Bikash Adhikari works as a carpenter in Kathmandu. His job entails visiting houses for small repairs and fixing furniture. He is yet to get vaccinated.

Adhikari, 31, from Bidur, Nuwakot, does not have a laptop. He owns a low-end android smartphone just to make calls.

“I have heard that I have to fill a form online. They say it should be done from a computer or a mobile phone,” said Adhikari, a school dropout. “I don’t know how to do it.”

People like Adhikari who cannot register their names online for vaccines or those who do not have access to the internet could be deprived of vaccines against Covid-19, as the government has decided to make online registration mandatory to get vaccinated.

The Health Ministry has asked everyone aged 18 and above to register online by logging on to its website. The website was launched on May 13. Initially, the ministry had not made an online form mandatory for getting vaccinated, as the country was still struggling to secure jabs.

But with vaccine doses trickling in, the government has decided to make online forms mandatory to help run the vaccination campaign smoothly.

Public health experts say the decision to ask people to register themselves online for vaccines is not wrong in itself, but there is a risk of creating a digital divide and it may rather hamper Nepal’s aim to inoculate as many people at the earliest.

At a time when the government is facing questions if it has been able to ensure equitable distribution of the vaccines, making online registration mandatory can further deprive many people without access to the internet—or knowledge of filling forms online.

“We need to take into consideration the size of the population that still lacks access to the internet and whether everyone can fill the online forms,” said Dr Sharad Onta, a public health expert. “The decision to make online registration mandatory is like creating a condition for people for vaccines. This may not help Nepal’s plan to inoculate all eligible people on time.”

According to the latest management and information report of the Nepal Telecommunications Authority, internet penetration in Nepal has reached 90.56 percent of the total population with 65.47 percent mobile broadband users.

The number of 4G users had reached 7.69 million as of mid-May, including 2.68 million 4G subscribers of Nepal Telecom, 4.8 million subscribers of Ncell and 206,393 subscribers of Smart Telecom. There are 11.95 million 3G users in the country.

So far, 1.4 million people have registered themselves online for vaccines. The number is too low compared to the number of people with access to the internet.

Dhana Bahadur Tamang sells food items in a cart in the Gongabu area of Kathmandu. Every evening, he serves dozens of people. He is highly vulnerable to the coronavirus but he is not vaccinated.

“My wife also has not got the vaccine yet,” said Tamang, 36, whose wife also assists him in his business.

His line of profession does not put him in any category that needs immediate vaccination. But he is in a business where he has to come in contact with various people every day.

“We have no idea how to get registered online for vaccines,” said Tamang.

The government has decided to inoculate all eligible citizens within mid-April next year and it has unveiled a plan to procure over 42 million doses of Covid-19 vaccines. So far, 4,359,277 (14.53 percent) have received their first doses and 2,130,900 people (7.1 percent) have been fully vaccinated.

Experts say Nepali authorities have a habit of bungling things, and if they keep on creating barriers rather than ensuring easy access to vaccines, the country will not be able to achieve its inoculation target.

“Authorities should encourage people who can easily register themselves online, as this registration will help the government maintain data,” said Onta. “But it should not be made mandatory and the government should find other ways to bring those without access to the internet or who cannot register themselves within vaccination coverage.”

According to Onta, it will be unfortunate if people are deprived of vaccines just because they cannot register themselves online.

“Online registration should be made optional,” he said.

Officials at the Health Ministry say that the decision to make online registration mandatory for vaccines has been taken to manage the crowds at immunisation centers and mismanagement, as well as to ensure that people from priority groups get the jabs without any hassles.

They hope that online registration would help lessen the crowds at immunisation centres, which can in turn lead to the spread of the virus.

“We believe a host of issues we have encountered at immunisation centers including crowds will be addressed if everyone registers for vaccines online,” said Dr Samir Kumar Adhikari, joint spokesperson for the Health Ministry. “Those who can use the internet and have access can themselves register their names and those who cannot use and do not have access can take help from others.”

Adhikari, however, concedes that a lot of people do not have access to the internet and also cannot register online.

“But mandatory online registration doesn't mean those who do not have access to the internet or cannot use it will be deprived of the vaccine,” said Adhikari. “The government is committed to providing jabs for free to all.”

Dr Keshab Deuba, a public health epidemiologist, however, says if the issue is mismanagement, there are multiple ways to address it.

“How can authorities bring a provision that could create a divide between those who can register online and who cannot?” Deuba told the Post. “We should not forget that a huge population resides in remote areas who may not be able to register online for vaccines.”

The digital divide, if not addressed immediately, could widen the vaccine divide, which could hugely affect the country’s plan to protect itself from Covid-19. As the number of cases are rising, the country faces a threat of a second wave peak, before it is hit by the Delta variant.

Cases of the super-contagious Delta variant have already been confirmed in Nepal. This variant of the coronavirus, which was first identified in India, is currently fuelling outbreaks worldwide, with countries like China and the United States struggling to tame it.

Nepal on Thursday reported 3,007 new Covid-19 cases from 11,870 polymerase chain reaction tests, and 931 others tested positive in 6,538 antigen tests. The positivity rate stands at around 25 percent.

The country’s current reproduction number, or the number of people one infected person can pass on the virus to, on an average, stands at 1 percent. The case doubling time is 10 to 12 days.

Experts say the best measure to tame the virus is vaccinating the maximum number of people.

Dr Binjwala Shrestha, a public health expert, said a lot of effort has to be put to make online registration mandatory with a view to streamlining and smoothening the vaccination drive.

“This is aimed at addressing most of the problems seen at vaccination centers and vaccination certification centers,” Shrestha told the Post. “However, it’s true that not everyone can register online. Authorities must consider setting up health desks, mobilising volunteers and school teachers for online registration of those who cannot do it themselves.”

A major concern is that the majority of the population in Nepal lives in rural areas where people might not have access to the internet or they might not have proper devices like a laptop or a smartphone or they might not know how to do it.

Nepal has a good track record when it comes to immunisation campaigns. Vaccinating people against Covid-19 should not be an issue, provided that there are enough doses, as the country has an impressive network of health workers and volunteers.

Experts say the government should, instead of enforcing online registration, find other ways to expand the vaccination coverage.

“If the decision to make the online registration mandatory, it could deprive hundreds of thousands of people of the jabs,” said Deuba, the public health epidemiologist. “Failing to vaccinate people just because of this digital divide could lead to negative health outcomes. We will never be able to win over the virus.”