An ambitious effort by the World Health Organization to calculate the global death toll from the coronavirus pandemic has found far more deaths than previously thought – a total of about 15 million by the end of 2021, more than double the official total of six million. reported by countries individually.
But the release of the astonishing estimate – the result of more than a year of research and analysis by experts from around the world and a comprehensive look at how deadly the pandemic has so far – has been delayed for several months due to objections from India, which questions the count of how many of its citizens have died and has tried to prevent it from appearing on public.
It is estimated that more than a third of the additional nine million deaths have occurred in India, where Prime Minister Narendra Modi’s government stood by its tally of nearly 520,000 people. They said the World Health Organization would show the country’s death toll to be at least four million, according to people familiar with the numbers who were not authorized to disclose, which would give India the highest death toll in the world. The Times was unable to obtain estimates for other countries.
WHO accounts combined national data on reported deaths with new information from local and household surveys, and with statistical models intended to account for deaths that were not recorded. Most of the difference in the new global estimate accounts for previously unaccounted deaths, most of which were directly from Covid; The new figure also includes indirect deaths, such as cases of people unable to obtain care for other illnesses due to the pandemic.
The delay in releasing the numbers is important because global data is essential to understanding how the pandemic is spreading and what steps could mitigate a similar crisis in the future. It has wreaked havoc in the usually interconnected world of health statistics — a dispute hidden in soothing language is taking place at the United Nations Statistics Committee, the global body that collects health data, spurred on by India’s refusal to cooperate.
“It is important for global accountability and the moral obligation of those who died, but it is also important from a practical point of view. It is important for accountability,” said Dr. Prabhat Jha, director of the Center for Global Health Research in Toronto and a member of the expert working group supporting the World Health Organization.
In an effort to take the true measure of the pandemic’s impact, the World Health Organization has brought together a group of specialists including demographers, public health experts, statisticians and data scientists. The Technical Advisory Group, as it is known, is collaborating across countries to try to compile the most complete accounts of deaths from the pandemic.
The Times spoke with more than 10 people familiar with the data. The World Health Organization had planned to release the numbers in January, but the release was ongoing Pay for retreat.
Recently, a few members of the group warned the World Health Organization that if the organization did not release the numbers, experts would do so themselves, three people familiar with the matter said.
“We aim to publish in April,” WHO spokeswoman Amna Ismael Begovic told The Times.
Dr Samira Asma, WHO’s Assistant Director-General for Data, Analytics and Delivery for Impact, who helps lead the accounts, said the data release was “a little bit late” but said that was “because we wanted to make sure everyone was being consulted”.
India insists that the WHO’s methodology is flawed. “India feels that the process was neither cooperative nor sufficiently representative,” the government said in a statement to the United Nations Statistical Commission in February. He also argued that the process “was not subject to scientific rigor and rational scrutiny as would be expected of an organization of the stature of the World Health Organization.”
The Ministry of Health in New Delhi did not respond to requests for comment.
India is not alone in reducing the number of deaths due to the pandemic: the new WHO figures also reflect the decline in the number of other densely populated countries such as Indonesia and Egypt.
Dr. Asmaa noted that many countries have struggled to accurately calculate the impact of the pandemic. Even in the most developed countries, she said, “I think when you look under the hood, it’s hard.” At the start of the pandemic, she said, there were wide variations in how quickly different US states reported deaths, and some were still collecting data by fax.
She said India had brought in a large team to review the analysis of WHO data, and the agency was happy to get them to do so, as it wanted the model to be as transparent as possible.
India’s work on vaccination has won praise from experts globally, but its public health response to Covid has been criticized for overconfidence. Mr. Moody splurge In January 2021 that India “save humanity from a great catastrophe”. Two months later, the Minister of Health announced that the country is so “At the end of the Covid-19 game.” Adjust satisfaction, leading to slips And Officials’ attempts to silence critical voices within elite institutions.
It was science in India increasingly politicized throughout the epidemic. In February, India’s health minister criticized a study published in the journal Science Which estimated the number of deaths in the country from Covid to be six to seven times greater than the official figure. in March , The government questioned Study methodology published in scalpel Which estimated the number of deaths in India at four million.
“Personally, I have always felt that science should be responded to with science,” said Bhramar Mukherjee, professor of biostatistics at the University of Michigan School of Public Health, who has been working with the World Health Organization to review the data. “If you have an alternative estimate, which is done by rigorous science, you just have to produce it. You can’t just say, ‘I won’t accept it.'”
India has not provided total death data to the World Health Organization for the past two years, but the organization’s researchers used figures collected from at least 12 states, including Andhra Pradesh, Chhattisgarh and Karnataka, which experts say show at least four to five times higher. Deaths as a result of Covid-19.
The initial presentation of the WHO’s global data was ready in December, said 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.
But India was not satisfied with the estimates. And then we did all kinds of sensitivity analyses, the paper is actually a lot better because of that wait, because we’ve gone to extremes in terms of model checks and we’re doing everything we can with the available data,” Dr. Wakefield said. “And we’re ready to go.”
The numbers represent what statisticians and researchers call “excess deaths” – the difference between all deaths that occurred and those that would have been expected under normal conditions. The World Health Organization accounts for those deaths directly from Covid, deaths of people with conditions complicated by Covid, and deaths of those who did not have Covid but needed treatment they were unable to get due to the pandemic. The calculations also take into account expected deaths that did not occur due to Covid restrictions, such as those from traffic accidents.
Calculating excess deaths globally is a complex task. Some countries closely tracked death data and immediately provided it to the World Health Organization, while others provided only partial data, and the agency had to use modeling to complete the picture. Then there are the plethora of countries, including nearly all of those in sub-Saharan Africa, that do not collect mortality data and for which statisticians have had to rely entirely on modeling.
Dr. Asmaa from the World Health Organization indicated that nine out of 10 deaths in Africa, and six out of 10 globally, are not registered, and more than half of the world’s countries do not collect the exact causes of death. This means, she said, that even the starting point for this type of analysis is “guessing”. “We have to be humble about it, and say we don’t know what we don’t know.”
To produce mortality estimates for countries with partial or no mortality data, experts in the advisory group used statistical models and made forecasts based on country-specific information such as containment measures, historical rates of disease, temperature, and demographics to compile national figures and, from there, regional and global estimates .
Besides India, there are other large countries where the data is also uncertain.
Russia’s Ministry of Health reported 300,000 deaths from Covid by the end of 2021, which was the figure the government gave the World Health Organization, but Russia’s National Statistics Agency, somewhat independent of the government, found an excess mortality rate of more than a million people – a figure that is said to be Close to those in the WHO draft. Members of the organization said that Russia contested the figure, but that it made no effort to stop the release of the data.
China, where the epidemic began, does not release death data publicly, and some experts have raised questions about the underreporting of deaths, especially at the start of the outbreak. China has officially reported fewer than 5,000 deaths from the virus.
While China has already kept levels much lower than most countries, it has done so in part through some of the world’s toughest lockdowns – which have had their own impact on public health. One of the Few studies To study China’s excess death rate using internal data, conducted by a group of government researchers, showed that deaths from heart disease and diabetes rose in Wuhan during that city’s two-month lockdown. The researchers said the increase was likely due to the inability or reluctance to seek help in hospitals. They concluded that the overall death rate in Wuhan was about 50 percent higher than expected in the first quarter of 2020.
India’s efforts to halt the release of the report make clear that pandemic data is a sensitive issue for the Modi government. “It’s an extraordinary move,” said Anand Krishnan, a professor of community medicine at the All India Institute of Medical Sciences in New Delhi who is also working with the World Health Organization to review the data. “I don’t remember a time when that happened in the past.”
They are a challenge for governments when they show a large number of excess deaths, said Ariel Karlinsky, the Israeli economist who built and maintains the global mortality dataset and has been working with the World Health Organization on the numbers. “I think it’s very reasonable for people in power to fear these consequences.”
Vivian Wang Contribute to the preparation of reports.
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