The World Health Organization’s report on excess deaths from Covid-19 has stirred a hornet’s nest in India, with doctors and health administrators contesting the gap between India’s reported death toll and that projected by the report.

India is projected to have witnessed 47 lakh deaths from Covid-19, the report said, almost 10 times the reported deaths at 4.8 lakh, up to December 2021.

The gap should be seen as a “symptom of the lack of a system” to capture the public health details behind a death, said veteran virologist Jacob John. “The truth is more towards the WHO side than the government numbers,” John told BusinessLine, adding that it was not India’s fault, and there was no intention to be “dishonest”.

“There is no public health system in the country to capture details on the death by disease or diagnosis, as it was never demanded”, he said, pointing out that he had been advocating for such a system for the last 30 years. The latest report is “a signal on the need to create such a system”, he said, pointing to agencies in the UK and the US that capture granular data and the disease event behind the statistic.

Civil registeries merely capture the civil data, he said, and not the public health event behind the death. And even though health administrators say they have captured granular details during Covid, John said it has not been verified in terms of the disease event behind the death.

Flawed projection

Dissecting the WHO statistics, Rajeev Jayadevan, Co-Chairman National IMA COVID Task Force, points out it was “ïmpossible that 8.9 out of 10 deaths from Covid were missed in a country like India”, which has robust systems in place. Even in the best of countries, it is accepted there will be under-counting for various reasons, he said. But a gap of 9.9x, he said, was off the mark.

Death reporting varies across villages in a single State, depending on the prevailing public health systems available, he said, indicating that it was flawed to project numbers from the experience of one region across multiple locations. Some regions may have been more severely affected than others, he said, indicating that it was erroneous to “generalise from the extreme”.

Meanwhile, the WHO report added a technical note for India, saying: “These estimates may not be regarded as the national statistics officially produced by India due to differences arising from the data and methods used by WHO. The information from the Civil Registration System in India for 2020 was made publicly available by the Registrar General of India on 3 May 2022... The newly published information in the report is being carefully examined and will be taken into consideration in revisions of the estimates.”