India objects to “the use of mathematical models for projecting excess mortality estimates in view of the availability of authentic data.”

New estimates from the World Health Organization (WHO) show that the full death toll associated directly or indirectly with the COVID-19 pandemic between 1 January 2020 and 31 December 2021 was approximately 14.9 million

The WHO’s estimates indicate that while India experienced roughly 830,000 excess deaths in 2020, the country saw over 3.9 million excess deaths in 2021. Of these, 2.3 million deaths took place over two months – April and May 2021 – at the height of the second Covid-19 wave.

India’s official death toll linked to Covid-19 as of December 2021 is 481,000, which implies that the WHO estimate is around ten times the government count.

The government of India has rejected the estimates. India’s health ministry said in a statement issued shortly after the WHO released its report on May 5.

“India strongly objects to the use of mathematical models for projecting excess mortality estimates in view of the availability of authentic data.”

India’s health ministry says New Delhi 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 Ministry adds.

India had also informed WHO that in view of the availability of authentic data published through Civil Registration System (CRS) by Registrar General of India (RGI), mathematical models should not be used for projecting excess mortality numbers for India.

The Ministry’s says India has consistently questioned WHO’s own admission that data in respect of seventeen Indian states was 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, the Ministry adds.

The data released by the Civil Registration System (CRS) report-2020 under the aegis of the office of Registrar General of India (RGI) was shared with WHO for preparation of excess mortality report.

“Despite communicating this data to WHO for supporting their publication, WHO for reasons best known to them conveniently chose to ignore the available data submitted by India and published the excess mortality estimates for which the methodology, source of data, and the outcomes has been consistently questioned by India,” the Ministry adds.

WHO says excess mortality is calculated as the difference between the number of deaths that have occurred and the number that would be expected in the absence of the pandemic based on data from earlier years.

Excess mortality includes deaths associated with COVID-19 directly due to the disease or indirectly due to the pandemic’s impact on health systems and society. Deaths linked indirectly to COVID-19 are attributable to other health conditions for which people were unable to access prevention and treatment because health systems were overburdened by the pandemic.

According to WHO, most of the excess deaths (84 percent) are concentrated in South-East Asia, Europe, and the Americas. Some 68 percent of excess deaths are concentrated in just 10 countries globally. Middle-income countries account for 81 percent of the 14.9 million excess deaths – 53 percent in lower-middle-income countries and 28 percent in upper-middle-income countries – over the 24-month period, with high-income and low-income countries each accounting for 15 percent and 4 percent, respectively.

WHO says the estimates for a 24-month period – 2020 and 2021 – include a breakdown of excess mortality by age and sex. They confirm that the global death toll was higher for men than for women – 57% male and 43% female – and higher among older adults. The absolute count of the excess deaths is affected by the population size. The number of excess deaths per 100,000 gives a more objective picture of the pandemic than reported COVID-19 mortality data.

“These sobering data not only point to the impact of the pandemic but also to the need for all countries to invest in more resilient health systems that can sustain essential health services during crises, including stronger health information systems,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “WHO is committed to working with all countries to strengthen their health information systems to generate better data for better decisions and better outcomes.”

“Measurement of excess mortality is an essential component to understand the impact of the pandemic. Shifts in mortality trends provide decision-makers information to guide policies to reduce mortality and effectively prevent future crises. Because of limited investments in data systems in many countries, the true extent of excess mortality often remains hidden,” said Dr Samira Asma, Assistant Director-General for Data, Analytics and Delivery at WHO. “These new estimates use the best available data and have been produced using a robust methodology and a completely transparent approach.”

Dr Ibrahima Socé Fall, Assistant Director-General for Emergency Response said: “Data is the foundation of our work every day to promote health, keep the world safe, and serve the vulnerable. We know where the data gaps are, and we must collectively intensify our support to countries, so that every country has the capability to track outbreaks in real-time, ensure delivery of essential health services, and safeguard population health.”

The production of these estimates is a result of a global collaboration supported by the work of the Technical Advisory Group for COVID-19 Mortality Assessment and country consultations.

This group, convened jointly by the WHO and the United Nations Department of Economic and Social Affairs (UN DESA), consists of many of the world’s leading experts, who developed an innovative methodology to generate comparable mortality estimates even where data are incomplete or unavailable.

This methodology has been invaluable as many countries still lack capacity for reliable mortality surveillance and therefore do not collect and generate the data needed to calculate excess mortality. Using the publicly available methodology, countries can use their own data to generate or update their own estimates.

“The United Nations system is working together to deliver an authoritative assessment of the global toll of lives lost from the pandemic. This work is an important part of UN DESA’s ongoing collaboration with WHO and other partners to improve global mortality estimates,” said Liu Zhenmin, United Nations Under-Secretary-General for Economic and Social Affairs.

Stefan Schweinfest, Director of the Statistics Division of UN DESA, added: “Data deficiencies make it difficult to assess the true scope of a crisis, with serious consequences for people’s lives. The pandemic has been a stark reminder of the need for better coordination of data systems within countries and for increased international support for building better systems, including for the registration of deaths and other vital events.”