An ambitious effort by the World Health Organization to calculate the global death toll from the coronavirus pandemic has found that vastly more people died than previously believed – a total of about 15 million by the end of 2021, more than double the official total of six. million reported by countries separately.
But the publication of the staggering estimate — the culmination of more than a year of research and analysis by experts around the world and the most comprehensive look at the pandemic’s lethality to date — has been delayed for months amid objections from India, which are contesting the calculating the number of its citizens who have died and tried to prevent it from becoming public.
More than a third of the additional nine million deaths are estimated to occur in India, where Prime Minister Narendra Modi’s government has maintained its own count of about 520,000. The WHO will show the country’s toll is at least four million, according to people familiar with the numbers who were not authorized to release them, which would put India the highest number 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 places and household surveys, and with statistical models intended to account for missed deaths. Most of the difference in the new global estimate previously represents countless deaths, 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 conditions because of the pandemic.
The delay in releasing the numbers is significant as the global data is essential to understanding how the pandemic has evolved and what steps could mitigate a similar crisis in the future. It has caused turmoil in the normally sedate world of health statistics – a feud veiled in anonymous language is playing out at the United Nations Statistical Commission, the world’s health data collection agency spurred by India’s refusal to cooperate.
“It is important for global accounting and the moral obligation for those who have died, but also very practical. If there are subsequent waves, then a real understanding of the death toll is key to knowing whether vaccination campaigns are working,” said Dr. Prabhat Jha, director of the Center for Global Health Research in Toronto and member of the WHO’s Expert Support Working Group. deductible calculation. “And it’s important for accountability.”
To truly measure the impact of the pandemic, WHO has assembled a pool of specialists, including demographers, public health experts, statisticians and data scientists. The Technical Advisory Group, as is well known, has worked together in several countries to try to compile the most complete accounts of the pandemic deaths.
The Times spoke to more than 10 people familiar with the data. The WHO had planned to release the figures in January, but the release has been continually delayed.
Recently, some members of the group warned the WHO that if the organization does not release the figures, the experts themselves would, said three people familiar with the matter.
A spokeswoman for the WHO, Amna Smailbegovic, told The Times: “We aim to publish in April.”
dr. Samira Asma, WHO’s assistant director-general for data, analysis and delivery for impact, who is helping lead the calculation, said the data release was “slightly delayed” but said it was “because we wanted to make sure everyone is consulted.”
India insists the WHO’s methodology is flawed. “India believes the process was neither collaborative nor sufficiently representative,” the government said in a statement to the United Nations Statistical Commission in February. It also argued that the trial was not “scientifically scrutinized and rationally as expected from an organization with World Health Organization status”.
The Ministry of Health in New Delhi did not respond to requests for comment.
India is not alone in underestimating the number of pandemic deaths: The new WHO figures also reflect the undercount in other densely populated countries such as Brazil and Indonesia.
dr. Asma noted that many countries have struggled to accurately calculate the impact of the pandemic. Even in the most advanced countries, she said, “I think if you look under the hood, it’s a challenge.” At the start of the pandemic, there were significant differences in how quickly different U.S. states reported deaths, she said, and some were still collecting the data via fax.
India brought in a large team to review the WHO data analysis, she said, and the agency was happy they did because it wanted the model to be as transparent as possible.
India’s work on vaccination has received praise from experts around the world, but its public health response to Covid has been criticized for its overconfidence. Modi boasted in January 2021 that India had “saved humanity from a major disaster”. A few months later, his health minister stated that the country was “in the endgame of Covid-19”. Complacency set in, leading to missteps and attempts by officials to silence critical voices within elite institutions.
Science in India has become increasingly politicized over the course of the pandemic. In February, India’s health minister criticized a study published in the journal Science that estimated the death toll from Covid 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 the death toll in India at four million.
“Personally, I’ve always felt that science needs to be answered with science,” said Bhramar Mukherjee, a professor of biostatistics at the University of Michigan School of Public Health who has worked with WHO to review the data. “If you have an alternative estimate based on rigorous science, you just have to make it. You can’t just say, ‘I don’t accept it’.”
India has not submitted its overall death rates to the WHO in 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 are at least four to five times higher. are 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 a first presentation of WHO’s global data was ready in December.
“But then India was not happy with the estimates. So then we then did all kinds of sensitivity analysis, the paper is actually a lot better because of this wait, because we went overboard in terms of model checks and did as much as we could with the available data,” said Dr. Wakefield. “And we’re done.” 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 been expected under normal circumstances. The WHO’s calculations include those deaths directly caused by Covid, deaths of people due to Covid-complicated conditions, and deaths of those who did not have Covid but needed treatment that they could not get because of the pandemic. The calculations also take into account expected deaths that have not occurred due to Covid restrictions, such as those from road accidents.
Calculating excess deaths worldwide is a complex task. Some countries have closely monitored the death data and immediately provided it to the WHO. Others have only provided partial data and the agency had to use models to complete the picture. And then there are a large number of countries, including almost all countries in sub-Saharan Africa, which do not collect death data and for which the statisticians had to rely entirely on models.
dr. Asma of the WHO noted that nine out of 10 deaths in Africa, and six out of 10 worldwide, go unrecorded, and more than half of the world’s countries do not collect accurate causes of death. That means even the starting point for this kind of analysis is an “estimation,” she said. “We have to be humble about it and say we don’t know what we don’t know.”
To make mortality estimates for countries with partial or no mortality data, the experts in the advisory group used statistical models and made predictions based on country-specific information such as containment measures, historical morbidity rates, temperature and demographics to collect national figures and, from there, regional and global estimates.
Besides India, there are other major countries where the data is also uncertain.
The Russian Ministry of Health had reported 300,000 Covid deaths by the end of 2021, which was the number the government gave to the WHO. that’s reportedly close to that in the WHO’s draft. Russia has objected to that number, but it has made no effort to delay the release of the data, group members said.
China, where the pandemic began, is not disclosing death figures, and some experts have raised questions about underreporting of deaths, especially at the start of the outbreak. China has officially reported fewer than 5,000 deaths from the virus.
While China has indeed kept the number of cases at a much lower level than most countries, it has done so in part through some of the world’s strictest lockdowns – which have had their own impact on public health. One of the few studies examining excess mortality in China using internal data, conducted by a group of government researchers, found deaths from heart disease and diabetes increased during that city’s two-month lockdown in Wuhan. The researchers said the increase was most likely due to the inability or unwillingness to seek help in hospitals. They concluded that the overall death rate in Wuhan in the first quarter of 2020 was about 50 percent higher than expected.
India’s attempt to block the publication of the report makes it clear that pandemic data is a sensitive issue for the Modi government. “It’s an unusual move,” 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 it being like this in the past.”
Ariel Karlinsky, an Israeli economist who built and maintained the World Mortality Dataset and who worked on the numbers with the WHO, said they pose a challenge to governments when they show high death rates. “I think it is very sensible that those in power should be afraid of these consequences.”
Vivian Wang reporting contributed.