The World Health Organization (WHO) expects to publish its COVID-19 death statistics “shortly”, despite objections from the government of India – apparently because the year-long study puts the Indian death toll at around four million while the government’s official death figure is 520,000 (to end 2021).

The row between India and the WHO was first reported in The New York Times. This was followed by a statement from India’s Ministry of Health and Family Welfare that questioned the WHO’s methodology, adding that it had sent six letters of complaint to the WHO.

India’s objections centre on a “one-size-fits-all” statistical model used by the WHO, which it says “cannot apply to a country of geographical size and population of India” and other countries with smaller populations, and the WHO’s use of “unverified data from 18 Indian States”. 

However, the WHO would not comment on India’s position, simply stating on Wednesday: “We are currently finalising these estimates and will publish them shortly.” 

Data integrity – especially accurate count of the dead & cause of death – is not just a moral imperative but more importantly, the bedrock of public health and modern medicine. @nytimes @WHO @MoHFW_INDIA @ICMRDELHI https://t.co/jlpRAD0FPO

— Dr PV Ramesh (@RameshPV2010) April 16, 2022

Last month, a study in The Lancet estimated that 18.2 million people had died of COVID-19 between 1 January 2020 and 31 December 2021, in comparison to the official global figure of 5.94 million.

Using country statistics and six models to estimate expected mortality, the study also found the highest cumulative excess deaths due to COVID-19 in India (4.07 million), followed by the USA (1.13 million), Russia (1.07 million), Mexico (798 000), and Brazil (792 000). 

The excess mortality rate was highest in Russia (374.6 deaths per 100 000) and Mexico (325.1 per 100 000).

The Economist, which has developed a COVID-19 death tracker, estimated that 18 million people had died over the same period.

Our World in Data, widely used by media outlets, relies on confirmed figures released by countries. According to these figures, Peru has the highest death rate in the world.

Crucial Zambian study exposes Africa’s toll

Understanding the impact of epidemics is essential for governments, particularly to identify weaknesses in their health systems and places that need more support.

There is a perception, for example, that most African countries have been spared the worst of COVID-19. 

But only South Africa, Egypt, Tunisia, Mauritius and Seychelles actually measure excess mortality with any degree of accuracy.

By early March, the South African Medical Research Council, which measures excess deaths, found an excess of 300,000 people had died since the start of the COVID-19 pandemic in March 2020 – three times the official COVID-19 death rate. However, not all these deaths would be directly caused by the virus, but could be the result of delays in treatment linked to the pandemic.

Small country-based African studies are also starting to emerge that portray a more accurate picture of the death toll. A pre-print Zambian study published in late March concluded that, during peak COVID-19 transmission periods, “90% of all deceased individuals tested positive for COVID-19”.

Researchers reached this conclusion by testing nasopharyngeal swabs from 1,118 bodies at a busy inner-city morgue in Lusaka, Zambia’s capital. One-third were infected with COVID-19, but during the country’s peak COVID-19 waves in July 2020, January 2021, and June 2021 (which marked the end of the research surveillance), COVID-19 was detected in 90% of all the deceased. Most of the dead had died at home and had not tested for COVID-19.

Helping governments track deaths

Approximately half of all deaths in the world go unrecorded, according to Bloomberg Philanthropies, which is supporting 29 countries through a Data for Health Initiative to strengthen their health statistics.

“Reliable mortality data—understanding how, where and when people have died—is invaluable for governments as they coordinate response measures and communicate with the public,” according to Adam Karpati, Vital Strategies’ Senior Vice President of Public Health Programs.

“The measurement of excess mortality captures not only deaths caused directly by COVID-19, but also deaths due to the pandemic’s indirect effects on health services and health-seeking behavior. Complete, well-functioning civil registration and vital statistics (CRVS) systems are the optimal source of this data,” adds Karpati, whose organisation is the implementing partner for the Data for Health Initiative.

Image Credits: Adnan Abidi/Flickr, Credit: Press Information Bureau (PIB).