The coronavirus pandemic has caused almost 15 million deaths worldwide, a “staggering toll” which is almost three times higher than the official count, according to new estimates from the World Health Organisation.
Between January 2020 and December 2021, roughly 5.4 million Covid-19 fatalities were reported worldwide.
But according to long-awaited figures published on Thursday – described by the WHO director general, Dr Tedros Adhanom Ghebreyesus, as “sobering” – excess deaths in the first two years of the pandemic stand at 14.9m, roughly 13 per cent higher than normally expected.
The disparity is largely down to patchy testing, overwhelmed health systems and fragmented death registrations – even before the pandemic, around six in 10 deaths globally went unreported.
The excess death figures include fatalities directly linked to Covid-19 but also indirect deaths, including people who could not access healthcare for other conditions when systems were swamped during huge waves of infection. It also accounts for deaths averted during the pandemic, for example because of the lower risk of traffic accidents during lockdowns.
'Numbers are sometimes controversial'
Already the numbers have proved controversial, especially in India. The WHO estimates that the country witnessed 4.7m Covid deaths – 10 times the official figure of 482,000 – and almost a third of fatalities globally.
The majority of these deaths were during the devastating delta surge between May and June 2021, which hit rural India especially hard.
But although other studies have come to similar conclusions, the Indian government has stalled the publication of the WHO data – which had initially been earmarked for January – as it could embarrass both Prime Minister Narendra Modi and his ruling Bharatiya Janata Party (BJP).
On Thursday, government officials doubled down on that criticism, insisting that the registration of both births and deaths across the country is “extremely robust”.
“Despite India’s strong objection to the use of mathematical models for projecting excess mortality estimates, WHO has released excess mortality estimates without adequately addressing India's concern,” the government added. “Validity of models used, and data methodology are questionable.”
At a briefing on Thursday, WHO officials said their figures were based on a transparent process using the “best available data and a robust methodology”, and would be updated as and when new data emerges.
“Numbers are sometimes controversial,” said Dr Samira Asma, assistant director-general for data, analytics and delivery at WHO. “Covid has illuminated a staggering toll already – but also a staggering data gap… our goal is for every country to have robust surveillance and data information systems, and it is possible.”
Colin Angus, a modeller at the University of Sheffield who was not involved in the study, said the WHO's methodology “looks entirely sensible”, adding that excess death estimates are critical to hold governments to account.
“India in particular appears to have deliberately avoided acknowledging the true, vast impact that Covid has had there,” he said. “Similarly China has consistently reported implausibly low mortality figures, and a recent study found strong evidence that Russia's Covid mortality figures were being manipulated.”
'Staggering' global toll hit men hardest
The latest figures were compiled by a panel made up of international experts who have been working on the data for months, using a combination of national and local information, as well as statistical models, to estimate totals where the data is incomplete.
India is not the only country where the new estimates differ significantly from the official total; 68 per cent of excess deaths were concentrated in just 10 nations - including Indonesia, Russia and the United States. In Egypt, the excess death toll was 12 times higher than reported figures, while that figure was eight times higher in Pakistan.
The largest disparities are in lower income countries, the WHO added, with just 15 per cent of excess fatalities coming from high income nations. Meanwhile the figures suggest the toll was worse for men, who account for 57 per cent of deaths.
“Knowing how many people died during the pandemic will help us be better prepared for the next one,” added Dr Asma, who called data the “lifeblood of public health”.
The WHO figures are actually slightly lower than those separately compiled by the Institute for Health Metrics and Evaluation and The Economist, which put the figure at between 18 and 21m respectively.
It is tricky to precisely compare the pandemic’s toll to previous international health emergencies. Fatality estimates for the Spanish flu, for instance, vary widely – from 20m to 100m, although the global population was far smaller then.
But the Covid toll is far higher than for other infectious diseases. Each year tuberculosis kills around 1.5m people and HIV around 680,000 people, while 627,000 people died from malaria last year.
Commenting on the figures Dr Michael Head, a senior research fellow in global health at University of Southampton, told the Telegraph that they demonstrate the need to boost routine data surveillance.
“A lack of real-time reporting in most countries around the world means that modelled estimates of the total death toll are as close as we'll ever get to the final numbers,” he said
“One 'lesson learned' for future pandemic preparedness should also look at strengthening routine datasets. Many countries don't have reliable birth and death registers. Availability of Covid-19 tests and real-time reporting has often also been difficult.”
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