THE Indian government’s refusal to consider the World Health Organisation estimates of excess deaths during the Covid-19 pandemic years and insisting that only India’s Civil Registration System  should be used for Covid-19 deaths, makes strange reading. WHO’s estimates of excess deaths have been used across the board for all countries. Even in countries with stronger birth and death registration systems than India such as the UK, US, WHO’s report shows that excess deaths have been much larger than the registered Covid-19 deaths. India has not been singled out for this exercise, but is the only country arguing against any modelling of excess Covid-19 deaths. 

Is this therefore another example of “narrative management”, something that the Modi government has specialised in? The Indian Express (Anisha Datta, May 10, 2022) had reported that the principal economic advisor in the ministry of finance, Sanjeev Sanyal in 2020 had prepared a 36-slide presentation on the danger of India’s ratings dropping sharply to junk status: “Subjective Factors that impact India’s Sovereign Ratings: What can we do about it?” Shorn of all the management jargon, it argues for “massaging the message” to improve ratings, even if the underlying data is bad.

Though the WHO excess death exercise has been widely reported, let us look at its broad conclusions. First the key global conclusions:

• The WHO calculated every country's excess death for 2020 and 2021
• India, Russia, Indonesia, the US, Brazil have the highest number of excess deaths
• In death per 100,000 India does not rank very high, it is roughly in the same range of countries like Russia, South Africa, Brazil, the US, Turkey etc.

If we summarise the conclusions, the reading of WHO’s exercise would lead us to the conclusion that India’s overall performance in the handling of the epidemic was not particularly bad. It is in the company of the larger middle income countries like Brazil, South Africa, Indonesia etc., and even some rich countries like the US. Where India differs from others is in the ratio of excess Covid-19 deaths to the Covid-19 deaths as declared by the government. This means that the government has done a significant undercounting of India’s Covid-19 deaths.

The Government of India’s response to WHO’s exercise has been that it should not have used any modelling for excess deaths, but relied only on Civil Registration Systems (CRS) data as the only authentic estimate of Covid-19 deaths. As many experts have pointed out, this makes very little sense. The CRS data on 2020 came out only two days before the WHO’s results were presented, and its 2021 figures are yet to come out. If we take the Government of India’s response seriously, this essentially means no excess death studies should be done at all!  

This is also strange as the Modi government has been quite fond of using modelling to tell us how wonderfully the government managed the Covid-19 pandemic and how the Indian “super model” showed that India would shortly be Covid-19 free. This was just before India got hit by the Delta wave in 2021, causing the virtual collapse of the hospitals and the supply of oxygen. Is the government arguing only models that show everything is hunky dory should be used, and not anything that shows us in an unfavourable light?

Before we look at WHO’s conclusions, let us understand what is “excess death” and why is it important to estimate this figure?

Excess deaths during an epidemic are the additional deaths that are not counted by government agencies as deaths due to the epidemic, but are due to the direct or indirect effects of the epidemic. In the case of Covid-19, additional deaths could be due to simply not registering deaths, or not registering it as Covid-19 death, particularly during a wave. Or people postponing routine care and other programmes like routine vaccination, TB care, etc., suffering as health agencies focus more on Covid-19. The computation of excess deaths compares what are likely deaths based on past data without the epidemic to the estimated deaths based during the epidemic period. Professor Gautam Menon, an expert on modelling and biostatistics also tells us that any such exercise has to compensate for the indirect factors such as traffic accidents, medical treatment being hard to access, to arrive at the final estimate of excess deaths due to the pandemic alone.

Why do we estimate excess deaths, even in countries where the death registration system is quite strong? And why do even these countries also show fairly high excess death figures? India is not alone in undercounting deaths due to the Covid-19 epidemic. The US is of course a standout example, boasting about its super efficient health system and among the worst performers.

What are WHO’s estimates for excess deaths for the world and India?

The WHO’s report estimates that total deaths from Covid-19 for the two years 2020 and 2021 is about 14.9 million deaths for the world, and about 4.7 million deaths for India. The official Indian Covid-19 toll for the same period is 0.48 million, or WHO’s estimates of Covid-19 deaths are about 10 times higher than India’s official figures.

Are the WHO’s estimates much higher than other estimates carried out by different groups? According to Professor Menon, the WHO’s figures are within the same ball park as other estimates carried, which vary from 2 million to 6 million; or 4 to 12 times the official figures. Even for the US, which boasts of a superior death and birth registry system, the excess death figures in WHO’s report is three times its official figures.

Why then is India the only country that is disputing the WHO’s figures? Instead of arguing why WHO’s approach to excess mortality is faulty, it has launched a broadside against the use of modelling to estimate Covid-19 deaths. The reason for this seems to be the inability to advance any cogent argument for rejecting such an exercise and perhaps the knowledge that any independent approach would expose the serious undercounting in the official figures of Covid-19 deaths. Crucially, the WHO’s or any other exercise in modelling excess deaths have shown that the highest number of excess deaths have occurred during the two earlier waves, particularly during the Delta variant wave in 2021.

This tallies with what we know from our experience and the newspaper reports for that period. The figures of cremations and burials done under Covid-19 protocol in major cities and the deaths as declared by the government varied significantly in these periods. This was in major cities and towns. As we know, this was worse in the rural areas, with bodies floating down the Ganga as people did not even have the money for a proper cremation or burial. To claim or expect proper recording of deaths in this period as the government is claiming, is the height of folly.

If the government claims that the WHO’s approach is faulty, the proper course would then be to set up an independent committee with proper credentials and even international participation. Make data available to them, let them devise methods to estimate excess deaths due to Covid-19 and let such a committee function independently of the government. A transparent procedure, making all data available, and a public discussion of the methods would then produce a credible report, instead of entering into an ad hominem attack on the WHO report. Unfortunately for India’s credibilty, it is the only country among the 194 member countries to have rejected the report.

The Modi government’s approach is to first try and manage the narrative. If that does not work, then shoot the messenger. The problem is that if both fail, then what? That is the credibility crisis that this government is facing, ranging from inflation to Covid-19 deaths.