Nandan Nilekani: The challenge is we don’t have adult vaccination system… Must build it from scratch for Covid-19

By: Express News Service | New Delhi |

October 19, 2020 3:40:21 am

Nandan Nilekani

Nilekani explains his three-phase Covid -19 vaccination process, says he doesn’t see an advertising global giant like Facebook, Google coming out of India, asserts Indian IT is more than “back-end”, and believes technology will become part of global geo-politics. The session was moderated by Executive Editor (National Affairs) P Vaidyanathan Iyer.

P VAIDYANATHAN IYER: What are some of the gaps in our system that need to be plugged before the Covid-19 vaccine arrives?

I can speak for what I am proposing. I think the vaccination is going to be a huge mission. We developed the Aadhaar enrolment system to do one-and-a-half million enrolments a day, and it took five-and-a-half years for India to reach a billion people with an Aadhaar number. Here, we have to vaccinate the entire population in two years, which means we have to reach 1.3 billion people in two years, and assuming that it is a dual dose vaccine, that’s 2.6 billion vaccinations, or 1.3 billion vaccinations a year. That’s more than a 100 million vaccinations a month and more than three million a day. So, this is a scale challenge that is unprecedented in our history, and therefore, thinking through the infrastructure and architecture of doing that is very important. Which is why I have been recommending that we should design a system that can do 10 million vaccinations a day across the length and breadth of the country, but all unified by a common digital backbone, so that every person gets the same experience and the same information is recorded. It is basically bringing population scale approach that we used in Aadhaar to a new issue (vaccination) which is, in fact, much more complicated.

P VAIDYANATHAN IYER: Given the state of our public health infrastructure, which the government has tried to ramp up in the past six months because of the pandemic, will there be a need for private sector participation on a large scale for the vaccination model that you are proposing?

First of all, India has a terrific record in vaccination for children and pregnant mothers. We have a child immunisation programme, we have done a great job with polio, but we have really no experience of adult vaccination and that is the bulk of what we have to do with the Covid-19 vaccination. In America, for example, flu vaccines are very common. About half the population of the US takes a flu vaccine every year. They have 330 million people and they do about 165 million flu vaccinations, and this year they are planning 200 million flu vaccinations. They do it through offices, pharmacies or doctors. So, they already have infrastructure for adult vaccination at scale. So for them to roll out a Covid-19 vaccine on top of that is not so difficult.

Our challenge is we don’t have an adult vaccination system at all. We will have to build it from scratch. If you load the Covid-19 vaccination on our existing infrastructure, not only will it be a huge overload, it will end up at a point where a baby is not getting immunised because people responsible for it have been diverted for Covid-19. My recommendation is that we build a completely new vaccination channel with 200,000 people who do vaccinations. Some of the current people can also participate but we will have to invest in creating a new infrastructure for vaccination at scale.

P VAIDYANATHAN IYER: So can you summarise your proposal for us?

My suggestion is that we create a platform to do eight-10 million vaccinations a day by authorised vaccinators. We will have a training system to train 200,000 people who will know how to vaccinate, explain to people the side-effects, they will know how to make people comfortable with the vaccination. Only certified vaccinators can participate in this. There will be a network of public and private vaccination centres. So it could be government-sponsored, or it could be a hospital or a corporate or a pharmacy, it doesn’t matter, but all of them use the same application technology. There will be an app on a PC or a smartphone, and one can take an appointment for vaccination. I will give my name, do an Aadhaar authentication… The name of the person, the name of the vaccinator, which vaccine was used, what time, date, location, will be recorded. The information could then be sent in real time to a cloud location, and it will send back a digital certificate to me, saying that I have been vaccinated. Because in the Covid-19 vaccine system, it is not only important that I am vaccinated, it is also important that you know that I am vaccinated. The digital certificate can then be shown at a job interview, airport, railway station, bus stand etc. If it is a two-dose vaccine, then you generate a provisional digital certificate the first time, and after three weeks or whatever is the time duration, you send a reminder by email or message for that person to come and get the vaccine, and then give them a final certificate.

If the immunisation is going to be limited, because we don’t know how long is the immunity of these vaccines, six months or two years, then you also need to send a reminder to that person at the end of that period to come back and get their vaccine refreshed. All this requires sophisticated technology because things have to be done for over a billion people.

P VAIDYANATHAN IYER: The cost of vaccination for the poor will have to be borne by the government. In such a scenario, how will private players linked with the project get remuneration?

Obviously, a large part of the population will have to be vaccinated by the government. It will be a free vaccine or covered by something like an Ayushman Bharat insurance scheme. Today, there are 100 million families, about 500 million people covered by Ayushman Bharat, so technically all those people could be eligible for free vaccine from the government. But the private companies should pay for their own employees. I don’t see why the government should fund that… We will have to divide things. Government funding for the vulnerable and those already covered by government insurance programmes, private sector funding for their employees and associates, and perhaps philanthropic funding for the rest from CSR etc. We have to think through the three models.

There are going to be three phases for the vaccine. The first phase is that there will be a vaccine shortage. I assume it would be in the first half of 2021. At this point the government will rightfully say that we will allocate the vaccine based on priority for people who are vulnerable, old, health workers, the police… In the second phase you will have vaccine adequacy, which means you can start bringing in the private sector to start vaccinating. And, in the third phase, by 2022 I believe, we will have a vaccine surplus… And whatever we design, should be designed for this kind of situation. Also, what I am proposing is a vaccine-agnostic system, that is I am not anticipating which vaccine will work.

P VAIDYANATHAN IYER: Has the government been in touch with you about taking the proposal forward? Also, if like Aadhaar you are given the opportunity to take charge of this project, will you do that?

I did make a presentation to a set of senior officials and they appreciated the ideas, and hopefully they will implement whatever they feel is fit.

I am happy, I am in Bengaluru, I am not looking for a job actually… There are enough people who actually worked with me on Aadhaar in government, who are now at Secretary level, and perhaps they could be roped in for this.

PRABHA RAGHAVAN: For the infrastructure that you are proposing, what sort of investment would be required?

It is not going to cost that much. Look, every month that we don’t come back to normal, the economy is taking a hit of hundreds of thousands of crores. The biggest cost actually will be the vaccines themselves. Vaccines cost $3-5 in the beginning, and it is a dual dose vaccine, that’s $10 per person. That means $13 billion for vaccinating the whole population which will be funded by the government, the private sector and philanthropy… It is not going to be that expensive. Given that we are looking for life to return to normal, the cost will be well worth it. But it is not a cost issue at all. The technology will cost a few hundred crores at best.

P VAIDYANTHAN IYER: Do you see a shift in the global delivery models post the pandemic?

There are two things that are going to happen. One is that most companies are localising, which means they are hiring local people. You would have noticed recently Infosys announced that they are going to hire 12,000 more people in the US in the next two-three years, on top of the 13,000 they have hired already. So local hiring is going to be a big thing. Secondly, there is going to be a lot of offshoring happening at the same time. So there will be a combination of more offshoring and local hiring.

NIRUPAMA SUBRAMANIAN: The Health ID that is going to be rolled out next year will be modelled on the Aadhaar card, and there are some concerns about privacy. Does it duplicate some of what Aadhaar is, and is it necessary?

I think the proposal is to have a Unique Digital Health ID, and that is different from Aadhaar. It is for electronic health records. The whole idea will be to have electronic health records which the person can pull up whenever they want… It is a very powerful thing and obviously all the necessary safeguards on privacy, security, encryption need to be followed.

P VAIDYANATHAN IYER: The Indian IT Industry is at least four decades old, but we are yet to see a Facebook or a Google come out of India. In fact, some of the big initiatives such as Aadhaar have been backed by the government. Is it because the Indian private sector is risk-averse?

If you look at Facebook and Google, the bulk of their revenue is advertising. The US is a few hundred billion dollar advertising market. India is just a $10 billion advertising market, of which digital advertising is about $3 billion. You can’t build a global company on those kind of revenues. We should look at the context. If you want to build a global company, you need a domestic market on which you build scale and then go out. Chinese companies such as Alibaba and Tencent have done this… Our niche in India has been the creation of public infrastructure, whether it is Aadhaar, UPI, account aggregator, FASTag… They are all great examples of population-scale infrastructure which have global replicability. But I don’t see how you can build an advertising global giant from India.

ANIL SASI: The Indian IT industry has had remarkable success since liberalisation, but in 30 years most companies, not just Infosys, have been restricted to back-end IT support. Does the lack of consumer-end interface put the kind of products that we have on offer at the risk of being taken over by Artificial Intelligence, machine learning and other advanced systems in the future?

The IT Industry does very, very sophisticated global transformation work, and it has become a $190 billion dollar industry based on that work. I think we should not trivialise that. It is not just back-end. Also, India has built a B2B business. It is not a B2C business. Yes, automation and Artificial Intelligence are going to dramatically change the industry, but Indian IT will respond to that challenge. Even with AI and automation, you still need to do a lot of other things. You need to be constantly morphing yourself to address new opportunities in the global market.

SUNIL JAIN: A US House panel report has suggested that big technology companies have to be broken up — that Google has too much power, Facebook has too much power. What is your opinion on this?

My view is that we have to use technology to handle technology. And in some sense what we have done in India is exactly that by creating a neutral ID… like Aadhaar or a UPI platform, which allows multiple big tech companies and banks to participate. We have to democratise access to identity and payments. Similarly, with the account aggregator approach which empowers people with their own data whether it’s to get loans for lending or for healthcare records, we have democratised data for everybody.

PRANAV MUKUL: A lot of players in the industry are trying to look at population scale problems in the education and health sectors. But without a data protection framework, is there uncertainty over these projects?

Laws evolve as things happen. If you look at the Aadhaar story, today we have a privacy framework because of Aadhaar. We began Aadhaar in 2009. In 2010, I wrote to then prime minister Manmohan Singh saying we need a data protection and privacy law. And then multiple versions of that law happened and then there was the Supreme Court judgment which said that Indians have a fundamental right to privacy but it could be constrained in certain situations. Then the Aadhaar law was tested against that. So that’s how societies evolve.

I think we are ready for a data protection law. And I do know that there is a law in Parliament. I don’t know its status. I think we need something like that as we depend more on technology and data.

SANDEEP SINGH: On the vaccination model that you have proposed, how do you see the preparedness of states on that?

Well I am only suggesting the digital infrastructure. The states can use that, and so can other market players. So the vaccination could be done by state governments, or it can be done by private hospitals, corporates, philanthropists or anybody else. The key thing is whoever does it, it must be done in the same way. It’s making sure that there is an identical approach.

P VAIDYANATHAN IYER: As a digital player, and as someone who believes in democratisation of platforms for larger public good, what do you make of such platforms being weaponised for spreading hate? What can governments and tech companies do about it?

The roots of it go back to the fact that the Internet companies did not have any consequential liability for what is on their platform because of Section 230 of the Communication Decency Act of 1996 in the US which essentially said that they would not be liable. In the US, they are now looking at whether they need to do something about it and bring in some kind of liabilities and perhaps we have to think about a framework where people are responsible for the content on their platforms… There is a delicate issue between free speech, censorship and making sure that we don’t have bad stuff on the Net. I think we need to have some rules. Now whether the rules that are being proposed are the right ones, I don’t know.

RAVISH TIWARI: India’s ban on several Chinese apps has fragmented the Internet. How do you see it?

With the Internet becoming such an integral part of every society, the old model where there was one Internet for the whole world is now under threat. And I think you will see more of this where countries choose to have their own rules… We are going to see the ‘splinternet’, where every country has a different system. This is inevitable. The Chinese, for example, did not allow US companies to participate in their economy, and now the Americans are retaliating… Technology has become so critical to nations that it is going to become part of global geo-politics.

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