The visit of Tedros Ghebreyesus, Director-General of the World Health Organization, to Gujarat for the Global Ayush Investment and Innovation Summit coincides with a simmering dispute between India and WHO on its forthcoming report on excess COVID-19 deaths between 2020 and 2021. In 2020, the organisation had computed three million deaths globally from the pandemic, much more than the 1.8 million officially reported by countries. It was due to update this estimate for 2021 by the year-end but could not, and reports suggest, because of ‘stalling’ by India. A report in The New York Times claims that WHO estimates India accounted for four million deaths, or about eight times the current official toll of 5.2 lakh. The report drew a sharp response from the Centre, with the Health Ministry criticising WHO’s use of mathematical extrapolation and assumptions that did not capture ground realities in India and its reliance on ‘unverified’ data sources. WHO is set to release its estimates for most countries in the near future but the disclosure of India’s displeasure again shines the light on a long-standing discomfort with independent estimates of the death toll. A high death toll undermines India’s official discourse that it has performed better than several western countries with better developed health infrastructure.
While India has traditionally been a laggard in health statistics, largely due to the wide disparity in health services across States, it has, in recent years, improved medical registration of deaths to as much as 86% in 2018. States such as Tamil Nadu, Kerala and Mizoram, for instance, have nearly 100% death registration; but even in these States, the percentage of certified deaths ascribing a cause is lower. States such as Bihar, Jharkhand and Uttar Pradesh have less than 50% and even fewer certified deaths. The infectious, pervasive nature of the pandemic continues to strain and overwhelm the most resilient health systems and there will never be an exact count of the toll. While it is possible that researchers could use indirect methods that may overestimate the toll, it is indefensible on India’s part to maintain that its official estimates offer a more accurate picture. While it may be years before the true numbers are known, India should view death estimates not as an indictment but as a marker for future generations that they may be better equipped and so invest appropriately to improve preparedness against inevitable blights. India must also officially commission a team of experts, supply them with the best available data, and have them independently investigate excess deaths, publishing their methods and numbers, without fear or favour, in reputed journals. This would go a long way in burnishing India’s health credentials.