Men take photographs of the body of a relative who died with COVID-19 at a hospital in Ahmedabad, January 24, 2022. Photo: Reuters/Amit Dave
- An analysis by Philip Schellekens suggests that India had the most excess deaths during the COVID-19 pandemic – 5 million.
- Most of India’s excess deaths likely occurred during the country’s debilitating second COVID-19 outbreak, even as its vaccination drive had just taken off.
- Death data in India has faced numerous allegations of undercounting. The government hasn’t officially admitted them but many of them are based on official sources.
New Delhi: According to a new analysis of COVID-19 data worldwide, India may have had the most deaths in the world during the pandemic.
The current understanding is that the US has reported the deaths due to the disease – a tally based on officially reported data.
Death data in India has faced numerous allegations of undercounting. Even if the Indian government hasn’t officially accepted these charges, many of them are hard to refute considering the official nature of their sources.
For example, many journalists and activists have found that the official toll due to COVID-19 in various parts of the country is at odds with the records of the Civil Registration System.
In another instance, the compensation claims state governments settled for the kin of people who had succumbed to COVID-19 – data they submitted to the Supreme Court – was greater than their respective official tolls.
In addition, India is also likely to have undercounted deaths that occurred during the pandemic, weren’t due to COVID-19 but may not have happened in the absence of the pandemic and the government’s response to it.
The new analysis cements this picture by comparing the number of excess deaths in India to those of other countries, and finds that India may be the country to have been most affected by the infectious disease and the government’s response to it.
Excess deaths is the total of deaths that occurred in a given population, by all causes and in a fixed period minus the number of deaths that were expected according to historical data.
Using data from The Economist and other sources, Philip Schellekens, a senior advisor to the World Bank group, estimated that the actual number of deaths during the pandemic in India could have been 5 million.
India has thus far officially registered around 0.5 million deaths due to COVID-19.
As Schellekens’s analysis shows, thanks to India’s ‘contribution’, the contribution of excess deaths during the pandemic years from low- and middle-income countries (LMICs) is three-times greater than that of the next income group.
Specifically, LMICs, he found, have officially owned up to 21% of all COVID-19 deaths – but the true fraction could be 53%.
Earlier this year, epidemiologist Prabhat Jha and his colleagues had reported that India’s actual COVID-19 toll could have been 3.2 million until July 2021.
The Indian government has denied any fatality undercounting on many occasions. Every time a study or a news report made this allegation, the government has issued a press release denying any discrepancies.
P. Arokiasamy, a demography and public health expert, told The Wire Science earlier that India needs a nationwide survey to ascertain the actual number of deaths due to, and during, COVID-19.
Schellekens and another analyst named Diego Sourrouille wrote in May 2020 that, contrary to the impression at the time that most COVID-19 deaths were being reported from ‘high-income countries’, they expected the contribution of LMICs to be 14-times higher.
They based this estimate on the higher prevalence of comorbidities in the population of these countries, their population density and access to good-quality sanitary conditions.
Schellekens’s current analysis is based on excess-mortality data from 84 countries that do share this information. The rest of the data, Schellekens writes on his site Pandem-ic, is based on a model to predict the number of excess deaths developed by The Economist.
The scripts for this model, using the R language, are available on GitHub. According to text accompanying the GitHub repository:
Estimating excess deaths for every country every day since the pandemic began is a complex and difficult task. Rather than being overly confident in a single number, limited data means that we can often only give a very very wide range of plausible values. Focusing on central estimates in such cases would be misleading: unless ranges are very narrow, the 95% range should be reported when possible.
Schellekens adds on Pandem-ic:
At its core, the model relies on a machine-learning algorithm (a gradient booster) that learns from official excess-mortality data and over 100 other statistical indicators. Where data on excess deaths is available, they are used. Where such data are not available, the model fills the gaps in the form of single-point estimates.
While India tops the chart on the estimated number of excess deaths during the pandemic, it still slips down the rankings on the number of deaths per capita.
This is reminiscent of some arguments that the Indian government’s health establishment floated in 2020 – to claim that concerns about an epidemic gone “out of control” were overblown because the virus’s per-capita toll was highly manageable.
However, the overall share of LMICs on this count remains high.
Schellekens’s analysis also throws the spotlight on the world’s vaccination coverage. He writes that most of the world’s unvaccinated people are in countries in Africa, South Asia and Southeast Asia, plus some in the Caribbean.
India and China however bucked this trend because they were also vaccine-manufacturers. The WHO took cue and has been helping scientists on the African continent copy the Moderna mRNA vaccine – after the American pharma company refused to transfer technology – to be able to manufacture it closer to the people who need it most.
Most of India’s excess deaths likely occurred during the country’s debilitating second COVID-19 outbreak, even as its vaccination drive had just taken off. Today, India’s vaccination coverage is much higher: 70% had received at least one dose and 56% had received both doses as on February 20, 2022.
However, low vaccination coverage was one half of the reason the second wave was so awful in India. The other half was the government’s complacent response – including to organise large public gatherings and to have insufficient medical oxygen supply.