There were likely 4.7 million deaths, directly or indirectly attributable to COVID-19 in India in 2020 and 2021, according to a report by the World Health Organisation on Thursday. These are the highest, by far, for any country and comprise nearly a third of the 15 million such deaths globally.
India officially estimated only 4.8 lakh cumulative deaths linked to COVID-19 as of December 2021, which implies that the WHO estimate is nearly 10 times the government count. As of May, India’s official COVID-19 death toll is 5.2 lakh.
“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,” said Tedros Adhanom Ghebreyesus, WHO Director-General. “WHO is committed to working with all countries to strengthen their health information systems to generate better data for better decisions and better outcomes,” he added.
Excess deaths or mortality is calculated as the difference between the number of deaths that have occurred and the number that would be expected in the absence of the pandemic based on data from earlier years. Excess mortality includes deaths associated with COVID-19 directly (due to the disease) or indirectly (due to the pandemic’s impact on health systems and society).
Deaths indirectly linked to COVID-19 are attributable to other health conditions for which people were unable to access prevention and treatment because health systems were overburdened by the pandemic. The estimated number of excess deaths can be influenced also by deaths averted during the pandemic due to lower risks of certain events, like motor-vehicle accidents or occupational injuries.
Most of the excess deaths (84%) are concentrated in South-East Asia, Europe, and the Americas. About two-thirds of the excess deaths are concentrated in just 10 countries globally. The pandemic globally claimed more men than women (57% male, 43% female) and the toll was higher among older adults. There were 5.3 lakh deaths in males 60 and older in India in 2020 and 19 lakh deaths in that age group in 2021. On the other hand, there were 3.5 lakh deaths among women 60 and older in 2020 and 15 lakh deaths in 2021.
India on Tuesday made public birth and death registration data from 2020 that reported 4.75 lakh excess deaths from all causes in 2020 over 2019. This data is from the Civil Registration System (CRS) that only counts deaths registered and doesn’t break down causes of death. The total number of deaths, from all causes, in 2020 was 81.2 lakh. The Health Ministry reported only 1.49 lakh COVID-19 deaths in 2020. The WHO, on the other hand, has estimated nearly 8.2 lakh excess deaths from all causes.
India’s prime objections, raised in the aftermath of a report by the New York Times in the last week of April, were that the WHO used mathematical modelling to estimate deaths for India using parameters from reports such as the Global Health Estimates, test positivity data, etc. that didn’t accurately reflect the Indian situation and ignored official death estimates.
Scientists from the WHO countered these points by stating that they relied on official data from the CRS, as well as reports that cited data accessed by Right to Information requests. They have said that they didn’t use the estimates that the Indian government has claimed they used. The scientists also said that they used official data from 17 States and one Union Territory, compared death reporting trends from previous years in these regions and then estimated deaths for months where data wasn’t officially available.
Though diverging from government estimates, the WHO estimates for India tally with several independent estimates that range from 2-5 million excess COVID-19 deaths for India. The Hindu in a series of stories, that relied on State- and municipal-level data, estimated that excess deaths were nearly six time the official toll as of May 2021.
WHO officials at a press conference on Thursday didn’t directly respond to India’s criticism but said that they were in constant dialogue with Indian government experts and that these estimates would be updated based on the availability of new data.
“We engage closely with member states to clarify methodology and have had a series of consultations with colleagues in India,” said Samira Asma, Assistant Director-General for Data, Analytics and Delivery at WHO. “These new estimates use the best available data and have been produced using a robust methodology and a completely transparent approach.”