over 189.3 million.

Even before taking the vaccine, millions of people like Ankush have a much bigger task of ensuring their family members don’t go hungry. “Vaccine will come at the will of politicians, but hunger can’t wait,” he says.