Even though, the Indian government has refuted the World Health Organization’s (WHO) report stating underestimation of COVID-19 deaths in the country, public health experts argue that the absence of reliable registration of COVID-19 deaths in India has prevented proper assessment and monitoring of the pandemic so far.
A report by the WHO released last week claimed that there were an estimated 4.7 million deaths in India in 2020 and 2021, directly or indirectly attributable to the pandemic. The apex public health agency said that these numbers are the highest so far for any country and constitute around a third of the 15 million COVID-related deaths at the global scale.
This is in stark contrast to the official data from India. As of December 2021, India officially recorded around 4.8 lakh deaths related to COVID-19. As of May, India has officially over 5.2 lakh deaths. The WHO’s figure is around 10 times the government's tally.
India has however been consistently objecting to the methodology adopted by WHO to project excess mortality estimates based on mathematical models. India had also informed WHO that in view of the availability of authentic data published through Civil Registration System (CRS) by Registrar General of India (RGI), mathematical models should not be used for projecting excess mortality numbers for India.
Public health experts have also argued that the science behind the estimation may be taken subjectively.
“The COVID-19 excess death estimate for India by the WHO only falls within a range of estimates put forward by different studies, including some in peer-reviewed scientific journals and there is no reason to discredit it. Moreover, unlike what the government claimed, the model by WHO did use available sub-national data from India,” said Rijo John, Health Economist and Adjunct Professor at Rajagiri College of Social Sciences, Kochi.
“It is not as if a projection was done out of thin air. It is also incorrect to depend only on officially registered death data to assess the true scale of deaths from this pandemic as our death registration is not 100 per cent. According to the recent National Family Health Survey (round 5, 2019-21), only about 71 per cent of deaths in the last three years were registered. The pandemic may have disrupted those registrations even more,” he added.
According to a study published in the latest issue of the PLOS ONE journal, the absence of reliable registration of COVID-19 deaths in India has prevented proper assessment and monitoring of the Coronavirus pandemic. In addition, India’s relatively young age structure tends to conceal the severity of Covid-19 mortality, which is concentrated in older age groups, the study has said. Indian virologists too agree with the scientists doing studies on the COVID-19 deaths' estimation.
“I agree that WHO is more likely to be right on the numbers. Exact figures are always hard, but we know the issues with vital registration as well,” said Gagandeep Kang, noted microbiologist and virologist, who is the professor in the Department of Gastrointestinal Sciences at the Christian Medical College, Vellore.
The findings of the PLOS ONE study point to a death toll of approximately 3.2–3.7 million persons by early November 2021. Once India’s age structure is factored in, these figures correspond to one of the most severe cases of COVID mortality in the world. India had recorded after February 2021 the second outbreak of COVID-19 that had affected the entire country. The accuracy of official statistics of COVIS-19 mortality had been questioned, and the real number of deaths is thought to be several times higher than reported, the study argued.
“The results imply that only one out of 7–8 deaths appear to have been recorded as a COVID-19 death in India. The estimates also point to a very high mortality rate, which is even higher after age and sex standardisation,” the study said, recommending improved surveillance system to monitor the progression of the pandemic and its spread across India’s regions and social groups.
“A country as diverse as India requires complex models to make estimates accurately and without right input parameters, extrapolations can be misleading and often incorrect. Having said that, there is no doubt that research in the country around COVID-19 is lacking due to non-availability of reliable data sets and when institutions like WHO come up with a number, that becomes debatable,” said Himanshu Sikka, lead—health, nutrition and, water, sanitation and hygiene (WASH) at IPE Global, an international development consultancy.
“There are many factors where India may differ from rest of the world such as relatively younger population, highly dispersed and largely rural population and high levels of immunisation for vaccines like BCG, whose indirect impact on Covid-19 severity is also being researched globally,” Sikka said further, adding that there is some research also going on about the general prevalence of viral infections and the possibility of stronger immunity response in sets of population because of that. Given all this it becomes imperative that going forward India strengthens its own data capturing and research capabilities.
As far as the WHO estimates are concerned, India had pointed out the inconsistencies in the criteria and assumption used by WHO to classify countries into Tier I and II as well as questioned the very basis for placing India into Tier II countries (for which a mathematical modelling estimate is used). India had also argued the fact that given the accuracy of the mortality data collected through an effective and robust statutory system, India doesn’t deserve to be placed in Tier II countries. The WHO till date has not responded to India’s contention, the union health ministry said in a statement.
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