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WHO Report Shows No Other Country Has Undercounted COVID Deaths as Much as India

Banjot Kaur

India’s COVID-19 death toll is almost 10 times its official tally, and the country is estimated to have had the highest number of COVID-19 deaths until December 2021 – 4.7 million. This is one of the conclusions of the much-anticipated WHO report on the world’s COVID-19 excess death estimates.

Of its 4.7 million deaths, 0.83 million (17.65%) occurred in 2020, according to the data; the rest were in 2021, as a result of India’s devastating second wave driven by the delta variant. As such, the trajectories of India’s official COVID-19 death toll and the estimated toll based on statistical models, from January 2020 to December 2021, are highly divergent.

Plot: WHO

India isn’t alone in having undercounted COVID-19 fatalities. Egypt is the sole country with a higher undercounting factor than India. But India undercounted the most in absolute terms. No other country has undercounted as much – and no other country appears to have so loudly opposed the WHO’s findings either.

The global undercounting factor stood at 3x. The three age groups with the most deaths were those aged 60-69 years, 70-79 years and 80+ years. Males accounted for 56.6% of all deaths – a split that reflected that in India as well. Note, however, that health data for women in India is unlikely to be accurate.

The WHO has also said that its figures aren’t final; the pandemic is still ongoing.

But within five hours of WHO releasing its data, three key senior government officials leading India’s COVID-19 response – Vinod K. Paul (COVID task force chairman), Balram Bhargava (director-general of the Indian Council of Medical Research) and AIIMS Delhi chief Randeep Guleria – published statements rubbishing the WHO’s estimates.

They voiced similar objections but deemed it necessary to say them separately. Also, even as the WHO’s press conference announcing its findings had been underway, the Union health ministry published a rejoinder to the estimates.

One key argument common to these three policymakers was that the WHO’s estimates were based on modelling studies and that they shouldn’t have been.

This is disingenuous. Modelling is an important tool with which researchers fill gaps in real-world data. And in India, death registration data hasn’t been available from all states at the same time, while also being up to date and representative.

If such data did exist, estimating excess deaths would have been a relatively simple exercise. It is the difference between registered deaths due to all causes in a pandemic year and the number of deaths that one expects to occur in that year if there hadn’t been a pandemic, estimated based on previous years’ data.

But such data doesn’t exist – so the need for models.

In India, the source of death registration data is the civil registration system (CRS), whose numbers the Registrar General of India’s office issues. CRS includes deaths due to all causes, so it is also known as all-cause mortality (ACM) data.

On May 3, the Registrar General released ACM data for 2020, which is only one of the two pandemic years, and only two days before the WHO was to publish its own report.

The health ministry press release of May 5 also claimed that it had shared this ACM data with the WHO when the latter had been preparing its estimates. “Despite communicating this data to WHO for supporting their publication, WHO, for reasons best known to them, conveniently chose to ignore the available data submitted by India,” the release reads.

But in the press conference, the WHO’s assistant director-general of data, analytics and delivery for impact, Samira Asma, said that the body learned of India’s official ACM figures only two days ago.

“As you know, India also released the 2020 estimates two days ago, and we will continue to have these conversations. In our next update, we will also include the data that India has provided,” she said, replying to a query from The Wire Science.

Second, even if India had availed its 2020 data sooner, it is yet to release the data for 2021. This data is crucial because all independent estimates of India’s COVID-19 death toll record a big jump in the number of deaths in this year.

“In the absence of complete and high quality data from [some] countries, of course, we had to rely on a modelling approach,” Somnath Chatterji, senior advisor at the department of data and analytics, WHO, said in the presser.

The WHO commenced its exercise to arrive at its newly released estimates a year and a half ago. According to its methods report, India belongs to a small set of those countries whose national ACM wasn’t available at the time. “We instead have ACM data from [India’s states], with the number of regions with data potentially changing over time.”

Further, according to the report, ACM data was available only for 17 states for the period of January 2020 to December 2021.

According to Chatterji, WHO researchers eventually used the following data distribution to conduct a “standard” modelling: “The information was either reported directly by the states through official reports and automatic vital registration, or by journalists who obtained death registration information through Right To Information [RTI] requests.”

In his statement, AIIMS chief Guleria said, “Data that WHO used is [based] more on hearsay evidence – what’s there in media or unconfirmed sources.” But according to the WHO, media reports were based on RTI applications while the other data originated with state government officials. So unless Guleria is invalidating either of these sources, the basis of his argument remains unclear.

Bhargava and Paul also took exception in their respective statements to using data from media reports. None of the individuals explained what was wrong with the data.

The WHO’s Chatterji also said that they had shared their input data with the respective countries, together with documentation on the modelling method and the programming code used. The idea is that countries should be able to “rerun these models to generate estimates” and compare their findings with those of the WHO.

The Indian government has, however, not published or publicised the results of a replication study, if it conducted one. As mathematician and disease-modelling expert Murad Banaji wrote, the absence of evidence of this exercise has also undermined the Indian government’s issue with the WHO’s findings.

In fact, in a statement coinciding with the release of the CRS data, Paul had accused modelling exercises in general of producing only “absurd” estimates.

Instead, in a previous press release aimed at the WHO’s estimates, India had objected to the country being classified as ‘tier II’ – the countries with incomplete data.

All of Paul, Bhargava and Guleria have also insisted that India has a “robust” death registration system. But the CRS data released recently itself admitted that various states couldn’t hold important meetings at the district and block levels and had to postpone training programmes for health officials thanks to the pandemic.

The WHO’s estimates aren’t the first to undercut the Indian government’s claims. It joins a coterie of studies that have all reached similar conclusions: that India has had 3-5 million deaths during the pandemic, and not the measly official figure of 0.5 million.

Nonetheless, the WHO is perhaps the most weighty entity to challenge the government’s narrative – carefully curated by delaying and suppressing data, vexing public dialogue on the topic and twisting definitions – that India’s COVID-19 death toll is really stupendously lower than the country’s anaemic public health system, the ferocious second wave and the government’s apathetic response to it suggest.

The Indian government is also unlikely to back down, given the health ministry’s conviction, on display in its May 5 press release, that the new estimates “may stretch to the limits of absurdity”.

(Courtesy: The Wire.)

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The World Health Organization Says the COVID Pandemic Has Killed Nearly 15 Million Across the Globe

Benjamin Mateus

The World Health Organization (WHO) released Thursday its much-awaited and anticipated report on global excess deaths associated with COVID-19 for the period from January 2020 to December 2021.

By the end of last December, officially reported global deaths had reached 5.42 million. However, the WHO study found that almost 15 million more people perished in the same period than usual, 2.75 times higher than the official total of COVID-19 deaths. The estimate of excess deaths gives a range from 13.3 million to 16.6 million.

The WHO defined excess death/mortality as “the difference between the total number of deaths and the number of deaths that would have been expected in the absence of the [COVID-19] pandemic.”

Dr. Tedros Adhanom Ghebreyesus, WHO director-general, remarked, “These sobering data not only point to the impact of the pandemic but also to the need for all countries to invest in more resilient health systems that can sustain essential health services during crises, including stronger health information systems.”

A regional comparison of excess deaths to official COVID-19 deaths underscores the seriousness of these warnings. But more than recognizing the disparities, without understanding why these exist, little can be expected to bring about the changes advocated by the WHO. The disparities are ultimately a byproduct of global capitalism and its criminal policies that allowed the virus free rein to infect the most vulnerable and the disenfranchised.

In this sense, the New York Times attempts to cover the criminal policies perfected in 2021, precisely the vaccine-only strategy that forced the piecemeal and systematic return to normalcy. They wrote yesterday, “Much of the loss of life from the pandemic was concentrated in 2021 when new and more contagious variants drove surges of the virus even in countries that had fended off earlier outbreaks.”

Rather than making a straight year-to-year comparison, the Times only notes that roughly 18 percent, an extra 10 million people, died in 2021 than “would have been without the pandemic.” It is worth noting that when the 2020 excess death report was published, there were 3 million excess deaths and 1.8 million official COVID-19 deaths. The Economist’s estimate placed those figures at 5.6 million excess deaths and 1.8 million COVID-19 deaths.

In other words, the number of excess deaths for 2021 is far more than twice the number that perished in 2020, despite having confirmed the efficacy of several COVID-19 vaccines and the recognition of the airborne nature of the virus, and the importance of respirators and high-efficiency ventilation to stem the tides of infection. It also became clear that the virus could mutate to forms with more virulent and contagious characteristics.

Instead, the de facto capitalist policy of vaccine nationalism and a vaccine-only strategy was used to begin the lifting of mask mandates and loosening of social restrictions and returning to “economic” normalcy that has cost the lives of millions more when every means to eliminate COVID-19 was available. That the scale of death doubled or tripled in 2021 only confirms that all remaining inhibitions for the social murder of the population had evaporated.

Twenty countries accounting for half of the global population saw more than 80 percent (11.9 million) of the estimated global excess mortality—Brazil, Colombia, Egypt, Germany, India, Indonesia, Iran, Italy, Mexico, Nigeria, Pakistan, Peru, the Philippines, Poland, the Russian Federation, South Africa, the United Kingdom of Great Britain and Northern Ireland, Turkey, Ukraine and the United States of America.

Ten countries accounted for 68 percent (10.1 million) of excess deaths—Brazil, Egypt, India, Indonesia, Mexico, Russia, South Africa, Turkey and the United States.

When these are sorted according to the World Bank income groups, lower-middle-income regions had the highest estimate of excess deaths with 7.87 million (52 percent) and the highest excess deaths per capita at 236 per 100,000 people. These regions also account for approximately 3.3 billion people and have a per capita GDP of only $2,217.

By comparison, upper-middle income regions saw 4.24 million excess deaths and high-income areas 2.16 million. But when compared on a per capita basis, they had similar excess death rates at 168 and 177 per 100,000, respectively. Low-income regions had only 0.64 million excess deaths, but the uncertainty bounds of the estimates are the largest because of poor registration systems for vital statistics.

Dr. Samira Asma, assistant director-general for data, analytics, and delivery at WHO, noted, “measurement of excess mortality is an essential component to understand the impact of the pandemic. Shifts in mortality trends provide decision-makers with information to guide policies to reduce mortality and effectively prevent future crises. Because of limited investments in data systems in many countries, the true extent of excess mortality often remains hidden.”

WHO experts told the New York Times, “About half of countries globally do not regularly report the number of deaths from all causes. Others supply only partial data. In the WHO African region, for example, the experts said that they had data from only six of 47 countries.”

By the WHO region categories, the population of Southeast Asia, which includes the Indian subcontinent, suffered the most significant number of excess deaths, with close to 6 million. With 4.7 million excess deaths, India accounted for nearly one-third of global excess deaths. The figure is almost 10 times higher than official COVID-19 deaths reported by Indian health officials. Most of these occurred during the explosive Delta wave that produced horrific scenes of burning piles of corpses across the country.

The delay in bringing out the report when it was completed in January was in large part due to objections raised by India on the methodology for estimating the excess deaths. According to several media reports, the complaints appear to be politically motivated to stall the release of the damning results until after elections in key Indian states were concluded in early March.

It also placed the WHO leadership in a precarious position. Many of the independent scientists working as technical advisors for the WHO and contributing extensively to the findings criticized the international agency for acquiescing to India’s delaying tactics. Though the report results are significant and now finally published, the delay underscores the politically explosive nature of the inconvenient truth.

The other country in Southeast Asia with a significant undercounting of COVID-19 deaths was Indonesia. More than 1 million people perished during the pandemic though official COVID-19 deaths stand at 156,000, a six-fold undercounting.

The case in Peru exemplifies that a robust vital registration system is not a substitute for investment in health systems and public health infrastructure. With a population of nearly 33 million, the excess deaths of 290,000 were only 1.4 times above the reported COVID-19 deaths. But on a per capita basis of 437 excess deaths for every 100,000 people, Peru is among the highest globally.

Dr. Elmer Huerta, an oncologist and public health expert in Peru, said, “When a health care system isn’t prepared to receive patients who are seriously ill with pneumonia when it can’t provide the oxygen they need to live, or even provide beds for them to lay in so they can have some peace, you get what you’ve gotten.”

In conjunction with the release of the WHO report on excess deaths, the mainstream press is acknowledging that the United States has reached the harrowing mark of 1 million COVID deaths. Though on an excess death per capita basis, the US stands in 40th place with 140 deaths per 100,000, the grim milestone is both substantively and symbolically a stain on the criminal policies that have been shaped initially by Trump and further carried out in the most criminal form by Biden.

Yesterday, new COVID-19 cases in the United States exceeded 100,000 again. Deaths sharply increased, with 1,929 deaths reported on May 4, 2022. Hospitalizations have also turned up sharply. And no preparations are underway to stem the seventh wave of infections.

(Courtesy: World Socialist Web Site, wsws.org.)