Excess COVID-19 deaths: India’s statement on WHO calculation model ‘inaccurate’, say experts

Global predictive model not used for India, WHO expert says dismissing claims by health ministry

By Taran Deol
Published: Monday 18 April 2022
Excess COVID-19 deaths: India’s statement on WHO calculation model ‘inaccurate’, say experts Photo: iStock

The Union health ministry’s questions about the “validity and accuracy” of the modelling exercise by the World Health Organization (WHO) to estimate excess COVID-19 deaths is “inaccurate”, said Jon Wakefield, a member of the WHO Technical Advisory Group on COVID-19 Mortality Assessment, April 18, 2022. 

The United Nations health agency is yet to make an official announcement but according to media reports, India’s pandemic toll was an estimated four million — significantly higher than the official count of 520,000. 

The Union health ministry had expressed its objection to the methodology used by the global health body in a statement released April 16, 2022. “One-size-fits-all approaches and models which are true for smaller countries like Tunisia may not be applicable to India with a population of 1.3 billion,” it noted. 

The ministry noted that six letters were issued to WHO between November 17, 2021 and March 2, 2022 but a satisfactory response is still awaited. China, Iran, Bangladesh, Syria, Ethiopia and Egypt have also expressed similar concerns, it added.

The statement read:

It is not clear why Global Health Estimates 2019 has been used for estimating expected deaths figures for India. For the tier-1 countries such as the United States, France and Germany, their own historical datasets were used. It was repeatedly highlighted that India has a robust system of data collection and management.

Wakefield shared an extract from a paper titled ‘Estimating Country-Specific Excess Mortality During the COVID-19 Pandemic’, revealing details on the subnational model that was used to obtain excess mortality estimates for India. It noted:

We stress that for India the global predictive covariate model is not used and so the estimates of excess mortality are based on data from India only.

The body had access to data from just 17 of the 36 states and Union territories during the pandemic period, a figure that varies by month. Underlining that a range of sources were used to assess deaths at the subnational level, WHO added: The information was either reported directly by the states through official reports and automatic vital registration, or by journalists who obtained death registration information through Right To Information requests.

The paper has been submitted for publication and will be available shortly.

Several studies have argued that data was not as easily available. A recent paper in PLOS Global Public Health published April 15, has found “a lack of granular data in the reporting of COVID-19 surveillance, vaccination and vacant bed availability”. 

Less than 22 per cent of cases and deaths data came with information on age and gender distribution, while less than 30 per cent death records had any comorbidity distribution until 5 June 2021.

“Amid rising concerns of undercounting cases and deaths in India, our results highlight a patchy reporting of granular data even among the reported cases and deaths,” the study noted. 

The four million figure being reported by media portals were in line with at least five studies — preprints and peer reviewed — which concluded the COVID-19 mortality in India to be more than three million. 

A Science study placed the figure above three million till June 2021. Another report published in PlosOne stated its between 3.2-3.7 million till November 2021, a MedRXiv preprint estimated 2-3.6 million till August 2021, a National Bureau Economic Research working paper found 4.5 million deaths till June 2021.

Another MedRXiv preprint found it fell between 2.8-5.2 million till June 2021 while a Centre for Global Development working paper estimated 3.4-4.9 million excess deaths till June 2021. The Civil Registration Scheme report was a key database four out of these six studies referred to. 

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