Rethink Aadhaar stands in solidarity with JSA Rajasthan, JSA Mumbai and JSA Maharashtra, to condemn the recent decisions taken by state governments to mandate Aadhaar for drugs in Maharashtra and for COVID-19 tests in Rajasthan. 

On 29 July 2020, the medical and health department of Rajasthan announced in directions for COVID-19 testing that it was mandatory for patients to produce an Aadhaar card before collecting their samples, which would be inputed into the RCT-PCR app. Earlier in July, there were also reports that the Food and Drug Administration department of the Government of Maharashtra had mandated, via a notification, the production of an Aadhaar card to purchase two drugs, being used on an experimental basis to combat COVID-19, Remdesivir and Tocilizumab. 

The right to health is  a basic and fundamental human right, recognized in the Indian constitution and in international human rights law. Healthcare should be accessible, available and affordable to all unconditionally. Linking it to an exclusionary technology or conditionalities violates this basic principle. Conditioning access to healthcare on Aadhaar will increase the risk that patients will be denied drugs or access to tests because they don’t possess Aadhaar numbers or have Aadhaar “cards”., This would also violate medical professional ethics which mandate that people should not be turned away, when services are available. In a pandemic, restricting access to drugs and testing during a pandemic is epidemiologically unwarranted, and could increase risks to the entire community.  

Over the years, various attempts to link Aadhaar to health services have faced widespread condemnation. In 2018, the Ayushman Bharat healthcare insurance scheme rolled back attempts to mandate Aadhaar for this scheme. Despite this, across the country in public and private hospitals, mandatory Aadhaar has continued to deny people access to their rights including blocking women’s access to safe abortions. As per the "saturation figures" published by the UIDAI, in Rajasthan about 84.8% of the total population may have an Aadhaar, and in Maharashtra the figure may be 92.4% — which makes exclusion, a certainty.

Linking health to Aadhaar also raises extremely serious concerns about surveillance, privacy, confidentiality and ethics related to the collection, storage and sharing of health data of patients. Linking this data to Aadhaar and centralized storage, increases the risk of unethical use and could facilitate the exploitation of the data for profit. Today, India lacks a data protection law or any oversight mechanism to ensure that Aadhaar, linked with health data, will not result in its use beyond the consent sought initially. In the absence of any institutional process to ensure the safety of personal data, gathering Aadhaar along with health data poses a clear hazard to persons. 

The Aadhaar Act itself mandates that demographic information collected under the Act shall not include “medical history”. The 2017 Right to Privacy judgement reaffirmed the right to privacy as a constitutional right, and defined its contours as the right to bodily autonomy. Medical records and history are “sensitive personal data,” under the S.43A of the Information Technology Act, 2000, and can not be collected without the informed consent of individuals. However these provisions only apply to body corporates, and contain wide exceptions permitting government agencies to collect this data for, inter alia, verification of identities.

The disclosure of personal health information has the potential to reinforce stigma, discrimination and marginalization of those seeking health care, leading to its denial and threat to lives especially for diseases such as Tuberculosis, HIV, and processes such as abortions. The disclosure of the names of patients afflicted with COVID-19, and the disastrous consequences of public shaming which ensued are illustrative of this.  

It is also pertinent to mention that the stated reason behind collecting or recording Aadhaar numbers is to keep track of persons who test positive for COVID-19. However, the Aadhaar database was created on the basis of self-authenticated documents, and the UIDAI has admitted in the Supreme Court that no system of checking was adopted by it during enrolment, to validate the authenticity of the data submitted to it. In light of this, relying on such a database to check the spread of the pandemic goes against the very aims it is trying to achieve. 

The pandemic has hastened the digitalisation of many systems, without adequate support or systemic reform that could address the root causes of lack of access to health. At a time when access to healthcare is even more urgent, restricting access because of Aadhaar enrolment is short-sighted and repugnant to human rights and dignity. 

The pandemic offers an opportunity for national and State governments to expand peoples’ access to healthcare as a matter of right, to ensure healthcare is accessible and affordable, and accessibility is not limited by imposing conditionalities such as enrolment in digital identification projects. We call on governments to adopt all possible measures to ease access to health services, such as free and additional testing, relaxing testing criteria, investing resources to improve health services, and delink the requirement of Aadhaar for testing or care.

The letter that Rethink Aadhaar has written to the government of Rajasthan is here.