Estimation of COVID-19's excess deaths by WHO and concerns of India.

• The World Health Organisation (WHO) was set to release an estimate of excess deaths during the pandemic period the world over
• The report had been delayed for months because of objections from the Indian government.
• The report is expected to show at least 4 million excess deaths in India, the highest such tally for any country in the world
• The Indian government responded to the report saying its basic objection to the report centred on the "methodology" adopted for the "same".

Excess deaths

• The excess deaths approach to calculating mortality 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 deaths due to the disease and those that occurred because of the pandemic overwhelming health systems among others.

Status of India regarding excess deaths

The corresponding figure for India is 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.

• There is substantial variation in registration and certification across States in India.
• Besides there is variation in the online availability of death registration numbers and there is also a significant variation in the delay in registration of deaths across States.

How excess deaths are measured

• Developed countries: 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, for instance, have near 100% registration of deaths with the cause of mortality known in every case, enabling excess deaths to be known in near real time.
• Developing countries: for countries like India, calculating excess deaths is not an easy task.
• The best way to do it is to individually calculate excess deaths for States with near 100% registration (based on a proper baseline for comparison) and to use suitable models to extrapolate deaths from limited data in others

Findings by the WHO and the methodology used for it

• The WHO has not released the final report as yet.
• But the report in The New York Times says that the excess deaths estimated by the WHO in India exceeded 4 million, nearly eight times the reported death toll of more than 5.2 lakh.
• Explaining the methodology in an extract from the unreleased WHO report, the authors of the report write that they based their estimates on all-cause mortality data from 17 States and one Union Territory in India.
• They used this approach using data from subnational regions in Argentina, China, Indonesia and Turkey as well, where national all-cause mortality data was not available.
• They then estimate the total number of excess deaths for the country by looking at the variations in the subnational level and their contributions to the overall death toll before the pandemic and the data for these subregions during the pandemic.

Why is the Indian government dismissive of the report?

• The Ministry of Health and Family Welfare stated it was concerned as to how the statistical model projects estimates for a country of geographical size and population of India also fits in with other countries which have smaller populations
• Such a one-size-fits-all approach and models which are true for smaller countries may not be applicable to India
• 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
• The Ministry also claims that the data published in the newspapers were “unverified”, though these were data that was accessed through various means, including Right to Information requests from the Civil Registration System for States for whom this data was available

Exam Track

Prelims Takeaway

• Excess Deaths

Mains Track

Q. Discuss about excess deaths and the related report on it by the WHO. Also mention about the objections raised by the Indian Government on it.