An ambitious effort by the World Health Organization to calculate the death toll from the coronavirus pandemic worldwide has found that far more people have died than previously believed – a total of about 15 million by the end of 2021, more than double. of the official total of 6 million reported by individual countries.
But the release of the impressive estimate – the result of more than a year of research and analysis by experts around the world and the most comprehensive analysis of the lethality of the pandemic to date – has been delayed for months due to objections from India, which disputes the calculation. of how many of its citizens died and tried to keep it from becoming public.
More than a third of the 9 million additional deaths are estimated to have occurred in India, where Prime Minister Narendra Modi’s government maintained its own tally of around 520,000.
The WHO will show the country’s death toll to be at least 4 million, according to people familiar with the figures who were not authorized to release them, which would give India the highest tally in the world, they said. The New York Times was unable to learn estimates from other countries.
The WHO calculation combined national data on reported deaths with new information from localities and household surveys and with statistical models that aim to account for omitted deaths.
Most of the difference in the new global estimate represents previously uncounted deaths, most of which directly from Covid-19; the new figure also includes indirect deaths, such as those of people unable to access treatments for other illnesses because of the pandemic.
The delay in releasing figures is significant because global data is essential to understanding how the pandemic unfolded and what measures could mitigate a similar crisis. This has created turmoil in the normally sober world of health statistics — a dispute shrouded in nondescript language is taking place at the United Nations Statistical Commission, the world body that collects health data, spurred by India’s refusal to cooperate.
“It’s important for global accounting and the moral obligation to those who have died, but it’s also important in practice. If there are subsequent waves, really understanding the total deaths is critical to whether vaccination campaigns are working,” Prabhat said. Jha, director of the Global Health Research Center in Toronto (Canada) and member of the expert working group that supports the WHO in calculating excess death. “And it’s important for accountability.”
To try to measure the true effect of the pandemic, the WHO has assembled a collection of experts, including demographers, public health experts, statisticians and data scientists. The Technical Advisory Group, as it is known, has been collaborating between countries to try to assemble the most complete accounting of those killed in the pandemic.
The Times spoke to more than ten people familiar with the data. The WHO had planned to release the figures in January, but this was continually delayed. Recently, some members of the group warned the WHO that if the organization did not release the figures, the experts themselves would, according to three people familiar with the matter.
A WHO spokeswoman, Amna Smailbegovic, told the Times: “We aim to publish in April.” Dr Samira Asma, WHO’s deputy director-general for data, analysis and delivery for impact, who is helping to lead the calculation, said the release of the data was “a little delayed”, but that was “because we wanted to ensure that everyone were consulted”.
India insists the WHO methodology is flawed.
“India feels that the process was neither collaborative nor adequately representative,” the government said in a statement to the UN Statistical Commission in February. It also argued that the process did not “maintain the scientific rigor and rational scrutiny expected of an organization the size of the World Health Organization”. The Ministry of Health in New Delhi did not respond to requests for comment.
The country is not alone in the undercount of pandemic deaths: the new WHO figures also reflect the undercount in other populous nations such as Brazil and Indonesia.
India has not submitted its total mortality data to the WHO in the past two years, but the organization’s researchers used figures collected from at least 12 states, including Andhra Pradesh, Chhattisgarh and Karnataka, which experts say show at least four to five times as many deaths. as a result of Covid.
Jon Wakefield, a professor of statistics and biostatistics at the University of Washington who played a key role in building the model used for the estimates, said an initial presentation of the WHO’s global data was ready in December.
“But then India was unhappy with the estimates. Later on, we did all kinds of sensitivity analyses. The work is actually much better because of that wait, because we went overboard in terms of model checks and did as much as we could with the data. available,” Wakefield said. “And we’re ready to go.”
The numbers represent what statisticians and researchers call “excessive mortality” – the difference between all deaths that have occurred and those that should have occurred under normal circumstances. The WHO’s calculations include deaths directly from Covid, deaths of people due to conditions complicated by Covid, and deaths of people who did not have Covid but needed treatment they could not get because of the pandemic. The calculations also take into account expected deaths that did not occur because of Covid restrictions, such as those resulting from traffic accidents.
Calculating excess deaths globally is a complex task. Some countries closely followed the mortality data and promptly provided them to the WHO. Others provided only partial data, and the agency had to use modeling to complete the picture. And there are also a large number of countries, including almost all of Sub-Saharan Africa, that do not collect death data and for which statisticians have had to rely entirely on modeling.
WHO’s Asthma noted that 9 out of 10 deaths in Africa and 6 out of 10 globally are unrecorded, and more than half of the world’s countries do not collect precise causes of death. This means that even the starting point for this type of analysis is a “guess,” she said. “We have to be humble about it and say we don’t know what we don’t know.”
To produce mortality estimates for countries with partial or non-existent data, experts in the advisory group used statistical models and made predictions based on country-specific information such as containment measures, historical disease rates, temperature and demographics to gather national figures. and, from there, regional and global estimates.
India’s effort to prevent the release of the report makes it clear that pandemic data is a sensitive issue for the Modi government. “It’s an unusual step,” said Anand Krishnan, a professor of community medicine at the All-India Institute of Medical Sciences in New Delhi, who also works with the WHO to review the data. “I can’t remember a time when I did that in the past.”
Ariel Karlinsky, an Israeli economist who built and maintains the World Mortality Dataset and who has been working with the WHO on the numbers, said they are a challenge for governments when they show a high excess of deaths. “I think it’s very sensible for people in power to fear these consequences,” Karlinsky said.
