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WHO’s Approach on Excess Deaths during the Pandemic

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April 25, 2022

What is the issue?

The WHO report estimates excess deaths during the pandemic period for which India has raised its objection.

What are the findings by the WHO?

  • The WHO report (not yet released) is expected to show at least 4 million excess deaths in India, the highest such tally for any country in the world.
  • The excess deaths approach considers the difference between the registered deaths before the pandemic and those during the pandemic period.
  • This gives a robust estimate of the true impact of the pandemic.
  • The findings are based on the estimates on all-cause mortality data from 17 States and one Union Territory in India.
  • It uses mortality figures directly obtained from Tier I set of countries and uses a mathematical modelling process for Tier II countries (which includes India).

How are excess deaths measured?

  • In most developed countries, death registration is full or nearly full and therefore, calculating excess deaths is relatively easier as deaths data are reliable and readily available.
  • Countries such as the U.S., the U.K., Italy and Germany have near 100% registration of deaths with the cause of mortality known in every case.
  • India’s case- In India, registration of deaths stands at 92% (as per the Annual Report on Vital Statistics of India based on Civil Registration System-2019) and only 20.7% of the deaths are medically certified.
  • Besides India witnesses several variations
    • Variation in registration and certification across States
    • Variation in the online availability of death registration numbers
    • Variation in the delay in registration of deaths across States
  • The best way to calculate excess deaths in India is to individually calculate excess deaths for States with near 100% registration and to use suitable models to predict deaths from limited data in others.

Why is the Indian government dismissive of the WHO findings?

  • India’s basic objection has not been with the result but rather the methodology adopted for calculating COVID-19 toll.
  • One-size-fits-all approach- The concern includes on how the models which are true for smaller countries like Tunisia is applicable to India.
  • Different estimates- It also said that the model gives two highly different sets of excess mortality estimates when using the data from Tier I countries and when using unverified data from 18 Indian States.
  • Validity- It raised concerns about validity and accuracy of such a modelling exercise.
  • Lack of scientific backing- The model assumes an inverse relationship between monthly temperature and monthly average deaths, which does not have any scientific backing to establish such peculiar empirical relationship.
  • Variations- Also, the variation in covid-19 positivity rate within the India was not considered for modeling purposes.
  • Quantification of containment measures- Quantifying various measures of containment is nearly impossible as the strictness of such measures have varied widely even among the States and Districts of India.
  • Unverified data- The Health Ministry also claims that the data published in the newspapers were unverified, though these were data that was accessed through Right to Information requests.
  • WHO’s stand- The authors of the WHO report emphasise that for India the global predictive covariate model is not used and so the estimates of excess mortality are based on data from India only.

 

References

  1. https://www.thehindu.com/news/cities/chennai/chen-health/explained-why-is-india-concerned-about-who-approach-on-excess-deaths-during-the-pandemic/article65348027.ece?homepage=true
  2. https://www.thehindu.com/news/national/india-objects-to-who-methodology-for-calculating-covid-19-toll/article65327583.ece
  3. https://www.livemint.com/news/india/india-objects-to-who-s-methodology-to-calculate-covid-19-death-toll-11650153706480.html

 

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