The World Health Organization is facing pushback from countries, including India, against publishing a report on its estimates of global excess deaths due to the coronavirus disease, reported Devex.

Excess deaths is the divergence between all-cause deaths reported during pandemic years and in normal years. The numbers are an indicator for undercounting of deaths caused by the coronavirus disease.

Citing a member of the WHO’s Technical Advisory Group, the report in Devex, published on March 30, said that the Indian government did not agree with the estimates, which are four times the official figure of around 5.2 lakh.

The WHO’s estimates were expected to be published in early April, but the report is not out yet.

On Saturday, The New York Times also reported that India was delaying the publication of the WHO’s estimates. Citing people familiar with the estimates, the article also put the toll in India at much higher – 40 lakh – than reported by Devex.

While India has said it does not have any objections to the estimates, it questioned the global health body’s methodology used to arrive at the figure.

The WHO’s estimate is based on country’s data on reported deaths, information from household surveys and statistical model to include deaths that have not been counted.

“The WHO’s calculations include those deaths directly from Covid-19, deaths of people because of conditions complicated by Covid-19, and deaths of those who did not have Covid-19 but needed treatment they could not get because of the pandemic,” the report said.

It added: “The calculations also take into account expected deaths that did not occur because of Covid-19 restrictions, such as those from traffic accidents.”

The New York Times report said that some countries have tracked mortality data and submitted it to the WHO, but that India has not done it for the last two years. It also said that mortality data was uncertain in India and some other countries.

In order to create mortality estimates for countries that have partial or no records on deaths, WHO experts used statistical models and made predictions based on a country’s containment measures, historical rates of disease, temperature and demographics.

The estimates were projected by a collaboration between the United Nations Department of Economic and Social Affairs and the Technical Advisory Group set up for this task. They began their work in February 2021.

The global health body had invited all member states to nominate a person to engage with the WHO, submit any data they felt was important to the project and nominate national experts to the advisory group.

A member of the team had told Devex that India wanted the estimates to be published 10 years later.

A spokesperson of the global health body had told the media organisation that they were actively engaging with Indian officials to address their questions.

“While WHO is doing everything to work to address concerns, this must be balanced against WHO’s obligation to publish health statistics,” the spokesperson had said. “Therefore, the estimates will be published, but noting India’s reservations.”

Later, WHO spokesperson Amna Smailbegovic told The New York Times that the report will be published in April.

Dr Samira Asma, WHO’s assistant director general for data, analytics and delivery for impact, said the publication of the estimates has been “slightly delayed” but added that it was because the health body wanted to make sure everyone was consulted.

Given the delay, members of the advisory group had warned WHO that if the estimates were not released, the experts would publish the report themselves, three unidentified officials told The New York Times.

According to the estimates, 1.50 crore people have died globally as a result of Covid-19. The official global toll currently stands at 61.97 lakh, according to Johns Hopkins University data.

India questions WHO’s methodology

In a statement, the Union health ministry on Saturday said that WHO was using mortality data submitted by Tier 1 countries for their estimates but was applying a mathematical modelling process for the projections from Tier 2 countries, which includes India.

It asked how the statistical model used for projecting estimates for a country that has the geographical size and population of India fits in with other places that have a smaller population.

“Such one size fit all approach and models which are true for smaller countries like Tunisia may not be applicable to India with a population of 1.3 billion,” the Union health ministry said.

The health ministry said the WHO model was giving different sets of excess death estimates when using data from Tier 1 countries and “unverified data” from 18 Indian states. It said that such wide variation raises concerns about the validity and accuracy of the model.

The health ministry said that if the model was reliable, it should be used for Tier I countries, including including the United States, Germany and France.

The statement said that India’s test positivity rate has not been uniform throughout the country at any given time but the model did not consider the variation in rates for the estimates.

“Further, India has undertaken Covid-19 testing at much faster rate then what WHO has advised,” it said. “India has maintained molecular testing as preferred testing methods and used Rapid Antigen as screening purpose only. Whether these factors have been used in the model for India is still unanswered.”

The ministry also said that the model assumed that there was inverse relationship between temperature and deaths. This means that the lower temperature led to higher toll and vice versa.

The statement said this assumption does have any scientific backing.

“India is a country of continental proportions climatic and seasonal conditions vary vastly across different states and even within a state and therefore, all states have widely varied seasonal patterns,” it said.

On the estimates using containment measures to create death estimates, the ministry said the approach was questionable. It said that the containment was a “subjective approach” to quantify and that the measures varied among states and districts in the country.

The statement also said it was surprising the The New York Times could obtain the figures of excess Covid-19 mortality for India but was “unable to learn the estimates for other countries”.

It added: “While India has remained open to collaborate with WHO as data sets like these will be helpful from the policy making point of view, India believes that in-depth clarity on methodology and clear proof of its validity are crucial for policy makers to feel confident about any use of such data.”

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Higher toll in India

Multiple reports have pointed out that guidelines have not been followed in cases of deaths caused due to post-Covid complications in India and that crematoriums were not maintaining proper records of fatalities.

In March, medical journal The Lancet had said in a study that India had the highest number of excess deaths in the world at 40.7 lakh between January 1, 2020, and December 31, 2021.

In June, an article published in The Economist on a research by Christopher Leffler of the Virginia Commonwealth University suggested that India’s actual toll could be more than 20 lakh. India’s official toll at that time was 3,67,081.

A month before that, The New York Times had reported that India’s toll could be as high as 6 lakh by conservative estimates, and up to 42 lakh in the worst case scenario. At the time of publishing of the report, India’s official toll was 3.15 lakh.

The Centre has dismissed all these reports.