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'Methodology Questionable': India as WHO Claims 4.7M Excess Deaths in 2020-21

The Union Health Ministry has rebutted WHO's use of a mathematical model to calculate the number of COVID-19 deaths,

Updated
COVID-19
5 min read
'Methodology Questionable': India as WHO Claims 4.7M Excess Deaths in 2020-21
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The World Health Organization (WHO) on Thursday, 5 May, said India witnessed 4.7 million "excess" COVID-19 deaths, which is 10 times the official value. India, it said, accounted for a third of COVID-19 deaths worldwide. WHO also said that globally COVID-19 led to the death of nearly 15 million people, which is 9.5 million more deaths than the officially reported count.

Meanwhile, the Union Health Ministry has rebutted WHO's use of a mathematical model to calculate the number of COVID-19 deaths, saying that the "figure is totally removed from reality."

The health ministry further said that India has an "extremely robust" system of births and deaths registration and called the WHO's system of data collection "statistically unsound and scientifically questionable".

"India has consistently questioned WHO's own admission that data in respect of seventeen Indian states was obtained from some websites and media reports and was used in their mathematical model," the Ministry of Health and Family Welfare said.
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"This reflects a statistically unsound and scientifically questionable methodology of data collection for making excess mortality projections in case of India," the statement added. "Despite India's objection to the process, methodology and outcome of this modelling exercise, WHO has released the excess mortality estimates without adequately addressing India's concerns," the ministry said.

"Throughout the process of dialogue, engagement, and communication with WHO, WHO has projected different excess mortality figures for India citing multiple models, which itself raises questions on the validity and robustness of the models used," the statement read.

"Despite communicating this data to WHO for supporting 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".

According to the data shared by the Ministry of Health and Family Welfare, COVID-19 was responsible for 1,48,994 deaths in 2020. The number increased to 3,32,492 in 2021.

What Did the WHO Report Say?

WHO said that the excess deaths occurred as several countries did not count COVID-19 deaths properly. Only 5.4 million deaths were reported as COVID deaths across the world. According to a report in BBC, the figure is 13 percent more than the normal statistic expected for over two years.

In its report, WHO said, "Excess mortality is calculated as the difference between the number of deaths that have occurred and the number that would be expected in the absence of the pandemic based on data from earlier years".

"Excess mortality includes deaths associated with COVID-19 directly (due to the disease) or indirectly (due to the pandemic's impact on health systems and society). Deaths linked indirectly to COVID-19 are attributable to other health conditions for which people were unable to access prevention and treatment because health systems were overburdened by the pandemic," the report read.

AIIMS Director Randeep Guleria Objects to WHO's Claim

Meanwhile, AIIMS Director Randeep Guleria, too, objected to WHO's claim on COVID-19 deaths in India.

"I have objections and I'll give three reasons for that. One, India has a very robust system of birth and death registration which has been going on for decades, we know it works very well and that data is available."

"That data should be used to see the number of excess deaths that happened during this time and excess deaths that could be attributable to COVID. WHO didn't use that data. Secondly, data that WHO used is more on hearsay evidence, what's there in media or unconfirmed sources," he further said.

"That data is questionable. Modelling on that data isn't correct and scientifically right thing to do, especially when you have data that is more robust. Third, India has been very liberal in offering compensation for people who died of COVID, that's there in a very open manner."

"So, even if there were excessive deaths that were COVID related, they would have been recorded because people would have come forward, and their relatives would have come forward for compensation. This has not been the case as far as the numbers that WHO is predicting. So, the prediction seems to be way beyond what actual numbers are and is based on data that is not substantiated. That is why I think that this is something which we, as a country, should object to and we need to present our data which is scientific and more on an evidence basis," he added.

'What Can Be Considered as a COVID Death?': ICMR DG

In response to WHO's claim, Dr Balram Bhargava, director-general (DG) of the Indian Council of Medical Research (ICMR) questioned as to what could be considered a COVID-19 death.

He asked that if a person died two weeks after getting tested positive, will the death be considered a COVID death?

"When we had COVID deaths occurring, we didn't have a definition of deaths, even WHO didn't have one," Bhargava pointed out.

"If one gets positive today and dies after two weeks – will it be COVID death, or after two months, six months – will it be COVID death?" Dr Bhargava asked, news agency ANI reported.

As per WHO's claim, the ICMR has looked at large amounts of data and arrived at the conclusion that 95 percent of the deaths that "occurred after testing positive for COVID-19 were occurring in the first four weeks," he stated.

He claimed that they had data of more than 97-98 percent of the 1.3 billion people who have been vaccinated with the first dose, reported ANI.

"A cut-off of 30 days was laid for the definition of death," he continued.

He further said that "190 crore vaccine doses" have been administered and the data has been "systematically collected".

"Once we have this systematic data, we do not need to rely on modelling, extrapolations and taking press reports and utilising them for putting into a modelling exercise," he added.

Background

Earlier, the Health Ministry had issued a statement on 17 April, in response to The New York Times' report on India's COVID-19 death toll, saying that the methodology applied by the WHO to estimate mortality figures was "flawed" and "fails to take into account the vast geographical size and population of the country".

The NYT article titled India Is Stalling WHO's Efforts to Make Global COVID Death Toll Public said that the global health agency believed the country's toll was at least four million, and not 5,20,000, as stated by Prime Minister Narendra Modi.

The Health Ministry said that it had raised concerns with the WHO over its 'one size fits all' model that was applicable for countries with a smaller population, such as Tunisia, but not for a country of 1.3 billion people.

"India's basic objection has not been with the result (whatever they might have been), but rather the methodology adopted for the same," the ministry had said in its statement.

(With inputs from BBC and ANI.)

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