India concerned about WHO approach on excess deaths

(Mains GS 2 : Government Policies and Interventions for Development in various sectors and Issues arising out of their Design and Implementation.)

Context:

• Recently, several news agencies reported that the World Health Organization (WHO) was set to release an estimate of excess deaths during the pandemic period the world over.
• The report is expected to show at least 4 million excess deaths in India, the highest such tally for any country in the world.

Objection to the report:

• The unreleased WHO estimates have been prepared by leading global experts but have left India’s health establishment perturbed, with its strong objections to these estimates.
• The Indian government responded to the report saying its basic objection to the report centred on the “methodology adopted for the same”. 
• India is in serious disagreement with the WHO-prepared COVID-19 mortality estimates and the argument being made by India’s health establishment through a public clarification is that this is an overestimation, and the methodology employed is incorrect.

Excess deaths approach:

• The excess deaths approach to calculating mortality considers the difference between the registered deaths before the pandemic and those during the pandemic period. 
• This gives a robust estimate of the true impact of the pandemic i.e. deaths due to the disease and those that occurred because of the pandemic overwhelming health systems among others.
• For example, millions who could not access care, i.e., diagnosis or treatment due to COVID-19 restrictions or from COVID-19 cases overwhelming health services.

Gap in death registration:

• In most developed countries, death registration is full or nearly full and therefore, calculating excess deaths is relatively easier as deaths data are reliable and readily available. 
• In such countries, most deaths are medically certified with cause of mortality and therefore a clear picture on excess deaths with causality can emerge quickly. 
• Countries such as the U.S., the U.K., Italy and Germany, for instance, have near 100% registration of deaths with the cause of mortality known in every case, enabling excess deaths to be known in near real time.

Case of India:

• The registration of deaths with the cause of mortality figure for India is 92% (as per the Annual Report on Vital Statistics of India based on Civil Registration System-2019) and only 20.7% of the deaths are medically certified. 
• Besides there is variation in the online availability of death registration numbers and there is also a significant variation in the delay in registration of deaths across States. 
• Therefore, for countries like India, calculating excess deaths is not an easy task and the best way to do it is to individually calculate excess deaths for States with near 100% registration (based on a proper baseline for comparison) and to use suitable models to extrapolate deaths from limited data in others.