India Is Stalling the W.H.O.’s Efforts to Make 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 many more people have died than previously believed: a total of around 15 million by the end of 2021, more double the official total of six million. reported by individual countries.

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, was delayed for months due to objections. from India, which disputes the estimate of how many of its citizens died and has tried to prevent it from being made public.

More than a third of the nine million additional deaths are estimated to have occurred in India, where Prime Minister Narendra Modi’s government has maintained its own count of around 520,000. The WHO will show that the number of victims in the country is at least four million, according to people familiar with the figures who were not authorized to release them, which would give India the highest figure in the world, they said. The Times was unable to see estimates for other countries.

The WHO calculation combined national data on reported deaths with new information from localities and household surveys, and with statistical models that aim to account for missed deaths. Most of the difference in the new global estimate represents previously uncounted deaths, most of which were directly from Covid; the new figure also includes indirect deaths, such as those of people unable to access care for other ailments because of the pandemic.

The delay in releasing the figures is significant 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 confusion in the normally staid world of health statistics: A dispute shrouded in bland language is playing out at the United Nations Statistical Commission, the world body that collects health data, spurred by India’s refusal to cooperate. .

“It is important for global accounting and the moral obligation to those who have died, but it is also very important in practice. If there are subsequent waves, really understanding total deaths is key to knowing if vaccination campaigns are working,” said Dr. Prabhat Jha, director of the Center for Global Health Research in Toronto and a member of the experts who support the WHO. overestimation of death. “And it’s important for accountability.”

To try to take the true measure of the impact of the pandemic, the WHO brought together a collection of specialists that includes demographers, public health experts, statisticians and data scientists. The Technical Advisory Group, as it is known, has been collaborating across countries to try to put together the most complete count of those killed by the pandemic.

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

Recently, some members of the group warned the WHO that if the organization did not release the figures, the experts would do so themselves, three people familiar with the matter said.

A WHO spokeswoman, Amna Smailbegovic, told The Times: “Our goal is to publish in April.”

Dr. Samira Asma, assistant director-general for data, analysis and impact delivery at the WHO, who is helping to lead the calculation, said the release of the data has been “a bit delayed” but said it was “because we wanted to make sure everyone is consulted.”

India insists that the WHO methodology is flawed. “India feels that the process was not collaborative or adequately representative,” the government said in a statement to the United Nations Statistical Commission in February. He also argued that the process did not “have the scientific rigor and rational scrutiny expected from an organization of the stature of the World Health Organization.”

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

India is not alone in undercounting pandemic deaths: The new WHO figures also reflect undercounting in other populous countries such as Brazil and Indonesia.

Dr. Asma noted that many countries have had difficulty accurately estimating 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 US states were reporting deaths, he said, with some 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 it wanted the model to be as transparent as possible.

India’s work on vaccination has drawn 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 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 junior health minister criticized a study published in the journal Science that estimated the number of Covid deaths 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 have always felt that science has to answer with science,” said Bhramar Mukherjee, a professor of biostatistics at the University of Michigan School of Public Health, who has been working with the WHO to review the data. “If you have an alternative estimate, which is through rigorous science, you just have to produce it. You can’t just say, ‘I’m not going to accept it.

India has not submitted its total mortality data to the WHO for the past two years, but the organization’s researchers have used numbers collected from at least 12 states, including Andhra Pradesh, Chhattisgarh and Karnataka, which experts say show at least four or five times more deaths 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 the WHO global data was ready in December.

“But then India was not happy with the estimates. So subsequently we did all sorts of sensitivity analyses, the paper is much better because of this wait, because we’ve gone overboard in terms of model checking and doing as much as we can with the available data,” said Dr. Wakefield. “And we are 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 be expected to occur under normal circumstances. The WHO estimates include deaths directly from covid, deaths of people due to conditions complicated by covid, and deaths of those who did not have covid but needed treatment that they were unable to obtain due to the pandemic. The calculations also take into account 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 have been closely monitoring mortality data and promptly providing it to the WHO. Others have provided only partial data, and the agency has had to use models to fill in the picture. And then there are a host of countries, including almost all of sub-Saharan Africa, that do not collect death data and for which statisticians have had to rely entirely on models.

WHO’s Dr. Asthma noted that nine out of 10 deaths in Africa and six out of 10 globally are unrecorded, and more than half of the world’s countries do not collect precise 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 partial or no death data, experts on the advisory group used statistical modeling and made predictions based on country-specific information such as containment measures, historical disease rates, temperature, and demographics to gather numbers. national and, from there, regional and global estimates.

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

The Russian Ministry of Health had reported 300,000 Covid deaths 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 of more than a million people, a figure reportedly close to that of the WHO draft. Russia has objected to that number but has made no effort to stop the data from being released, members of the group said.

China, where the pandemic began, does not make mortality data public, and some experts have raised questions about underreporting of deaths, especially early in the outbreak. China has officially reported fewer 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 strictest lockdowns, 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 rose in Wuhan during that city’s two-month lockdown. The researchers said the increase was most likely due to inability or reluctance to seek help from hospitals. They concluded that the overall death rate in Wuhan was about 50 percent higher than expected in the first quarter of 2020.

India’s effort to stop the report from being released 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 has also been working with the WHO to review the data. “I don’t remember a time when I’ve done it in the past.”

Ariel Karlinsky, an Israeli economist who built and maintains the World Mortality Data Set and who has been working with the WHO on the figures, said they are a challenge for governments when they show high excess deaths. “I think it’s very sensible for people in power to fear these consequences.”

viviana wang contributed report.

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