An ambitious effort by the World Health Organization to calculate the global death toll from the coronavirus pandemic has found that far more people died than previously thought – a total of about 15 million by the end of 2021, more than double the official total of six million reported by countries individually.
But the release of the staggering estimate – the result of more than a year of research and analysis by experts around the world and the most comprehensive look at the pandemic’s mortality to date – has been delayed for several months due to objections from India, which dispute the calculation of how many of its citizens died and have tried to prevent it from becoming public.
More than a third of the additional nine million deaths are estimated to have occurred in India, where Prime Minister Narendra Modi’s government has stood at its own figure of around 520,000. The WHO will show that the country’s toll is at least four million, according to people familiar with the figures, who were not authorized to reveal them, which would give India the highest figure in the world, they said. The Times was unable to learn the estimates for other countries.
The WHO calculation combined national data on reported deaths with new information from localities and household surveys and with statistical models aimed at taking into account missed deaths. Most of the difference in the new global estimate represents previously innumerable deaths, the majority of which were directly from Covid; the new figure also includes indirect deaths, e.g. persons unable to access treatment for other disorders due to the pandemic.
The delay in publishing the figures is significant because global data are crucial to understanding how the pandemic unfolded and what steps could mitigate a similar crisis in the future. It has created unrest in the normally locked world of health statistics – a feud obscured in feeble-minded language unfolds at the UN Statistical Commission, the world body that collects health data, spurred on by India’s refusal to cooperate.
“It is important for the global accounts and the moral obligation to those who have died, but also very practically important. If there are subsequent waves, then it really is the key to understanding the death toll to know if vaccination campaigns work, ”said Dr. Prabhat Jha, director of the Center for Global Health Research in Toronto and a member of the expert working group that supports the WHO’s excess death calculation. “And that’s important for accountability.”
To try to take the true measure of the impact of the pandemic, the WHO gathered a collection of specialists, including demographers, public health experts, statisticians and data researchers. The technical advisory group, as it is known, has collaborated across countries to try to put together the most complete accounts of the dead in the pandemic.
The Times spoke to more than 10 people who were familiar with the data. The WHO had planned to publish the figures in January, but the publication has been pushed back on an ongoing basis.
Recently, a couple of members of the WHO group warned that if the organization does not release the figures, the experts would do it themselves, said 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 Assistant Director – General for Data, Analysis and Delivery for Power, who is leading the calculation, said the release of the data has been “slightly delayed”, but said it was “because we wanted to ensure we are all being heard. “
India insists that the WHO methodology is deficient. “India feels that the process was neither cooperative nor sufficiently representative,” the government said in a statement to the UN Statistical Commission in February. It also claimed that the process did not “hold scientific rigor and rational control as expected from an organization the size of the World Health Organization.”
The New Delhi Ministry of Health did not respond to requests for comment.
India is not alone in counting pandemic deaths: The new WHO figures also reflect undercounting in other populous countries such as Indonesia and Egypt.
Dr. Asma noted that many countries have struggled to accurately calculate the impact of the pandemic. Even in the most advanced countries, she said, “I think it’s challenging when looking under the bonnet.” At the beginning of the pandemic, there were significant differences in how quickly different U.S. states reported deaths, she said, and some were still collecting data via fax.
India had a large team involved in reviewing the WHO data analysis, she said, and the agency was happy to get them to do so because it wanted the model to be as transparent as possible.
India’s work on vaccination has won praise from experts globally, but its public health response to Covid has been criticized for arrogance. Sir. In January 2021, Modi boasted that India had “saved humanity from a great catastrophe.” A few months later, his health minister declared the country “in the playoffs of Covid-19.” Satisfaction set in, leading to missteps and officials’ attempts to silence critical voices in elite institutions.
Science in India has become more and more politicized during the pandemic. In February, India’s younger health minister criticized a study published in the journal Science, which estimated the country’s Covid deaths to be seven to eight times the official figure. In March, the government questioned the method in a study published in The Lancet, which estimated India’s deaths at four million.
“Personally, I have always felt that science must respond with science,” said Bhramar Mukherjee, a professor of biostatistics at the University of Michigan School of Public Health who has worked with the WHO to review the data. “If you have an alternative estimate that is through rigorous science, you should just produce it. You can not just say, ‘I will not accept it.'”
India has not submitted its overall mortality data to the WHO in the last two years, but the organization’s researchers have used figures collected from at least 12 states, including Andhra Pradesh, Chhattisgarh and Karnataka, which experts say show at least five to six times as many deaths due to Covid-19.
Jon Wakefield, 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 WHO’s global data was ready in December.
“But then India was unhappy with the estimates. “So we have subsequently done all sorts of sensitivity analyzes, the newspaper is actually much better because of this waiting time, because we have gone overboard in terms of model checks and done as much as we possibly can based on the data that is available,” said Dr. Wakefield. “And we’re ready to go.”
The numbers represent what statisticians and researchers call “excess mortality” – the difference between all the deaths that occurred and those that would have been expected to occur under normal circumstances. WHO calculations include those deaths directly from Covid, deaths among humans due to conditions complicated by Covid, and deaths in those who did not have Covid but needed treatment they could not get due to the pandemic. The calculations also take into account expected deaths that did not occur due to Covid restrictions, such as those from traffic accidents.
Calculating excess deaths globally is a complex task. Some countries have closely monitored mortality data and provided them to the WHO immediately. Others have provided only partial data, and the agency has had to use modeling to round off the image. And then there are a large number of countries, including almost all of them in sub-Saharan Africa, that do not collect death data and for which statistics have had to rely entirely on modeling.
Dr. Asma from the WHO noted that nine out of 10 deaths in Africa and six out of 10 globally are not recorded and more than half of the countries in the world do not collect exact causes of death. That means even the starting point for this kind of analysis is a “guess timer,” she said. “We have to be humble about it and say we do not know what we do not know.”
To produce mortality estimates for countries with partial or no death data, the 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 collect national figures and, hence, regional and global estimates.
Besides India, there are other major countries where the data is also uncertain.
Russia’s health ministry had reported 300,000 Covid deaths by the end of 2021, and that was the figure the government gave the WHO. But the Russian National Bureau of Statistics, which is fairly independent of the government, found excess mortality of more than a million people – a figure reportedly close to that in the WHO draft. Russia has objected to this figure, but it has made no effort to stop the release of the data, members of the group said.
China, where the pandemic began, does not release public mortality data, and some experts have raised questions about underreporting deaths, especially at the beginning of the outbreak. China has officially reported fewer than 5,000 deaths due to the virus.
While China has actually kept case volumes at much lower levels than most countries, it has done so in part through some of the world’s most severe shutdowns – which have had their own impact on public health. One of the few studies to examine China’s excess mortality using internal data, conducted by a group of government researchers, showed that deaths due to heart disease and diabetes increased in Wuhan during the city’s two-month shutdown. The researchers said the increase was most likely due to inability or reluctance to seek help at hospitals. They concluded that the overall death rate in Wuhan was about 50 percent higher than expected in the first quarter of 2020.
India’s efforts to halt the release of the report make 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 has also worked with the WHO to review the data. “I do not remember a time when it did that in the past.”
Ariel Karlinsky, an Israeli economist who has built and maintains the World Mortality Dataset and who has worked with the WHO on the numbers, said they are challenging for governments when they show high excess deaths. “I think it makes a lot of sense for those in power to fear these consequences.”
Vivian Wang contributed with reporting.