An ambitious effort by the World Health Organization to estimate the global death toll from the coronavirus pandemic has found that many more people have died than previously thought: a total of about 15 million by the end of 2021, more twice the official total of six million. reported by countries individually.
But the publication of the startling estimate, the result of more than a year of research and analysis by experts around the world and the fullest look at the lethality of the pandemic to date, has been delayed for months due to objections from India, which questions the calculation of how many of its citizens died and has tried not to go public.
It is estimated that more than a third of the additional nine million deaths have occurred in India, where the government of Prime Minister Narendra Modi has maintained its own account of about 520,000. The WHO will show that the country’s toll is at least four million, according to people known to the figures who were not allowed to disclose them, which would give India the highest count in the world, they said. The Times was unable to find estimates from other countries.
The WHO calculation combined national data on reported deaths with new local information and household surveys, and with statistical models aimed at taking into account lost deaths. Most of the difference in the new global estimate represents deaths not previously counted, most of which were directly from Covid; the new number also includes indirect deaths, such as those of people who are unable to access care for other illnesses due to the pandemic.
The delay in publishing the figures is important because global data is essential to understanding how the pandemic has unfolded and what steps could mitigate a similar crisis in the future. It has created turmoil in the usually quiet world of health statistics: a covert fight over bland language is unfolding in the United Nations Statistics Commission, the world’s health data collection agency, spurred on by India’s refusal to cooperate.
“It is important for global accounting and the moral obligation with those who have died, but also very important in practice. If there are subsequent waves, it is key to really understand the total death toll to see if vaccination campaigns work, “said Dr. Prabhat Jha, director of the Toronto Global Health Research Center and a member of the d experts support the WHO. calculation of excess death. “And it is important for responsibility.”
To try to take the true measure of the impact of the pandemic, the WHO brought together a collection of specialists including demographers, public health experts, statisticians and data scientists. The Technical Advisory Group, as it is known, has collaborated between countries to try to gather the most complete accounts of those killed by the pandemic.
The Times spoke to more than 10 people familiar with the data. The WHO had planned to make the numbers public in January, but the launch has been continuously delayed.
Recently, some members of the group warned the WHO that if the organization did not publish the figures, the experts would do it themselves, said three people familiar with the matter.
WHO spokeswoman Amna Smailbegovic told The Times: “We plan to publish in April.”
Dr Samira Asma, WHO’s Deputy Director-General for Data, Analysis and Impact Delivery, who is helping to lead the calculation, said the publication of the data had been “slightly delayed”, but said that it was “because we wanted to make sure everyone is consulted.”
India insists that the WHO methodology is flawed. “India considers the process to be neither collaborative nor adequately representative,” the government said in a statement to the United Nations Statistics Commission in February. He also argued that the process did not “maintain the scientific rigor and rational scrutiny as expected of 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 not counting pandemic deaths: new WHO numbers also reflect an insufficient count in other populated countries such as Brazil and Indonesia.
Dr. Asthma noted that many countries have struggled to accurately calculate the impact of the pandemic. Even in the most advanced countries, he said, “I think when you look under the hood, it’s a challenge.” At the start of the pandemic, there were significant disparities in how quickly different U.S. states reported deaths, he said, and some were still collecting data by fax.
India brought in a large team to review the WHO data analysis, he said, and the agency was glad they did, because they wanted the model to be as transparent as possible.
India’s work on vaccination has garnered praise from experts around the world, but its public health response to Covid has been criticized for overconfidence. Mr. Modi boasted in January 2021 that India had “saved humanity from a great disaster.” A couple of months later, his health minister declared that the country was “at the end of the Covid-19 game.” Complacency was installed, which led to missteps and attempts by officials to silence critical voices within elite institutions.
Science in India has become increasingly politicized throughout the pandemic. In February, India’s health minister criticized a study published in the journal Science which estimated the death toll for Covid in the country to be six to seven times higher than the official number. In March, the government questioned the methodology of a study published in The Lancet that estimated India’s deaths at four million.
“Personally, I’ve always felt that science has to be answered with science,” said Bhramar Mukherjee, a professor of biostatistics at the University of Michigan School of Public Health who has been working with WHO to review the data. . “If you have an alternative estimate, which is through rigorous science, you should just produce it. You can’t just say, ‘I won’t accept it.’
India has not sent its total mortality data to the WHO for the past 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 they say they show at least four or five times more. died as a result of Covid-19.
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 WHO global data was ready in December. .
“But then India was not satisfied with the estimates. Then we did all kinds of sensitivity analysis, the document is actually much better because of this wait, because we exaggerated in terms of model checks. and we’ve done everything we can to keep the data available. ” Dr. Wakefield said. “And we’re ready to go.”
The numbers represent what statisticians and researchers call “excess mortality”: the difference between all deaths that occurred and those that would have been expected to occur under normal circumstances. WHO calculations include those killed directly by Covid, deaths of people due to conditions complicated by Covid, and deaths of those who did not have Covid but needed treatment that they could not receive due to the pandemic. The calculations also take into account the expected deaths that did not occur due to Covid restrictions, such as traffic accidents.
Calculating the excess deaths worldwide is a complex task. Some countries have closely monitored mortality data and provided them quickly to the WHO. Others have only provided partial data, and the agency has had to use modeling to complete the image. And then there are a large number of countries, including almost all of sub-Saharan Africa, that do not collect death toll and for which statisticians have had to rely entirely on modeling.
WHO’s Dr Asma noted that nine out of 10 deaths in Africa, and six out of 10 worldwide, are unregistered, and more than half of the world’s countries do not report specific causes of death. That means even the starting point for this type of analysis is an “estimate,” he 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 or without partial 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 demographic data to gather national figures and, from there, regional and global estimates.
In addition to India, there are other large countries where the data is also uncertain.
Russia’s health ministry had reported 300,000 deaths from Covid by the end of 2021, and that was the number the government gave to the WHO. But Russia’s national statistics agency, which is fairly independent of the government, found an excess mortality rate of more than a million people, a figure. which is close to the WHO draft. Russia has opposed the figure, but has made no effort to halt the release of the data, group members said.
China, where the pandemic began, has not publicly released mortality data, and some experts have raised questions about the underestimation of deaths, especially at the onset of the outbreak. China has officially reported less than 5,000 deaths from the virus.
While China has kept the number of cases at much lower levels than most countries, it has done so in part through some of the world’s tightest blockades, 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 from heart disease and diabetes increased in Wuhan during the two-month blockade. this city. Researchers said the increase was most likely due to the inability or reluctance to seek help from hospitals. They concluded that the overall mortality rate in Wuhan was about 50 percent higher than expected in the first quarter of 2020.
India’s efforts to curb 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 Indian Institute of Medical Sciences in New Delhi, who has also been working with the WHO to review the data. “I don’t remember any time I did it in the past.”
Ariel Karlinsky, an Israeli economist who created and maintained the global mortality dataset and has been working with the WHO on the figures, said they are a challenge for governments when they show a large excess of deaths. “I think it’s very reasonable for people in power to be afraid of these consequences.”
Vivian Wang provide reports.