India’s excess COVID deaths statement inaccurate, says WHO technical group member

India raises objections to methodology used by WHO to compute excess deaths

April 19, 2022 06:33 pm | Updated April 20, 2022 12:37 pm IST - NEW DELHI

Health workers and relatives perform cremation during a mass funeral of COVID-19 victims, at West Hill in Kozhikode. File

Health workers and relatives perform cremation during a mass funeral of COVID-19 victims, at West Hill in Kozhikode. File | Photo Credit: PTI

“Inaccurate,” is how a scientist, part of a World Health Organisation (WHO) team computing the global death toll of the COVID-19 pandemic, described India’s objections to the method used. A forthcoming WHO analysis reportedly computes India’s true toll to be much higher than official estimates.

The Union Health Ministry on Saturday, in response to article, “India is Stalling the WHO’s Efforts to Make Global Covid Death Toll Public” on the same day in The New York Times (NYT), raised objections to the methodology used by the WHO to compute excess deaths.

So far, the WHO hasn’t officially released estimates for India but the NYT claims the health body as having computed 15 million deaths by the end of 2021, or more than twice the official total of six million reported by countries individually. Of these, India accounts for four million deaths, or about eight times the current official toll of 5.2 lakh (as of Tuesday), the report said citing unnamed sources.

The Ministry’s detailed statement said it was in regular touch with the WHO on this issue and had shared “concerns with the methodology”, along with China, Iran, Bangladesh, Syria, Ethiopia and Egypt to the WHO six times since November 2021.

Classification of countries

India’s core concerns are that these death tolls are computed using a statistical model that doesn’t account for the size and variation in the country. The WHO methodology classified countries into Tier 1 and Tier 2 countries, and used mortality figures from Tier 1 countries and used them on Tier 2 countries—an unjustifiable approach, India contends. It also objects to using ‘global covariates’ such as monthly temperature and monthly average deaths, income.

John Wakefield, member of the WHO’s Technical Advisory Group that’s responsible for the modelling, tweeted on Monday that the Ministry’s statement on the excess mortality method was “inaccurate” and supplied a link to a research paper describing the method employed. Wakefield is a Professor of biostatistics at the Washington State University.

For most countries that provided a national all-cause mortality rate, or the deaths by all causes monthly, the authors relied on the data provided. Argentina, China, India, Indonesia and Turkey, on the other hand, didn’t have a national all-cause mortality number and—for 2021-- only data from a few months. India only had data from 17 States. Data for India, the research paper noted, was sourced from the registered number of deaths at the State and Union Territory levels that 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. “We stress that for India, the global predictive covariate model is not used and so the estimates of excess mortality are based on data from India only,” the paper noted.

Discrepancy in deaths

An objection that has been raised by India is that “...the model gives different mortality estimates when using data from Tier 1 countries and unverified data from 18 Indian States. Such wide variations raises concerns about validity and accuracy of such a modelling exercise,” underlining that India does not consider these State-level data as ‘verified,’ Excess deaths are the discrepancy in deaths in the pandemic years of 2020 and 2021, compared to the average deaths recorded in the pre-pandemic 2019 and 2018. The assumption is that most upward deviation from the pre-pandemic years represent COVID-19 deaths.

Through the past years, independent efforts by researchers and newspapers, including The Hindu, have furnished evidence that COVID-10 deaths in Gujarat, Madhya Pradesh and other States have been several times more than the official death toll reported by the States. A key cause of discrepancy is that the States have varying health infrastructure and many deaths outside hospital settings are neither recorded nor their causes determined. It is only through separate sample registration surveys of a subsection of households, such deaths are revealed, and this process, Indian officials have reiterated, takes time.

This isn’t the first time that India has objected to studies that estimate the scale of the pandemic’s toll in the country. The Lancet reported last month that India accounted for around over 20% of the global excess deaths as of December 31, 2021. India’s objections are that the study relies on numbers from “newspaper reports and non-peer reviewed studies,” and that it doesn’t account for “multiple pandemic management efforts, including lockdown, containment zones, testing and contact tracing, wider dissemination and implementation of clinical management protocols and world’s largest vaccination drive, which form the foundation of pandemic management in the country.”

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