WHO estimates 4.74 mn COVID-19 deaths in India in 2020, 2021; nearly 10 times the official toll

The official count of deaths directly attributable to COVID-19 and reported to WHO in that period, from January 2020 to the end of December 2021, is slightly more than 5.4 million. In other words, the estimated toll is 9.5 million higher than the confirmed fatalities by countries.

“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 Dr Tedros Adhanom Ghebreyesus, WHO Director-General in a statement.

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The WHO data takes into account people who died of COVID-19 as well as those who died as an indirect result of the outbreak, including those who could not access healthcare for other conditions as systems were overwhelmed during huge waves of the infection. It further includes deaths averted during the pandemic, for example, because of the lower risk of traffic accidents during lockdowns.

India objects 

Soon after the WHO press conference on the new report, the Union health ministry issued a statement saying that India “strongly objects to the use of mathematical models for projecting excess mortality estimates in view of the availability of authentic data”.

It also said that the validity and robustness of the models used and methodology of data collection are questionable.

India has been consistently objecting to the methodology adopted by WHO to project excess mortality estimates based on mathematical models, said the statement. Despite India’s objection to the process, methodology and outcome of this modelling exercise, WHO has released the excess mortality estimates without adequately addressing India’s concerns.

India had also informed WHO that in view of the availability of authentic data published through the Civil Registration System (CRS) by the Registrar General of India (RGI), mathematical models should not be used for projecting excess mortality numbers for India.

On India’s objections, WHO assistant director-general for data, analytics and delivery for impact Samira Asma said in response to a query in the press conference that WHO has had a series of consultations with India on COVID-19 data.

“We have responded to questions with regard to tier classification in terms of data availability, methodology and we are continuing to engage with colleagues from India,” she said.

Asma added that as India released Civil Registrations Systems report for 2020 two days ago, WHO continues to have conversations with the country and will update the data after the latest input.

‘Half the uncounted deaths in India’ 

The WHO report said that almost half of the deaths that until now had not been counted were in India. A comparison between officially confirmed deaths and estimated deaths showed that there were 11.6 times more deaths in Egypt, 9.9 times in India, eight times in Pakistan, Indonesia 7.1 times, and Bangladesh five times.

The WHO said it had not yet fully examined new data provided this week by India, which has pushed back against the WHO estimates and issued its own mortality figures for all causes of death in 2020 on Tuesday. It also said that it may add a disclaimer to the report highlighting the ongoing conversation with India.

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The WHO panel, made up of international experts who have been working on the data for months, used a combination of national and local information, as well as statistical models, to estimate totals where the data is incomplete, a methodology that India has criticised.

Other independent assessments have also put the death toll in India far higher than the official government tally, including a report published in Science, which suggested that three million people have likely died of COVID-19 in the country.

Some other models have also stated that the global death toll was far higher than the recorded statistics. To understand by example one can look at the figures of previous health crises, such as the Spanish Flu pandemic in 1918, which is said to have killed around 50 million people across the world, and the HIV epidemic that began in the 1980s, which has killed 36 million people so far.

Asma, who co-led the calculation process, said data was the "lifeblood of public health" and countries needed to assess and learn from what happened during the pandemic, and called for more support for countries to improve reporting.