India is blocking WHO efforts to make the global Covid death toll public

An ambitious effort by the World Health Organization to calculate the global death toll from the coronavirus pandemic found that far more people have died than previously believed, totaling around 15 million by the end of 2021, more than the 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 from around the world and the most comprehensive look at the lethality of the pandemic to date – has been delayed for months due to India’s objections. , which disputes the calculation of how many of its citizens have died and has tried not to make it 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 met its tally of around 520,000. WHO will show that the country’s budget is at least four million, according to people familiar with the numbers they are not allowed to disclose, which would give India the highest tally 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 locality and household surveys and with statistical models that aim to account for lost deaths. Most of the difference in the new global estimate represents previously uncounted deaths, most of which came directly from Covid; the new number also includes indirect deaths, such as those of people unable to access treatment for other ailments due to the pandemic.

The delay in publishing the figures is significant because global data is essential for understanding how the pandemic unfolded and what measures could mitigate a similar crisis in the future. It has created turmoil in the normally calm world of health statistics: a feud cloaked in anodyne language is taking place at the United Nations Statistical Commission, the global body that collects health data, spurred on by India’s refusal to cooperate.

“It is important for global accounting and moral obligation to those who have died, but also very practical. If there are successive waves, really understanding total death is the key to knowing if vaccination campaigns are working, “said Dr. Prabhat Jha, director of the Center for Global Health Research in Toronto and member of the expert working group. which supports the WHO excess mortality calculation. “And it’s important for accountability.”

To try and take the real measure of the impact of the pandemic, WHO has 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 across countries to try to put together the most comprehensive account of the dead pandemic.

The Times spoke to more than 10 people familiar with the data. WHO had planned to release the numbers in January, but the release has been ongoing rejected.

Recently, some members of the panel warned WHO that if the organization didn’t release the data, the experts would do it on their own, three people familiar with the matter said.

A WHO spokesperson, Amna Smailbegovic, told the Times: “We aim to publish in April.”

Dr Samira Asma, WHO Deputy Director-General for Data, Analysis and Delivery for Impact, who is helping to drive the calculation, said the release of the data was “slightly delayed”, but said that it was “because we wanted to make sure everyone was consulted”.

India insists that the WHO methodology is flawed. “India believes the process was neither collaborative nor adequately representative,” the government said in a statement to the UN Statistical Commission in February. He also said the trial did not “hold the scientific rigor and rational control as expected by an organization of the stature of the World Health Organization.”

The New Delhi Ministry of Health did not respond to requests for comment.

India isn’t alone in underestimating pandemic deaths – the new WHO numbers also reflect underestimation in other populous countries like 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, you said: “I think when you look under the hood it’s a challenge.” At the start of the pandemic, there were significant disparities in the rate at which different states in the United States reported deaths, she said, and some were still collecting the data by fax.

India brought in a large team to review WHO data analysis, he said, and the agency was happy to do so, because they wanted the model to be as transparent as possible.

India’s work on vaccination has received praise from experts globally, but its public health response to Covid has been criticized for being over-secure. 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”. Compliance established, leading to missteps Other Attempts by officials to silence critical voices within elite institutions.

Science in India was increasingly politicized during the pandemic. In February, the young Indian health minister criticized a study published in the journal Science which estimated the country’s Covid death toll to be seven to eight times the official number. in March, questioned the government the methodology of a study published in The hand who estimated India’s deaths at four million.

“Personally, I’ve always thought that science has to be solved with science,” said Bhramar Mukherjee, a professor of biostatistics at the University of Michigan School of Public Health who worked 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 hasn’t submitted its total mortality data to WHO for the past two years, but the organization’s researchers used numbers 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 from 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 wasn’t happy with the estimates. So we then ran all sorts of sensitivity analyzes, the paper is actually a lot better because of this wait, because we went overboard in terms of checking the model and doing everything possible given 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 have occurred and those that would have occurred under normal circumstances. WHO’s calculations include those deaths directly from Covid, deaths of people due to conditions complicated by Covid and the deaths of those who did not have Covid but needed treatment they could not get due to the pandemic. The calculations also take into account the expected deaths that did not occur due to Covid restrictions, such as those from road accidents.

Calculating excess deaths globally is a complex task. Some countries closely tracked mortality data and promptly provided it to WHO Others provided only partial data and the agency had to use modeling to complete the picture. And then there is a large number of countries, including nearly all of those in sub-Saharan Africa, that do not collect data on deaths 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 globally are not registered and more than half of the world’s countries do not collect accurate causes of death. This means that the starting point for this type of analysis is also an “estimate”, she 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 partial or no death data, the advisory group’s experts used statistical models and made predictions based on country-specific information such as containment measures, historical disease rates, temperature and demographics to assemble data. national and, from there, regional and global estimates.

Besides India, there are other large countries where the data is also uncertain.

The Russian health ministry had reported 300,000 deaths from Covid by the end of 2021, and this was the number the government provided to WHO. which is reportedly close to that in the WHO draft. Russia opposed that number, but made no effort to block the release of the data, group members said.

China, where the pandemic began, does not publicly release mortality data and some experts have raised doubts about the underestimation of deaths, especially at the beginning of the epidemic. China has officially reported fewer than 5,000 deaths from the virus.

While China has actually kept the workload at much lower levels than most countries, it has done so in part through some of the world’s toughest lockdowns, which have had their impact on public health. One of 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 that city’s two-month lockdown. The researchers said the increase was most likely due to an inability or reluctance to seek help in hospitals. They concluded that the overall death rate in Wuhan was about 50% higher than expected in the first quarter of 2020.

India’s effort to block the release of the report makes 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 also worked with WHO to review the data. “I don’t remember a time he did that in the past.”

Ariel Karlinsky, an Israeli economist who built and maintains the World Mortality Dataset and who worked with WHO on the data, said they are a challenge for governments when they show a high number of excess deaths. “I think it is very delicate for the people in power to fear these consequences.”

Vivian Wang contributed reportage.

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