‘WHO's Methodology Has Been Robust'

Death reporting is inconsistent across India’s states. And sample registration survey data comes with 2-year lag  

- Sanjiv Shankaran

T Sundararaman, former executive director of the National Health Systems Resource Centre, unpacks World Health Organisation’s estimate of the excess mortality caused by the pandemic in a conversation with Sanjiv Shankaran:

What is the scope of WHO’s estimate?

It’s about excess mortality, which means the difference between what would have been expected to be the mortality given the previous trend if there had been no pandemic as compared to the actual deaths that occurred after the pandemic. It includes Covid deaths, deaths due to the disruption of other essential health services and worsening of social determinants like poverty. You can’t measure all these separately. What you do measure is the net effect of a pandemic, that is, excess mortality.

What it does not say is the break-up between the three. At no point does WHO comment on the number of deaths attributable to Covid. There are reasons why excess mortality is preferred. One reason is that direct and indirect effects, as long as they lead to mortality, are equally important. Mortality due to indirect causes is completely missed unless we look at excess mortality.

India’s Sample Registration System (SRS) is the main source of mortality data. How is it connected to the Civil Registration System (CRS) of states?