India at odds with WHO over Covid tally

Covid-19 could have killed as many as 4.7 million people in India in 2020 and 2021, either due to infection or through its indirect impact, said the World Health Organisation (WHO) last week.

The figure, disputed by the Indian government, is nearly 10 times the country's official Covid death toll of 481,000 at end-2021.

WHO also suggested that India accounts for almost one-third of Covid deaths globally.

In its report on Covid-related excess deaths, WHO said an estimated 15 million people were likely to have died globally, from direct or indirect impact of the virus, in the first two years of the pandemic - instead of the 5.4 million recorded by countries.

WHO estimated about 830,000 deaths in India in 2020 alone.

The numbers came two days after India released its annual data for registration of births and deaths for 2020 - recorded in its civil registration system (CRS) - which showed about 475,000 more deaths than in previous years - consistent with the trend of rising registrations.

The CRS does not record cause-specific mortality.

"Essentially, Indian death rates from Covid were not exceptionally low, only exceptionally under-counted," said Dr Prabhat Jha, director of Centre for Global Health Research in Toronto and a member of the expert working group supporting WHO's excess death calculation.

Three peer-reviewed studies found that India's deaths from the pandemic by September 2021 were "six to seven times higher than reported officially". But the Indian government has repeatedly objected to the process and methodology adopted by WHO to calculate the excess deaths, and have sent at least 10 letters to the global organisation in this regard.

Last week, the Indian government said: "WHO has released the excess mortality estimates without adequately addressing India's concerns." The authorities described the WHO report as "fallacious, ill-informed and mischievous in nature" and alleged that the methodologies and sampling sizes were flawed.

According to WHO, the deaths linked indirectly to Covid are those that happened due to conditions for which people were unable to access treatment because the health systems were overburdened by the pandemic. It also accounts for fewer deaths due to road accidents and other events when lockdowns were in place.

"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 WHO Director-General Tedros Adhanom Ghebreyesus.

But India's Health Ministry said: "Despite communicating the (CRS) data to WHO... for 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."

Mr Bhramar Mukherjee, a professor of biostatistics and epidemiology at the University of Michigan, finds India's stubborn insistence on the veracity of its official pandemic toll baffling.

"Data paucity and data opacity have been the hallmarks of the pandemic in India, There is often an insular, nonchalant arrogance about not improving data quality or making data available," he told the BBC.

Researchers say India should incentivise reporting of death and improve the civil registration system, medical certification and data. India could also crowdsource deaths data through modern machine learning and community health workers and from sources such as inactive biometric identity cards and cell phone records.

One way India could get a fairly quick grip on the number of people who died of Covid would be to add a simple question to the upcoming census: Was there a death in your household since Jan 1, 2020? If yes, please tell us the age and sex of the deceased and the date of death.

"This would provide a direct estimate of excess deaths during the pandemic," Dr Jha said. Indo-Asian News Service

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