India is halting WHO’s efforts to make Covid’s global deaths public

Ambitious efforts by the World Health Organization to calculate the number of deaths worldwide from the coronavirus pandemic have found that significantly more people have died than previously thought – a total of about 15 million by the end of 2021, more than twice the official total six million reported by the states separately.

But the publication of the stunning estimate – the result of more than a year of research and analysis by experts around the world and the most comprehensive view of pandemic mortality to date – has been delayed for months due to objections from India, which disputes estimates of how many died. tries to prevent this from becoming public.

More than a third of the additional nine million deaths are thought to have occurred in India, where the government of Prime Minister Narendra Modi has maintained its own figure of about 520,000. The WHO will show that the country’s victims are at least four million, according to people familiar with the numbers, who were not authorized to disclose them, which would give India the highest number in the world, they said. The Times failed to learn the forecasts for other countries.

The WHO calculation combines national data on reported deaths with new information from localities and household surveys, as well as statistical models that aim to account for missed deaths. Most of the difference in the new global assessment is untold deaths, most of which are directly from Covid; the new number also includes indirect deaths, such as those of people who do not have access to care for other diseases due to the pandemic.

The delay in the release of figures is significant, as global data are essential for understanding how the pandemic unfolded and what steps could be taken to mitigate such a crisis in the future. This has created turmoil in the normally stable world of health statistics – a feud disguised in anodic language is being played out at the UN Statistical Commission, the world’s leading data collection organization, driven by India’s refusal to cooperate.

“This is important for global accounting and the moral obligation to the dead, but it is also important and very practical. If there are subsequent waves, then really understanding the total number of deaths is key to knowing if vaccination campaigns work, “said Dr. Prabhat Ja, director of the Center for Global Health Research in Toronto and a member of the expert WHO working group. calculation of excess death. “And that’s important for accountability.”

To try to take the real measure of the pandemic’s impact, the WHO has assembled a collection of experts, including demographers, public health experts, statisticians and data scientists. The Technical Advisory Group is known to be cooperating from different countries to try to gather the most complete account of the pandemic dead.

The Times spoke to more than 10 people familiar with the data. The WHO planned to release the data in January, but publication was constantly delayed.

Recently, several members of the group warned the WHO that if the organization does not release the figures, experts will do it themselves, said three people familiar with the matter.

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

Dr Samira Asma, WHO Assistant Director-General for Data, Analysis and Impact Assistance, which helps guide calculations, said the publication of the data was “slightly delayed”, but said it was “because we wanted to be sure everyone is consulted. “

India insists that the WHO methodology is wrong. “India believes the process was neither joint nor sufficiently representative,” the government said in a statement to the UN Statistical Commission in February. He also claims that the process does not “contain scientific rigor and rational control, as expected by an organization with the status of the World Health Organization.”

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

India is not alone in under-reporting pandemic deaths: new WHO figures also reflect under-reporting in other populated countries such as Brazil and Indonesia.

Dr Asma noted that many countries have struggled to calculate the exact impact of the pandemic. Even in the most advanced countries, she said, “I think when you look under the hood, it’s a challenge.” At the start of the pandemic, there were significant differences in how quickly the various U.S. states reported deaths, she said, and some were still collecting data by fax.

India has brought in a large team to review the analysis of WHO data, she said, and the agency was happy to get them to do so because it wanted the model to be as transparent as possible.

India’s work on vaccination has garnered 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 calamity”. A few months later, his health minister announced that the country was “at the end of the Covid-19 game.” Complacency ensued, leading to erroneous steps and attempts by employees to silence critical voices in elite institutions.

Science in India is becoming increasingly politicized during the pandemic. In February, India’s junior health minister criticized a study published in the journal Science that found the number of deaths in the country from Covid was 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 4 million deaths in India.

“Personally, I’ve always thought that science has to answer with science,” said Bhramar Mukherjee, a professor of biostatistics at the University of Michigan’s School of Public Health who works with the WHO to review the data. “If you have an alternative assessment that is through rigorous science, you just have to do it. You can’t just say, “I won’t accept it.”

India has not provided its total mortality figures to the WHO for the past two years, but the organization’s researchers used numbers collected from at least 12 states, including Andhra Pradesh, Chhattisgarh and Karnataka, which experts say show at least four to five times more. deaths as a result of Covid-19.

John 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 the initial presentation of WHO global data was ready in December.

“But then India was not happy with the estimates. So we did all sorts of sensitivity analyzes afterwards, the newspaper is actually much better because of that wait, because we went too far with model checks and we did as much as we could, given the available data, ”said Dr. Wakefield. “And we’re ready to go.”

The figures represent what statisticians and researchers call “excessive mortality,” the difference between all deaths that would be expected to occur under normal circumstances. WHO estimates include those deaths directly from Covid, deaths due to conditions complicated by Covid, and deaths from those who did not have Covid but needed treatment they could not receive due to the pandemic. The calculations also take into account expected deaths that did not occur due to Covid’s limitations, such as those from road accidents.

Calculating redundant deaths worldwide is a complex task. Some countries have closely monitored mortality figures and provided them immediately to the WHO. Others provided only partial data and the agency had to use modeling to complete the picture. In addition, there are a large number of countries, including almost all in sub-Saharan Africa, that do not collect deaths and for which statisticians had to rely entirely on modeling.

Dr. Asma of the WHO noted that nine out of 10 deaths in Africa and six out of 10 worldwide have not been reported and more than half of the world’s countries do not collect the exact causes of death. This means that even the starting point for this type of analysis is a “guess”, she said. “We have to be modest about it and say we don’t know what we don’t know.

To prepare mortality estimates for countries with partial or no mortality data, the experts in the advisory group used statistical models and made forecasts based on country-specific information, such as mitigation measures, historical disease levels, temperature and demographics, to collect national data and, hence, regional and global estimates.

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

Russia’s Ministry of Health reported 300,000 deaths from Covid by the end of 2021, a number the government gave to the WHO. But the Russian National Statistics Agency, which is fairly independent of the government, found an over-death rate of more than one million people, a figure reportedly close to that of the WHO project. Russia has objected to the issue, but has made no effort to delay the release of the data, group members said.

China, where the pandemic began, has not made public deaths, and some experts have raised questions about lowering the number of deaths, especially at the start of the epidemic. China has officially reported less than 5,000 deaths from the virus.

Although China has indeed kept the number of cases at much lower levels than most countries, it has done so in part through some of the world’s most severe blockades – which have had their own impact on public health. One of the few internally-studied studies of over-mortality in China conducted by a group of government researchers found that deaths from heart disease and diabetes had risen in Wuhan during the city’s two-month blockade. Researchers said the increase was most likely due to an inability or unwillingness to seek help in hospitals. They concluded that the overall mortality rate in Wuhan was about 50 percent higher than expected in the first quarter of 2020.

India’s efforts to delay the publication of the report make it clear that the pandemic data is a sensitive issue for the Modi government. “This is an unusual step,” said Anand Krishnan, a professor of public medicine at the All India Institute of Medical Sciences in New Delhi who also works with the WHO to review the data. “I don’t remember a moment when he did it in the past.”

Ariel Karlinsky, an Israeli economist who built and maintained the global mortality data set and works with the WHO on the figures, said they are a challenge for governments when they show high mortality. “I think it is very reasonable for the people in power to be afraid of these consequences.

Vivian Wang contributed to the reporting.

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