The World Health Organization’s estimates that 4.74 million lives were lost in India due to Covid-19 is flawed, the Union government said on Thursday with a rebuttal pointing out four major grounds on to dispute the finding.
Going by WHO’s estimates, India’s true death toll due to Covid-19 comes to approximately 10 times the 481,000 Covid-19 fatalities recorded till December 31, 2021. Globally, there were close to 15 million deaths in 2020 and 2021, the WHO said, roughly thrice the known death toll.
“India has been consistently objecting to the methodology adopted by WHO to project excess mortality estimates based on mathematical models. 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,” the government said in a statement, within minutes of the WHO report’s release.
Samira Asma, assistant director-general, data, analytics, and delivery for impact at WHO, said during the briefing that the WHO “engages in a close consultative process with all member states to address the questions and clarify the methodology and request the input data”.
“…As you know that India also released 2 days ago the 2020 estimates and we will continue to have these conversations. In our next update we will also include the data” she added.
According to people familiar with the matter in the government, the Indian administration wrote at least 10 letters to the UN body in the last 4-5 months asking for clarity and vital information regarding the processes having been followed, but was met with a lukewarm response.
“Even during the member consultation meeting on the modeLling exercise, India raised its flag thrice to speak but was given a chance only towards the end, and even then, they weren’t able to convince us on points that we raised regarding the modelling methodology etc.,” said an official, requesting anonymity.
India’s objections hinged roughly on four major grounds. First, it opposed modelling as an approach – which was reserved for tier II countries that India was classified in — and said only data from Registrar General of India based on the Civil Registration system should be used for such estimation.
It said India should not be classified a tier II country, for which WHO used modelling, since the country’s “mortality data collected (is) through an effective and robust statutory system”. WHO till date has not responded to India’s contention, the official added.
The CRS data released for 2020 was released on May 3, and found in the first year of the pandemic, India recorded roughly 470,000 more deaths.
Second, it objected to WHO using data from 17 states that were “obtained from some websites and media reports and was used in their mathematical model. This reflects a statistically unsound and scientifically questionable methodology of data collection for making excess mortality projections in case of India”.
“They were not willing to share the states from which data was collected; first they said 18 states then they said 17, and later said data was taken from state websites and media reports based on RTI responses. In November we were informally told 13 lakh (1.3 million) excess deaths, which in a matter of 15 days jumped to 33 lakh (3.3 million); how on earth can there be such huge variation, is something we cannot understand,” said the person quoted above.
Third, the government said, WHO used its own Global Health Estimate 2019 as the base for calculation, which “itself is an estimate”. “Therefore, a modelling approach which provides mortality estimates on the basis of another estimate, while totally disregarding the actual data available within the Country exhibits lack of academic rigour.”
Fourth, it said that WHO did not capture variations in test positivity and severity across the country, creating a “one size fits all” approach and model that India objects to.
“There is no explanation to why a war-torn country like Iraq where data collection, analysis and reporting can be questioned is in tier1, and India that has been putting out all data statewise from day one on the central government’s website including positivity rate and other vital numbers in tier 2 list. We also shared civil registration system data with them the day before (May 3), to which they replied today (May 5) that it would take about 3 months to process,” said the person quoted above.
Experts said India has several systems in place to know the numbers. “In the time of an epidemic when excess deaths due to all causes are reported with no explanation, it can be attributable to the disease that has caused the outbreak. However, it is an assumption; CRS data is one of the methods, and if you want to validate it then you can compare it with Sample Registration data. Another thing that can help is getting a more thorough census done that will give a more accurate picture,” said Dr Dileep Mavalankar, director, Indian Institute of Public Health-Gandhinagar.