Beyond The WHOdunnit

Modelling for death estimates is problematic. But India's real-time medical data can improve a lot

- K Srinath Reddy

A heated debate has been triggered by the World Health Organisation’s report on ‘excess deaths’ ascribed to the Covid pandemic. While the report estimates such deaths worldwide during 2020 and 2021 (14.9 million), it is the number of deaths attributed to India (4.7 million) that has elicited spirited rebuttals from the government and a number of experts.

This estimate places India topmost among countries in terms of excess deaths during this period, though when adjusted for the population size, there are other countries which rank higher.

The term ‘excess deaths’ denotes the number of deaths which occurred during a defined period, over and above the number of deaths expected if mortality trends followed the pattern of the preceding two years. When a public health emergency arrives, as in a pandemic, this pattern is disrupted.

During the Covid pandemic, excess deaths arose from (a) the disease itself; (b) co-morbid health disorders that were aggravated by the infection; (c) neglect of other health needs due to disrupted or diverted health services; and (d) social and economic instability caused by the pandemic, through effects on livelihoods, nutrition, loss of shelter, forced migration and interrupted social services.

During a pandemic that unleashes a fast-spreading virus, disrupts global supply chains, and trips economic engines, not all of these causes are in the control of a single national or state government.

India has counted deaths directly attributable to the infection. WHO has counted all ‘excess deaths’. So, a disparity is expected. However, it is not just what is measured that is being debated. It is how it was measured that is being disputed.