Guidance-2022 note for Corona 2.0

1. Background: (Guidance note for COWIN 2.0)

To reduce the burden of the COVID-19 pandemic in the country, India started the COVID-19 vaccination program on 16th January 2021 targeting 30 crore beneficiaries based on priority groups identified by NEGVAC. A detailed guide for planning (including training, logistics & vaccine management), implementation, tracking, and management of AEFIs, monitoring, and evaluation of the COVID vaccination program at the National, State, and District level was released on 28th Dec 2020 (https://www.mohfw.gov.in/pdf/COVID19VaccineOG111Chapter16.pdf).

 

One of the key aspects of the COVID Vaccination program in India has been the rollout of the COWIN portal. COWIN is an end-to-end solution that has utilities for the entire public health system from the national up to the vaccinator level. The COWIN 1.0 system allowed for the creation of users (admins, supervisors, vaccinators), registration of beneficiaries (bulk upload and individual registration), facilities/planning unit, and session sites followed by planning and scheduling sessions and implementation of the vaccination process. 

As of 24th February 2021, more than 1.23 crore (~1.09 crore 1st dose and ~14 lakh 2nd dose) doses have already been administered through more than 263,000 sessions at more than 45,000 sites targeting the health care workers and frontline workers.

 

In accordance with the prioritization as guided by the NEGVAC, the next phase of vaccination is due for citizens of age-appropriate categories, including initially the people above 60 years of age and those aged from 45 years to 60 years and have the comorbidities. To augment and simplify the process of registration vaccination, the MoHFW is coming with COWIN 2.0, based on the feedback received during the implementation of Phase 1 of the Covid-19 vaccination drive.

 

2. Purpose of document:

 

This guidance note is intended to specify the underlying principles that Guidance-2022 note for Corona 2.0, for the vaccination of eligible citizens. This document also defines key roles, responsibilities, and SOPs for various modules of COWIN2.0. The document also highlights the key features/modules and relevance of the COWIN 2.0 intended to be used by program managers at the state/district and facility level. Further guidance will also be issued from time to time whenever necessary.

3. Terms and their meaning:

 

a. Eligible Beneficiary – Following persons are eligible for coverage –

A. All Health Care Workers and Frontline Workers as specified by the MoHFW.

 

B. All citizens that are aged, or will attain the age of, 60 years or more as on 1st January 2022.

 

C. All such citizens that are aged, or will attain the age of, 45 years to 59 years as of 1st January 2022, and have any of the specified comorbidities, which have been recommended by the National Expert Group on Vaccine Administration for COVID-19 (NEGVAC) and approved by Government of India from time to time, subject to certification to that effect by a Registered Medical Practitioner. The list of specified co-morbidities (20) and the form for comorbidity certificate are annexed at Annexure 1(A) and 1(B) respectively.

 

b. COVID Vaccination Centers (CVCs) – This is a health center where COVID vaccines will be administered. Types of CVCs are detailed in para 4.2.

 

c. Government COVID Vaccination Center (GCVC) – This is a Government Health Facility being operated as a COVID Vaccination Center.

 

d. Private COVID Vaccination Center (PCVC) – This is a Private Health Facility that complies with the requirements as specified in para 4.2(c).

 

e. Vaccinator (Vaccination Officer 1 (VO1)) – A trained health care worker who will provide the vaccination services at the CVC. Vaccinator Officers could be from public health facilities or private health facilities. Their roles and responsibilities are already detailed in the Operational Guidelines.

 

f. Verifier (Vaccination Officer 2 (VO2))– Verifier Officer will be the person responsible for verifying the identity of the beneficiaries at the time of vaccination before a vaccine dose is administered. Verifier will also be responsible for on-site registration and verification of HCWs, FLWs, and citizens, at the CVC.

 

g. CVC Manager – The CVC Manager will be responsible for the overall planning, implementation, and grievance redressal at the CVC. He will also be responsible for maintaining stocks and accounts & safekeeping of vaccines supplied to the CVC.

 

h. CVC Location – The geolocation of the CVC as identified by any GIS software using latitudes and longitudes.

 

i. Vaccination Cycle – A period of not more than 28 days for which a Target Number of Doses are planned.

j. Target Number of Doses – The number of doses planned to be administered is decided by the respective State/UT Government for a Vaccination Cycle. Total vaccination slots for a vaccination cycle should not exceed the Target Number of Doses. The Targets should further be decided district-wise and within a district Vaccination Center-wise for preparing and entering the Vaccination Time Tables for Vaccination Centers in COWIN.

 

k. Vaccination Time Table – The date-wise schedule to be populated in COWIN for each Vaccination Center with details of various types of Vaccination Slots.

 

l. CVC Session Capacity - The total number of Vaccination Slots for a CVC for a day. This would be decided based on the operational capacity for a CVC in day. The CVC Session Capacity is variable and is an input to the system by the District Admin at the time of the creation of a session.

 

m. Vaccination Slots – The number of doses to be administered at a CVC in a day including all types of Vaccination Slots. Following types of vaccination slots will be available – 

A. Reserved Slots – These can be further classified as: 

1. Mobilization slots - Slots for which respective State/UT Government shall mobilize beneficiaries for on-site registration, appointment, verification, and vaccination (all on-site on the same day). There will not be any need for pre-registering beneficiaries through an online interface for this. The proportion of such slots will be decided by the respective State/UT Government.

 

2. Slots reserved for 2nd dose for beneficiaries who have already received 1st dose, including HCWs, FLWs, and citizens, at a CVC. These slots will be filled by the COWIN system based on data available in the system regarding vaccination details of partly vaccinated beneficiaries (such as CVC, Vaccine Type, and Vaccination Date).

 

B. Open slots – Open for online appointments by general citizens. The number of Open Slots for a session will be worked out by subtracting the number of Reserved Slots from the CVC Session Capacity.

 

4. The Framework and underlying Principles:

 

4.1. Determination of Target Number of Doses for a Vaccination Cycle –

a) The schedule of vaccination of Eligible Beneficiaries, is closely linked with the availability of vaccine doses. The States/UTs will decide the target number of doses be administered in a Vaccination Cycle, based on already available vaccine doses and additional doses like to be available in a Vaccination Cycle.

 

b) Since, when a beneficiary is being vaccinated with 1st dose, COWIN will automatically confirm the appointment of the beneficiary for the 2nd dose at the same Vaccination Center, the target number of doses should be decided with careful consideration of available stocks and requirement of vaccine stocks for 2nd dose vaccinations for the already partly vaccinated beneficiaries.

 

c) The Ministry will, from time to time, indicate the state-wise allocation of vaccine doses to the States/UTs.

 

4.2. Vaccination Centers: A CVC must be a health facility and can be one of the following types:

 

a) Government Health Facilities (GCVC) – These include all Government Medical Colleges, District Hospitals, Sub-District Hospitals, Community Health Centers, Primary Health Centers, and Sub-Health Center. Government Health Facilities also include Central Institutions, Health Facilities of other Ministries such as Railways, ESIC, Home, etc., and all CGHS Dispensaries.

 

b) Private Health Facilities (PCVC) – For a Private Health Facility to be operated as a PCVC, it would be necessary for such a facility to be empaneled either under the PMJAY or under the CGHS or under any health insurance scheme of the state/UT government. Hence, the private facilities will include –

 

1. All Hospitals empaneled under the PMJAY.

 

2. All Hospitals empaneled under the CGHS.

 

3. All Hospitals empaneled under the health insurance scheme(s) of any state/UT government.

 

c) For any Private Health Facility to be operated as a PCVC, the facility must have the following –

 

1. Sufficient Cold Chain equipment and capacity.

 

2. Sufficient rooms/space for waiting area, vaccination, and observation post-vaccination.

 

3. Sufficient number of trained vaccinators and verifiers 

4. Ability to manage the Adverse Events Following Immunization (AEFI), as per the norms and guidelines of the Ministry.

4.3. Free & Paid services – Vaccination will be provided free of charge at the Government Health Facilities and will be on a payment basis in the Private Health Facilities, at a rate as may be decided by the Government of India from time to time.

 

4.4. Determination of the number and list of CVCs to be operated:

 

a) States will be required to plan the adequate number of sites (COVID Vaccination Centers) along with appropriate geographical spread, for achieving the Target as decided by the State/UT for a period. The State and districts will be required to pre-register these CVCs in the COWIN portal before the registration is opened for Citizens (Annexure 2 (A) - Registration of CVCs).

 

b) States must ensure that all PMJAY/CGHS impaneled facilities are registered on COWIN with correct details.

 

c) Although, the list of CVCs with Open Slots will be available in the public domain through COWIN or other COWIN compliant applications, the list of CVCs must also be adequately publicized by the concerned State/UT using all necessary mediums for informing the citizens.

 

4.5. Vaccination Time Table for a CVC:

 

a) The District Administrator will create a Vaccination Time Table (using COWIN 2.0) for vaccination at each CVC based on the target doses to be administered and the number of days in which the coverage is planned.

 

b) The number of days or dates may be decided by the respective State/UT Government.

 

c) Determination of the session capacity for a day: The CVC Capacity for a day will be an input to the system. The minimum capacity for a day will be equal to the number of 2nd doses due at a CVC for that day.

 

d) Determination of Open Slots:

 

1. Apart from the CVC Capacity, the District Admin will also specify the percentage of remaining capacity (CVC Capacity – 2nd dose reserve) to be opened for online appointments by citizens.

 

2. The number of open slots for a session will then be calculated by the system by subtracting total reserve slots from the CVC capacity. Example: If the specified CVC capacity for a session on 5th March is 200, the 2nd dose due on 5th March at that CVC is 50 and the specified %age of open slots is 40%, then – a) the remaining capacity is 150 (200 – 50 2nd dose slots), b) The number of online open slots is 150*40% = 60 and c) the number of reserved slots for on-site registration = 200 – 50 – 60 = 90.

3. If the specified %age is zero, then the whole session will be for reserved slots. There will not be any open slots and such sessions will not be visible to the citizens for online appointments.

 

4. If the specified %age is 100%, then there will not be any mobilization slots, and all the remaining capacity (after subtracting the 2nd dose capacity from Session Capacity), will be classified as open slots, which will available to the citizens for online appointment.

 

e) Following precautions are suggested –

 

1. It is recommended that, to begin with, based on local context and plan, one particular CVC may be either fully reserved or their full capacity is opened for online self-appointment, to avoid the confusion and problems in physical queue management on-site at the CVC.

 

2. If it is so decided that a CVC will have both the reserved and the open slots, session timings for open slots may be carefully selected to avoid overlap of beneficiaries between the ones coming through the online appointment and the ones being mobilized for mobilization slots. The timings for on-site registrations in such a case should also be carefully publicized.

 

3. Session capacities for a CVC and the number of CVCs should be increased incrementally to leave the room for new mobilization slots/ open slots, as in the later period, the number of 2nd doses due will progressively increase.

 

f) Further details of the creation of the Vaccination Time Table are given in Annexure 3. (Annexure 3 – Creation of Vaccination Timetable and Vaccination Slots in COWIN 2.0)

 

4.6. Access to Citizens/beneficiaries –

 

a) Advance Self Registration (Online Registration and Appointment):

 

1. Registration and appointment will be available to citizens through the COWIN Portal or through other IT Applications such as Arogya Setu etc.

 

2. Basic demographic details of beneficiaries and details of the photo ID Card to be used by the beneficiary at the time of vaccination will be captured at the time of registration.

 

3. The list of the CVCs along with the date and time of availability of vacant slots will be available to the citizens at the time of registration and appointments wherein he/she would be able to choose the CVC of his/her choice and book and appointment based on the slots available.

 

4. The details of the process for Online Registration and Appointment for Citizens are at Annexure 4 (Annexure 4 – Online Registration for Citizens).

 

b) Facilitated Cohort Registration (Mobilization of Beneficiaries): The States/UTs may plan to fully reserve identified CVCs for some sessions at a CVC for on-site registration of beneficiaries. In such cases, State/UT/District teams should make all necessary efforts and arrangements to mobilize a sufficient number of beneficiaries so as to utilize full planned capacity.

 

c) 2nd dose appointments will be automatically scheduled by the System.

 

d) On-site Registration of eligible beneficiaries will also be possible. However, this must be planned carefully so as to avoid overcrowding of willing beneficiaries.

 

e) All beneficiaries, regardless of the mode of access, i.e. through online registration or mobilization through on-site registration, must be advised to carry the following for verification at the time of vaccination –

 

1. Aadhar Card; and

 

2. Electoral Photo Identity Card (EPIC); and

 

3. The Photo ID card is specified at the time of registration in case of online registration.

 

4. Certificate of comorbidity for citizens in age group of 45 years to 59 years.

 

5. Employment certificate/ Official Identity Card – (either but with photo) for HCWs and FLWs.

 

4.7. Coverage of HCWs and FLWs: The vaccination of HCWs and FLWs will also happen using the new utility. The detailed SOPs for coverage of HCWs/FLWs are at Annexure 5. (Annexure 5 – Registration and Vaccination of HCWs and FLWs using COWIN 2.0)

 

4.8. Verification, vaccination, and certification of beneficiaries at the time of vaccination:

 

a) Multiple Verifiers and Vaccinators can be assigned for a session at the CVC.

 

b) The full list of beneficiaries, as available in COWIN, will be visible to all verifiers and vaccinators designated for a session, i.e. all verifiers and vaccinators will work on the same full list.

 

c) Verification will be done by Verifier (Vaccination Officer 2). Verification will preferably be done using Aadhar.

d) In case Aadhar authentication is not possible at a CVC for any reason, the Verifier will verify the identity and eligibility of the beneficiary from the photo ID Card indicated by the beneficiary at the time of registration.

 

e) If the identity and eligibility of a beneficiary are established upon verification, the beneficiary will be vaccinated and his/her vaccination status will be updated, else the beneficiary will not be vaccinated.

 

f) All Vaccination Events must be recorded in real-time through the COWIN Vaccinator Module.

 

g) The process for certification and AEFI reporting remains the same as in the current version of COWIN.

 

5. The COWIN system will transition to Version 2.0 from 27th February. The system will be run in test mode on 27th and 28th February. Once the transition is done from the backend, which is planned for the night of 26th February, all sessions planned after 26th February will be deleted. The states must finalize their data for sessions held on February 26th by 9:00 pm. It is therefore advised that the sessions for the 26th of February may be closed by 9:00 pm and no sessions are scheduled for the 27th and 28th of February. This period will be utilized for registration of CVCs, planning, and population of sessions, populating the duelists for 2nd doses and preparing the system for providing access to citizens.