India’s government has rejected a new World Health Organization report that says the country’s death toll from COVID-19 is about 10 times higher than the official count, and the highest in the world.
How many lives were lost in India due to the pandemic has been a hotly contested subject. The study by WHO puts India’s COVID-19 death toll at 4.7 million through the end of 2021, while the government's tally puts the number at 481,000.
Other studies, including one by the medical journal Lancet, released last month, have said that India’s fatalities have been undercounted. They estimated the death toll at six to seven times higher than the official number.
The WHO’s estimate includes people who died either directly from COVID-19 or indirectly through the pandemic's wider impact on health systems.
But the government has slammed the methodology used and said that the WHO has published the excess mortality estimates "without adequately addressing India's concerns" or taking into account “authentic” data submitted by India.
The health and family welfare ministry said in a statement that the country's size, diversity and population of 1.3 billion meant the 'one size fits all' approach and model used by the United Nations body may not be applicable to India.
Experts however say the study should be taken seriously because the WHO numbers are more or less in line with independent estimates of undercounting in India.
“The modelling systems used for these studies are fairly standard and if the Indian government had a rebuttal, they should provide their argument for rejecting them,” says Gautam Menon, professor of Biology and Physics at India’s Ashoka University and a mathematical modelling expert. “They have not been very specific but only said that the country’s mechanisms for recording deaths are very good.”
Others point out that even recent data made public by the Indian government suggests a higher death toll compared to official numbers. This week the government released data showing 8.1 million excess deaths in 2020 -- that is 6% higher or about half a million more deaths compared to the previous year. In 2020, India counted 149,000 deaths due to COVID-19.
Excess deaths are a measure of how many more people died than expected compared with previous years.
The government has however said the higher numbers of deaths in 2020 could not be attributed to the pandemic. “There is a public narrative in the media, based on various modelling estimates, that India’s COVID-19 deaths are many times the reported figure - that's not the case in reality," V.K. Paul, a top health official spearheading India’s fight against the pandemic, told state television. He said modelling can lead to “overestimation, absurd estimation.”
Indian health officials have consistently maintained that the country’s total infections and death toll as a proportion of its massive population were lower than those in many countries, including developed nations and said that this underlined the country’s success in battling the pandemic.
But experts underline the need to estimate accurate numbers.
“I don’t know why they are so exceptionally stubborn and are digging their heels in on the question of deaths due to the pandemic,” says Prabhat Jha, director of the Centre for Global Health Research in Toronto, and a member of the expert working group supporting the WHO’s excess death calculation. “Every government does not want bad news. But India has done very well in areas such as its vaccination program. Accurate mortality data would only help judge how this program has helped reduce mortality.”
Through April 2022, India has reported 524,000 COVID-19 deaths and 43 million infections -- the highest numbers after the United States and Brazil.
India is not the only country where the death toll was underestimated, according to the WHO report. It says countries such as Indonesia and Egypt had the same problem.
“There is information that was collated from government data itself of a large number of excess deaths particularly during the deadly Delta [variant] wave last year,” points out Menon. “This suggests there may have been similar undercounting throughout the pandemic.”
As the health system in many parts of the country buckled during the Delta wave, there had been reports of mass cremations as crematoriums overflowed with COVID victims and bodies washing up in the Ganges River, which local media reports said could be people who died after getting the virus.
Menon however cautions that there could be a margin of error in the studies on India’s death toll – he estimates the number may have been closer to 3 million.
Experts point out that India’s issue with counting deaths from COVID-19 is partly rooted in a longstanding problem – the cause of many of the deaths in India is often not accurately classified. For example, a death caused by respiratory problems after contracting the infection may not be attributed to the virus.
Two-thirds of the more than 1.3 billion people live in villages where there are few hospitals and health systems are inadequate.
But proper mortality data, say experts, would only help in framing policies to improve health care systems.
“Counting the dead due to the pandemic would help the living. It’s a social responsibility to know where we are going with this health crisis,” says Jha. “Why should we battle COVID blindfolded?”