Experts back India figures in COVID death toll clash over WHO data

People cremate the bodies of victims of the coronavirus disease (COVID-19), at a crematorium ground in New Delhi, India, April 24, 2021. REUTERS/Danish Siddiqui

With COVID-19 thought to be receding into the background, a fresh controversy around it has surfaced, this time from mortality figures provided by the World Health Organisation (WHO) and backed by similar claims from renowned global medical journals like The Lancet and Science.

The world’s premier health body has claimed that more than 4.7 million people in India–nearly 10 times higher than official records suggest–are thought to have died because of COVID-19.

The Indian government has rejected the figure saying the WHO methodology is flawed and that ample public evidence was available for the global body not to slip up.

India has officially recorded more than half a million deaths due to the novel coronavirus until now. It reported 481,000 COVID-19 deaths between January 1, 2020 and December 31, 2021, but the WHO’s estimate puts the figure 10 times higher.

In their view, India accounts for almost a third of COVID-19 deaths globally, which then naturally pushes up global figures.

According to the BBC, in November 2020, researchers at the World Mortality Dataset – a global repository that provides updated data on deaths from all causes – asked authorities in India to provide information.

"These are not available," India's main statistical office told the researchers, according to Ariel Karlinsky, a scientist who co-created the dataset and is a member of an advisory group set up by the WHO for its estimates of excess deaths caused by COVID-19 globally during 2020 and 2021.

India’s absence from such global databases means that the only national numbers the country has are model-based estimates of all-cause excess deaths.

Also read: CCHFW passes resolution terming WHO's modelling for India's Covid death estimate flawed

Earlier this week, the government released civil registration data (CRS) showing 8.1 million deaths in 2020, a 6 percent rise over the previous year. Officials played it down, saying all the 474,806 excess deaths could not be attributed to COVID-19.

According to official records, some 149,000 people died of COVID-19 in India in 2020. The CRS is a record of all deaths and births, but does not categorise deaths by causes. It showed that there was an increase of about 4.75 lakh deaths compared to the previous year. The total number of deaths, 81.16 lakh, also include deaths caused by COVID-19.

Since then, a war of words has broken out between the government and the Congress party, which has demanded a commission of inquiry into COVID-19 casualties. Moneycontrol spoke to five leading experts, including Prabhat Jha from Toronto, who reviewed the report with Ariel Karlinsky, and has stuck to his conclusions.

Prabhat Jha, founding director of the Centre for Global Health Research at St. Michael’s Hospital in Toronto

WHO’s estimate is consistent

Yes, WHO's estimate is consistent with our study in Science and other studies. See some replies below from me and one of the authors, Ariel Karlinsky. I was not involved in writing the report, only reviewing it.

Indeed, the difference between Government of India 2020 CRS estimates of 8.1 million versus average of 2018-19 (7.3 million) is 0.8 million excess deaths (11 percent) excess, which is the same as WHO estimates for that year. Our national polling data, published in Science in January 2022 for only about eight months in 2020, found 0.6 million deaths (9 percent excess).  So, far from refuting the WHO numbers, the Ministry of Health and Family Welfare (MOHFW) press release and CRS data corroborate it.

Do the same steps for Maharashtra for 2020 and you get 19 percent excess, and as we all know, Maharashtra had among the worst of 2020 COVID-19 scenarios.

Completeness of CRS varies widely between states and within states. This has been known for years.

The CRS registered 8.11 million deaths in 2020. WHO estimates (attempt to) account for total deaths, not just registered deaths, both before 2020 and during 2020-2021. WHO/UN totals for India are 10 million per year, not 8.3 million.

Huge undercounts are possible. There are many local testimonies of a lot of deaths during peak COVID-19 waves, which have not been certified as COVID-19. Also, there are other countries where the ratio between excess to reported COVID-19 is higher than 10 percent, such as Egypt, Tajikistan, Nicaragua, and others. This is very plausible, unfortunately.

The data used by WHO is official state-level data, obtained either directly from the official online portals of the states or from Right to Information (RTI) requests submitted by journalists to these states.

2021 data is key. Most of it should be already available with the government and they should release it. States should release their data as well. The central government should release more health management information system (HMIS) data as well.

Also read: India's top health experts question WHO report on excess COVID deaths, term it untenable

Vineeta Bal, Indian Institute of Science Education and Research, Pune, autonomous public research university established in 2006 by the Ministry of Education

There have been cases of massive COVID-19 under-reporting in India

I do not have access to how WHO has collated its data, but even after the second wave, there were enough independent assessments to show that there were massive cases of COVID-19 under-reporting in India. There were innumerable shortfalls. That was more than evident. It is likely that sources like Lancet have reported numbers, which are close to what the WHO has said.

Also read: 45% people who died in 2020 didn't receive any medical care: Govt data

Rakesh Mishra, Director, Tata Institute for Genetics and Society

The ball is in the government’s court

It is very tricky. How can it be said that all who died in India passed away due to COVID-19? It is hard to say. While there can be differences in methodology, it could also lead to a gap in numbers, but not 10 times over! What are the data points? It seems that WHO has based its assessment on independent studies (in the absence of official data) to arrive at its numbers, which are considerably higher than what the Indian government is saying.

So, the ball is now, so to speak, in the government’ court. It should pinpoint in detail where the WHO or other western agencies have gone wrong in their assessment and how there can be so much discrepancy in numbers.

MC Mishra, former director, AIIMS

What is the credibility of WHO, Lancet and others? COVID-19 has exposed them

Did the WHO count the bodies before arriving at their numbers? This is an exercise in statistical jugglery or mathematical modelling. Anyone can extrapolate any number. And what is the reputation of WHO or even a publication like Lancet, which has been exposed during this pandemic. Lancet is more of a political magazine rather than a medical journal. They have been forced to withdraw many of their articles during the pandemic. If WHO is so keen on dishing out mortality figures about India, then how about doing the same with China, which has a population size bigger than India? They will not because some of them may have been bribed by the Chinese.

The problem in India is that it has too many liberals and leftists, who are keen to present a damaging picture of the country outside. It is no surprise that most western predictions two years ago about the pandemic holocaust in India, including Ivy League institutions in the US, have been widely off the mark. And so is this WHO projection.

I can sit on my table and arrive at a mathematical equation. That does not mean that I am right.

Samiran Nundy, additional director general, ICMR

More clarity is needed on all sides

I have not read the WHO report, but in such circumstances, it is always good to have complete clarity from both sides. The government of India’s data is reliant upon state governments, while the WHO normally talks about a range. So, I believe that instead of a controversy, what is needed is total clarification from both the government of India and WHO. It is true that those who died from COVID-19, about 95 percent, expired within four weeks of the illness. And let us not forget that not just India, but every country is grappling with these figures.