Engage, not dismiss: On India’s response to WHO’s COVID-19 deaths report
The release of a report by WHO that estimates excess deaths during the COVID-19 pandemic to be nearly 10 times the reported COVID-19 death toll of 4.8 lakh in India between January 2020 and December 2021, the highest for any country, is not surprising. The pandemic did not just contribute to a surge in disease-related mortality, especially of the aged and the infirm, but also disrupted health systems that could have resulted in many other avoidable deaths. A robust estimation of the excess deaths was necessary to understand the pandemic effect in India where death registration after occurrence is not universal across States and medical certification of deaths is quite low in number. The Government has strongly denied the numbers and dismissed the methodology by saying that the WHO approach is based on modelled estimates and not actual data. It countered it by finally releasing the Civil Registration System report for 2020 (two days prior to the release of the WHO report) and saying that the cumulative increase in the number of deaths in 2020 was only 4.74 lakh, lower than the corresponding number for 2019. While most deaths — close to two thirds — occurred during the second wave in India from March to June 2021 (and later in some States such as Kerala), and therefore the late release of the CRS 2020 report does not entirely negate the WHO estimates that are based on registered deaths data available from “sub-national” units, there is indeed a discrepancy for 2020 data.
The WHO estimates for States were based on CRS registration data obtained by news organisations — the bulk of them by The Hindu. For 2020, cumulatively, the excess deaths estimations (close to 5.5 lakh for 12 States) for most such States for which data were obtained, match the CRS 2020 calculations (5.3 lakh). Discrepancies are quite high for those States where CRS data were only partially or not available earlier. A case in point is Uttar Pradesh where death (8.73 lakh in 2020 vs 9.45 lakh in 2019) and birth registrations (48.5 in 2020 vs 51.3 lakh in 2019) fell significantly and therefore skewed the overall country-wide excess deaths numbers. But without the release of the Sample Registration System data, it is difficult to believe that in States such as U.P., there has been an increase in registration levels even while there is a decrease in actual birth and death registration. The NFHS-5 2021 interviews show that death registration in 2020 was lower than previous years as opposed to the Government’s claims based on CRS 2020. The Government must not dismiss the WHO estimates and should instead look at undertaking its own exercise on excess deaths based on registration data in the CRS/SRS. After all, other methods, including surveys, have corroborated the fact that there was a high under-reporting of COVID-19 deaths during the pandemic.