With the Covid-19 pandemic seemingly receding into the background, a fresh controversy around it has surfaced regarding the mortality figures provided by the World Health Organisation (WHO). Recently the world’s premier health body published its estimates of total deaths due to Covid-19 pandemic in the years 2020 and 2021. While WHO claimed 14.9 million people died around the world – more than double the official figure of 6 million – due to the pandemic as well as its secondary effects, what was more disconcerting than the overall global figure is India’s death toll of 4.7 million. This means India was the hardest-hit country by Covid, with approximately a third of the global excess deaths, according to WHO.
Not surprisingly, the WHO’s estimates have triggered a debate with claims and counterclaims. The government has not only rejected the figure saying the WHO methodology is flawed but hit back with several rebuttals. India has officially recorded more than half a million deaths due to the novel coronavirus until now. While deaths reported between January 1, 2020, and December 31, 2021, stand at 481,000; WHO’s estimates put the figure 10 times higher. The government has maintained that the official Indian figures are accurate, claiming further that the death registration during the pandemic has seen a significant improvement with 99 per cent of death registrations in 2020. So, what’s the truth? How many people really died of Covid and disruptions of other essential health services in India?
Estimates vary and it’s difficult to say how far available estimates are precise or speculative. India’s problem with data provided by international agencies is not new. Whether it is Hunger Index, Inequality Report, Economic Statistics, or Press Freedom, India under the Modi government has always been at loggerheads with the methodology of international organisations. Whenever a report has questioned India’s performance on various human development indicators, India has taken a belligerent stance against international institutions. But there are also times when the data and methodology of international organisations, if favourable, is not just accepted but flaunted as well. The WHO data is not about deaths due to Covid alone. It is about excess mortality, which includes Covid deaths, deaths due to disruptions and breakdown of the health services, and worsening of social determinants like poverty. In other words, the WHO data is about the net effect of the pandemic, that is excess mortality.
The politics over data is not new. India has traditionally been seen to be poor with data collection. The WHO data of excess Covid deaths relies on the mathematical modelling for India in the absence of All-Cause Mortality (ACM) data at the international level. Various other countries that collect ACM data have not been accorded abnormally high numbers of Covid deaths by the WHO. According to the global health body, India has provided data from up to 17 states (out of 26) over the pandemic period, “but this number varies by month”. The WHO data has not gone down well with the government because it believes that India has a robust system of data collection regarding deaths and in the government’s view, the WHO “figure is totally removed from reality”. Calling the WHO report of 4.7 million excess deaths in India “worrisome”, Dr. N K Arora, chief of India’s Covid Working Group, said it does not stand any “logic or fact”.
Dr. Arora has also said that while there can be a 10 to 20 per cent discrepancy, India’s robust and accurate death registration system ensures that a majority of virus-related deaths are covered. There may be inconsistencies in the WHO report, but doubts persist over India’s official Covid death toll as well. It is quite possible, and it appears so, that the WHO data, based on a mathematical model, may have overestimated India’s Covid death toll. It could be off the mark and appears stretched, given that a mathematical model may not always give credible results and has the potential of overstating the dead. But it is also true that India’s official Covid death count may not be accurate or credible, given the problem of a testing capacity-led undercount of Covid deaths as also the fact that the pandemic had caused the collapse of the public health system and deaths were reported on roads and in public places for lack of hospital beds and timely medical care.
Several independent studies have also suggested that India’s official death figures are a “drastic undercount”. For example, in March a study published in The Lancet medical journal put the Covid-related toll at more than 4 million. But India has been constantly dismissive of these scientific estimates. This may be because such high mortality figures have a political cost and it is not difficult to assume what is at stake for the Modi government, which goes an extra mile to be one up in the perception battle. Irrespective of the official numbers, the true picture of the Covid mortality can be assessed from the state of sheer collapse of the system during the killer second wave in April-May last year when every healthcare service seemed unavailable at the time. Thus, unreliable data, even with sophisticated statistical methodology, would lead to imprecise and speculative estimates.
But the paradox is that democracy did not produce a political reaction to this incredible mass distress, as voters in various state elections did not hold the BJP to account for the collapse of the healthcare system. Neither was the ruling dispensation blamed for the world’s harshest and unplanned lockdown in March 2020 which caused the migrant workers crisis, destroyed livelihoods, and saw the economy suffer more than any other in the world. As a result, the Modi government lauded itself for managing the Covid disaster much better than all the advanced countries. Does that mean the official Covid death toll is correct? The truth is we may never know the true Covid death count for the simple reason that the country was never ready to deal with the pandemic.
(The writer is an independent Mumbai-based senior journalist. He tweets at @ali_chougule)
