Last week, Union Health Ministry sources stated that India will take up “glaring anomalies’’ in a World Health Organisation (WHO) report on excess mortality estimates associated with the COVID-19 pandemic. The report suggested that there were around 47 lakh deaths in the country, directly or indirectly attributable to the pandemic in 2020 and 2021. This figure is 10 times higher than the government count of 4.8 lakh cumulative deaths as of December last year.
India disputing the global health organisations’ data on impact of a disease is not new. In 1998, the Joint United Nations Programme on HIV/AIDS (UNAIDS) put the death toll due to HIV between 1,60,000 and 3,40,000, while WHO put the toll at 1,79,000.
“They are quoting different figures when we ourselves don’t have any data on deaths,” the then health minister C.P. Thakur was quoted as saying. Again in 2006, the UNAIDS pegged the caseload due to HIV at 5.2 million in the 15-49 age group. India challenged those figures, but with data.
The National AIDS Control Organisation (NACO), which was tasked with tackling the HIV virus, stepped in and wrote to key institutions including UNAIDS, WHO, CDC Atlanta, Imperial College of London, asking them to check the data first hand. “We had sentinel surveillance data, community survey data and NFHS data. We said we are willing to share the raw data with any organisation to be used for their modelling. CDC sent in their biostatistician and they all agreed that our figure of 2.5 million cases was accurate,” says Sujata Rao, former health secretary who headed the NACO at that time. “Transparency is the key. We did not accuse the UNAIDS of tampering with the data. We showed them our data and they had to agree with our figures,” says Ms. Rao.
The result: the 2007 UNAIDS document conceded India’s contention. “New, more accurate estimates of HIV indicate that approximately 2.5 million (2 million–3.1 million) people in India were living with HIV in 2006, with national adult HIV prevalence of 0.36%.” These estimates brought down the global projection of HIV cases by a whopping 16%.
“We had the highest number of cases because of our population. But we brought down the number,” says Ms Rao. The UNAIDS gave reasons for the revised estimates due to “expanded and improved surveillance system (in India), and the use of more robust and enhanced methodology. The inclusion of the results of the recent national household survey (the National Family Health Survey 3, conducted in 2005–2006) in the estimation process contributed significantly to the revised estimates”.
For its COVID-19 excess deaths modeling released on March 29, 2022, the WHO relied on data from 17 Indian States. “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 requests,” says the WHO paper.
In other words, the WHO had to rely on information provided by secondary sources to create the projection of excess mortality.
“If India really wants to challenge the WHO data on COVID-19 death toll, it should share all the data that it has. We have robust registration data. Attributing motives or jingoism will not help. We should share data and challenge the findings,” says Ms. Rao.