India refutes WHO claim of 40 lakh COVID deaths, says methodology is wrong

As the World Health Organisation (WHO) is reportedly gearing up to make its estimate of the global COVID death toll figures public, India has shared its serious objections over the methodology adopted to arrive at the number of deaths during the pandemic. According to the WHO calculations, in India, 4 million people have died, which is almost eight times the official figure of 520,000.

One of India’s major grievances is over WHO’s ‘one size fit all approach’. A release issued by the ministry of health and family welfare on Saturday (April 16) stated that the statistical model projects the estimates for a country of geographical size and population of India along with other countries which have 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,” said the ministry. Moreover, WHO is yet to share the confidence interval (which measures the degree of uncertainty or certainty in a sampling method) for the present statistical model across various countries, added the release.

Response to NYT article

This statement by the ministry is interestingly in response to a New York Times article titled, “India Is Stalling the WHO’s Efforts to Make Global Covid Death Toll Public”, dated April 16, 2022. The article alleges that WHO’s extensive research and analysis by experts around the world for a year on the number of people who died during the world-wide pandemic, has been delayed for months because of objections from India, which disagrees with the calculation of how many of its citizens died and has tried to keep it from becoming public.

However, India, which claimed that it has been open to collaborate with WHO since such data sets would be helpful from the policy making point of view, had said earlier too that it required an “in-depth clarity on methodology” and “clear proof of its validity”. India felt the WHO process was neither collaborative nor adequately representative and the process did not “hold scientific rigour and rational scrutiny as expected from an organisation of the stature of the World Health Organisation.”

Rahul slams government

Senior Congress leader Rahul Gandhi on Sunday targeted Prime Minister Narendra Modi over the NYT report. Taking to Twitter, he said that Modi neither speaks the truth nor allows others to speak it. He added that his earlier claim of 40 lakh deaths in India due to the virus stands vindicated, and urged the government to provide ₹4 lakh as compensation to families of those who died of COVID.

“Modi ji does not speak the truth, he does not let (others) speak it,” Rahul tweeted in Hindi along with a screenshot of the NYT article.

मोदी जी ना सच बोलते हैं, ना बोलने देते हैं।

वो तो अब भी झूठ बोलते हैं कि oxygen shortage से कोई नहीं मरा!

मैंने पहले भी कहा था – कोविड में सरकार की लापरवाहियों से 5 लाख नहीं, 40 लाख भारतीयों की मौत हुई।

फ़र्ज़ निभाईये, मोदी जी – हर पीड़ित परिवार को ₹4 लाख का मुआवज़ा दीजिए। pic.twitter.com/ZYKiSK2XMJ

— Rahul Gandhi (@RahulGandhi) April 17, 2022

What is the WHO methodology?

The New York Times article detailing the WHO methodology said that WHO has combined national data on reported deaths with new information from localities and household surveys. Additionally, statistical models were drawn up to account for deaths that were missed and also included the number of indirect deaths, like those of people who could not access medical care for other ailments due to the lockdowns in the pandemic.

Moreover, WHO used demographers, public health experts, statisticians and data scientists. Researchers deployed numbers gathered from at least 12 states, including Andhra Pradesh, Chhattisgarh and Karnataka, which experts say show at least five to six times as many deaths as a result of Covid-19, said the NYT article.

They also included what statisticians and researchers call “excess mortality” — the difference between all deaths that occurred and those that would have been expected to occur under normal circumstances. Also, since some countries only had partial or no death data, the WHO experts turned to tapping statistical models and made predictions based on country-specific information such as containment measures, historical rates of disease, temperature and demographics to assemble national figures and, from there, regional and global estimates.

India’s objections: Wide variation in estimates

In its statement issued in response to the NYT article, the ministry hit out at the WHO  model which gives two highly different sets of excess mortality estimates when they use  data from Tier I countries and when they use unverified data from 18 Indian states. “Such wide variation in estimates raises concerns about validity and accuracy of such a modelling exercise,” said the ministry

India has asserted that if the model is accurate and reliable, it should be authenticated by running it for all Tier I countries and if the result of such exercise may be shared with all member states.

No scientific backing 

The model assumes an inverse relationship between monthly temperature and monthly average deaths, which does not have any scientific backing to establish such peculiar empirical relationship, said the ministry picking holes in WHO methodology.

“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, adding that therefore estimating national level mortality based on these 18 states data is statistically unproven.

Not using historical datasets

Moreover, the ministry, slammed the Global Health Estimates (GHE) 2019 on which the modeling for Tier II countries is based since it is itself an estimate. The present modeling exercise seems to be providing its own set of estimates based on another set of historic estimates, while disregarding the data available with the country, said the ministry.

India said it is unclear why GHE 2019 has been used to estimate expected death figures for India, while for Tier 1 countries, their own historical datasets were used when it has been repeatedly highlighted that India has a robust system of data collection and management

Variation in Covid-19 positivity rate

Also, the ministry questioned whether factors about the non-uniformity of the test positivity rate for Covid-19 in India was taken into account. This variation in Covid-19 positivity rate within India was not considered for modelling purposes, neither was how India undertook Covid-19 testing at much faster rate then what WHO has advised. Moreover, India used molecular testing as preferred testing methods and used Rapid Antigen as screening purpose only. According to the ministry, were these factors considered in the model for India? This question remained unanswered, said the ministry.

Using information on containment measures

India questioned using information on containment to measure deaths in this calculation since it involves a lot of subjective approach (such as school closing, workplace closing, cancelling of public events etc.,) to quantify itself. “But, it is actually impossible to quantify various measures of containment in such a manner for a country like India, as the strictness of such measures have varied widely even among the States and Districts of India. Therefore, the approach followed in this process is very much questionable,” said the ministry.

At the end of the release, India evinced surprise that NYT purportedly could obtain the alleged figures of excess Covid-19 mortality in respect to India but it was “unable to learn the estimates for other countries”!! However, the NYT report did say that India is not alone in undercounting pandemic deaths and the new WHO numbers also reflect undercounting in other populous countries such as Indonesia and Egypt. But it does not share any figures like it does on India.