Over the last year, the World Health Organization (WHO) has been busy, in an unprecedented effort, to calculate the global death toll from COVID-19. This effort, however, has India’s health establishment up in arms. Globally from an estimated six million reported deaths, WHO now estimates these deaths to be closer to almost triple the number. India, deeply affected by successive COVID-19 waves, is not delighted with this revision.
There are gaps
Several news reports have pointed at a significant gap in India’s COVID-19 story — significantly under-reported mortality figures. The unreleased WHO estimates have been prepared by leading global experts but have left India’s health establishment perturbed, with its strong objections to these estimates.
Why? Because as in these figures, India would have had close to four times the COVID-19 deaths reported-a figure that varies highly from India’s previously self-reported figures. This would make India’s tally of COVID-19 deaths amongst the highest globally.
Not surprisingly, India is in serious disagreement with the WHO-prepared COVID-19 mortality estimates. In fact, its continued objections have been holding back the Global WHO Report. The argument being made by India’s health establishment through a public clarification is that this is an overestimation, and the methodology employed is incorrect.
The new estimates also take into account formerly uncounted deaths, but also deaths resulting from the impact of COVID-19. For example, millions who could not access care, i.e., diagnosis or treatment due to COVID-19 restrictions or from COVID-19 cases overwhelming health services.
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The methodology for this estimation, led by global experts, is unlikely to be faulty. India’s disagreements with the methodology can be easily addressed through consultation. Also, the need to plump up India’s COVID-19 deaths unnecessarily would serve little or no purpose.
Why then this objection? A quick study of India’s COVID-19 response is insightful. India’s COVID-19 response has been replete with delays and denials. For instance, for the longest time that India’s COVID-19 number rose, the health establishment continued to insist that community transmission was not under way. It took months and several lakh cases before they agreed that COVID-19 was finally in community transmission.
Second wave’s devastation
The end of the first wave saw a slew of congratulatory and adulatory messages by the political leadership applauding India’s leadership in ending COVID-19 in the country. India’s people were told that the war against COVID-19 had been won and over. Until the deadly second wave arrived and crept up on the country which had turned complacent.
The devastation of the second wave showed how unprepared we were to combat the deadly Delta variant. People began dying from lack of access to basic health facilities and infrastructure such as oxygen, beds, ventilators and therapeutics. The wave devastated India’s citizens in unimaginable ways. Crematoriums ran out of wood, people were forced to bury their family members on the banks of rivers. By the time the wave subsided, India’s population was devastated, and helpless, seeing dignity neither in disease nor in death.
Potential fallout
The need then to deny these new mortality figures is much like the case of the emperor’s new clothes. The establishment shudders to think what these figures reveal to the public not just about the lack of preparedness but also the human costs to the country, and communities.
Also, at this time, there is rising unemployment, rising fuel prices and inflation in India. The figures then also have enormous political relevance. They are the much-needed ammunition that a beleaguered and often out of sync and clueless Opposition needs to counter the Government’s victory drumbeat against COVID-19.
These new figures also have the power to revive public memory which is otherwise short-lived. Human tendency is also to gloss over suffering and believe in the mainstream narrative which makes loss more bearable and often easier. These numbers then are important because they can revive the memories of the desperation and the helplessness millions of Indians faced during the devastating second wave.
The COVID-19 mortality data from WHO is more than a disagreement. It is food for thought and poses several questions to India’s health establishment. Were these deaths avoidable? Could India have been better prepared? Was India’s health establishment dismissive in the face of global warnings? Should India have gone to elections in the middle of a pandemic? But the most important question is — why not count the dead?
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Even for the Government’s most fervent supporters, these questions are difficult to answer or deflect when faced with such overwhelming mortality figures. It is no surprise then that those figures create fear and spark denial. The figures ratchet up not only issues of administrative but also moral accountability for governments that they have been previously side stepped through effective and misleading media narratives. But, most importantly, these figures pose several key questions before us, the people of India. How much lack of accountability under-reporting are we willing to accept? Do these reduced figures not amount to an erasure of our collective suffering, grief and loss? And who, if anyone, will be held accountable if these figures are accurate? Perhaps it is just as well that death is the end of all questions.
Chapal Mehra is public health specialist, activist and writer based in New Delhi
