India is delaying WHO's efforts to publish the global covid-19 deaths.
An ambitious effort by the World Health Organization to calculate the global death toll from the coronavirus pandemic has found that deaths far exceed previous estimates, with a total of about 15 million deaths by the end of 2021, more than double the official total of 6 million reported by countries individually.
But that alarming estimate was delayed for months due to Opposition from India. This is the result of more than a year of research and analysis by experts around the world, and the most comprehensive study of the lethality of the new crown virus to date. India has questioned the way its citizens' death toll is calculated and has sought to prevent it from becoming public.
It is estimated that more than a third of the 9 million new deaths have occurred in India. Indian Prime Minister Narendra Modi himself counted the death toll at about 520,000. According to people familiar with the matter, WHO will show that india has at least 4 million deaths, but is not authorized to disclose these figures, which will make India the country with the highest number of deaths in the world. The New York Times was unable to obtain estimates from other countries.
WHO's calculations combine nationally reported death data with new information from local and household surveys, combined with statistical models designed to account for missing deaths. Most of the differences in the new global estimates are previously uncounted deaths, most of which are directly caused by COVID-19; the new deaths also include indirect deaths, such as those who have not been able to access care for other diseases due to the outbreak.
Delay
Delaying the release of data is significant because global data is critical to understanding how the outbreak is evolving and what can be done to mitigate similar crises. It has created chaos in the usually dreary world of health statistics, and with India refusing to cooperate, the United Nations Statistical Commission, the world agency that collects health data, is staging a dispute disguised by bland language.
"This is important for global accounting and for ethical obligations to the dead, but it is also very practical," said Dr Prabhat Jha, director of the Toronto Global Health Research Centre and a member of the expert working group supporting WHO's calculation of additional deaths. ”
To truly measure the impact of the outbreak, WHO has brought together a team of experts, including demographers, public health experts, statisticians and data scientists. As we all know, the Technical Advisory Group has been working together in countries to try to piece together the most complete statistics on outbreak deaths.
The New York Times interviewed more than 10 people familiar with the data. WHO had planned to release the figures in January, but the news has been delayed. Recently, several members of the group warned WHO that if the organization does not publish data, experts will publish themselves, according to three people familiar with the matter. AMNA Smailbegovic, a WHO spokeswoman, told The New York Times: "We plan to publish it in April. Dr Samira Asma, WHO's Assistant Director-General for Data, Analysis and Impact Delivery, who is helping to lead the calculation, said the release of the data was "slightly delayed", but said it was "because we wanted to make sure everyone was consulted".
Defective
India insists that the WHO approach is flawed. In February, the Indian government said in a statement to the United Nations Statistical Commission: "India believes that this process is both lacking in cooperation and insufficient representation. It also argues that the process does not have "a scientifically rigorous and rational review, as organizations like the World Health Organization would expect."
The New Delhi Health Ministry did not respond to reporters' requests for comment. India is not the only country to underreport deaths: WHO's new figures also reflect underreporting in other populous countries, such as Indonesia and Egypt.
Dr Asma noted that it is difficult to accurately calculate the impact of the outbreak in many countries. Even in the most developed countries, she said, "I think it's a challenge when you look closely." At the start of the outbreak, there were significant differences in the rate at which states reported deaths, and some states were still collecting data by fax, she said.
India sent a large team to review WHO's data analysis, and WHO is happy to have this team do it because it wants the model to be as transparent as possible, she said. India's work on vaccination has won praise from experts around the world, but its public health response to COVID-19 has been criticized for being overconfident. Modi boasted in January 2021 that India "saved humanity from a catastrophe". A few months later, his health minister declared the country "at the end of the COVID-19 pandemic."< Complacency began to build, leading officials to missteps and trying to silence critical voices within elite institutions.
Then, in April 2021, a devastating second wave of attacks. Hospitals had to keep patients out and ran out of oxygen. But many deaths are not counted. During the pandemic, science in India has become increasingly politicized.
In February, India's junior health minister criticized a study published in the journal Science that estimated the number of COVID-19 deaths in the country to be 7 to 8 times the official figure. In March, the Indian government questioned the approach of a study published in The Lancet that estimated the death toll in India at 4 million.
Bhramar Mukherjee, a professor of biostatistics at the University of Michigan School of Public Health, said: "I personally have always believed that science must respond to science with science. "He has been working with the World Health Organization to review these data." If you have an alternative estimate made through strict science, you should give it directly. You can't just say, 'I don't accept it. ’”
Estimates
India has not submitted its total mortality rate data to WHO over the past two years, but the organization's researchers have used data collected from at least 12 states, including Andhra Pradesh, Chhattisgarh and Karnataka, which experts say show at least 5 to 6 times as many people have died from COVID-19.
Jon Wakefield, a professor of statistics and biostatistics at the University of Washington, said a preliminary report of WHO global data was prepared last December. Wakefield played a key role in building models for estimation. "But then India was unhappy with those estimates. We then did various sensitivity analyses. Because of this waiting, this paper is actually much better because we went too far in terms of model checking and did as much as we could with the available data. Wakefield said. We're ready. ”
These figures represent what statisticians and researchers call "excess mortality," the difference between all deaths that have occurred and those expected under normal circumstances. WHO's calculations include the number of people who died directly from COVID-19, the number of deaths from complications caused by COVID-19, and the deaths of people who were not infected with COVID-19 but could not access the treatment they needed because of the outbreak. The calculation also takes into account expected deaths that did not occur due to COVID-19 restrictions, such as traffic accidents.
Calculating the global toll of excess deaths is a complex task. Some countries closely follow mortality data and quickly make them available to the World Health Organization. Others provided only a fraction of the data, and the agency had to use modeling to refine that picture. There are also many countries, including almost all sub-Saharan African countries, that do not collect death data, and statisticians have to rely entirely on models.
Dr Asma of WHO noted that nine out of 10 deaths in Africa are unregistered, six out of 10 deaths worldwide are unregistered, and more than half of the world's countries do not collect accurate causes of death. That means even the starting point for this analysis is a "guessed estimate," she said. "We have to be humble about it and say we don't know what we don't know."
To estimate mortality in countries with partial or no mortality data, the Experts of the Advisory Group used statistical models and made projections based on country-specific information such as containment measures, historical morbidity, temperature and demographic data, collecting national data, regional and global estimates.
— This article was originally published in The New York Times.