On May 5, the World Health Organisation finally bit the bullet and published its report on excess deaths associated with Covid-19.
Three weeks before, on April 16, the New York Times claimed that India had been seeking “for months” to suppress the WHO report, apparently on the grounds of “concerns over methodology”. According to an anonymous member of the WHO Technical Advisory Group, India had sought to delay the publication of the report for 10 years. These objections, even before the report was released, were examined critically by data journalist Rukmini S and found to be misleading.
The WHO report estimated that between 2020 and 2021 there were 14.9 million “excess deaths” world-wide. This “excess deaths” number is an estimate based on statistical modelling using the best available actual data from a range of sources. It is the number of deaths over and above the baseline number expected in the absence of Covid, that are estimated to have occured in those 24 months from all causes; it is a net figure that takes into account the deaths that might have been prevented by measures such as lockdowns and travel restrictions.
For India, WHO’s estimate is 4.7 million excess deaths (see table).
Indian authorities are not pleased with the WHO’s numbers. The ministry of health and family welfare in a press release made the government of India’s position clear – it did not agree with the methods used, was disappointed that the data provided by India was “ignored”, and rejected the claim that the true human cost of Covid in India may have been almost 10 times the officially reported figure.
However, it did not come up with its own estimate of the extent of under-reporting, implying that it was firmly standing by the officially reported number of dead – 481,486 as on December 31, 2021, and 524,064 as of May 7, 2022.
There were individual rebuttals also from the civil servants in charge of India’s pandemic response. Randeep Guleria, the chief of New Delhi’s All India Institute of Medical Sciences, Balram Bhargava, the head of the Indian Council of Medical Research, and Vinod K Paul of Niti Aayog all put out tweets or gave interviews objecting to the WHO report. Remember, these were three of the four top doctors who “botched India’s Covid response” according to health journalist Vidya Krishnan. At the political level, a meeting of state health ministers with the union health minister Mansukh Mandaviya passed a resolution rejecting the WHO report, because it “attempts to tarnish India’s image”.
Health journalist Banjot Kaur has summarised and examined the arguments comprehensively, finding them weak, irrelevant and in parts disingenuous. The WHO’s is merely the latest in a series of academic publications like this one by Prabhat Jha, a professor at the University of Toronto’s Centre for Global Public Health, and reports by health and data journalists, all of which conclude that the officially reported deaths are serious undercounts.
Without a doubt, the weight of scientific evidence would lead any thinking person to the safe conclusion at least that deaths were undercounted everywhere, including India. There may be a debate to be had about the extent of such undercounting and the likely true mortality numbers. Even the WHO estimate of 4.7 million deaths for India comes with a margin of error such that the real number could be somewhere between a lower estimate of 3.3 million and an upper bound estimate of 6.47 million. Indeed, the WHO estimate is at the lower end of the many studies that have looked at this question using different methods.
And yet, officially, India, supported by some journalists with reach, has chosen to reject outright the conclusions of the WHO’s analysis.
Why? Why the extreme pigheaded obstinacy?
I believe the answer lies in the political compulsion to maintain a façade of nationalist pride that was erected at the start of the Modi government in 2014. A facade that rested on the idea of India as an ancient civilisational superpower that had long been denied its rightful place in the world by a combination of western imperialist tendencies supported by an English-speaking elite in academia and among sections of the intelligentsia.
While the propagation of this notion may have started as convenient electoral campaign rhetoric, it soon demanded continually to be fed, as Shivam Vij wrote in May 2020, by a steady stream of increasingly brazen lies, denials of obvious truths, and grandiose claims merely to keep up the pretence.
In the case of Covid deaths, the Big Lie that has to be fed, watered and sustained is the grandiloquent speech on January 28, 2021 by prime minister Modi at a plenary session of the World Economic Forum at Davos.
To fully comprehend the effect of that speech on the subsequent course of the pandemic and India’s approach to its management, one needs to listen to it fully or read the official transcript.
The context is relevant. As of that date, India had reported 10.73 million infections (10.4 percent of the world’s total at that time) and 152,274 deaths (6.6 percent of the world total). The vaccination programme in India had been launched two weeks earlier on January 16, 2021, just a few weeks after the first vaccines had been administered in the UK on December 8, 2020 and in the United States on December 14, 2020.
And yet, PM Modi told his Davos audience that India had “saved humanity from a big disaster by containing corona effectively”. He claimed that at the start of the pandemic, experts (whom he did not name) had “predicted that India would be the most affected country”, with “700-800 million Indians infected” and two million dead. But, the prime minister claimed, by taking a “proactive approach with public participation”, by “strengthening Covid-specific health infrastructure”, and using “technology massively for testing and tracking”, India had pulled through, and had defeated the coronavirus.
Looking to the future, he said India was fulfilling its global responsibility, giving “online training to health workers from other countries” and guiding “the world regarding...ayurveda” which was “helpful in boosting immunity”.
This was hubris. Yes, cases were coming down at the time, but a second wave was predicted. No one knew for certain that vaccines could be rolled out fast enough, or that they would be effective. It was not immediately obvious what the “Covid-specific health infrastructure” was in reality. No country was being complacent because there were no easy answers, no magic antiviral drug. But the prime minister was promoting ayurveda despite the lack of serious science behind it. This was the rhetoric of an Indian exceptionalism that was as expedient as it is without basis in fact.
The WHO report now of an estimated 4.7 million deaths associated with the pandemic – almost 10 times the officially reported number – must bring back painful memories of the terrible events of the summer of 2021. Indeed 2.38 million of the 4.7 million deaths – fully half of all the excess deaths – are thought to have occurred in the two months of May and June 2021. This grim statistic is in keeping with the news reports of the time: of long queues at cremation grounds, makeshift funeral pyres, and bodies washing up on river banks. That the official recorded number of dead was far fewer allowed the government to brazen it out and hide the real truth at the time, and the prime minister to stay out of sight until things calmed down.
To accept the death toll estimated by the WHO report would be to question Modi about the bold assertions he made, and the glorious role for India that he promised to his Davos audience. Having claimed that India would “save humanity from a disaster by controlling corona effectively”, his government cannot now be seen to accept a report that says India accounted for a third of the excess deaths. Stout denial was the only option.
In any civilised democracy, questions would be asked of those in charge – the expert advisers and the political decision makers. But not in India, where a pliant media is more used to the theatre of Hindu versus Muslim communal debates than holding the executive to account.
In February this year, Harsh Mander asked the question, “How many people actually died in the second wave?” It was easy for the government to ignore his question then. Now that the WHO has given us its answer to Mander’s question, the government can hardly ignore it by silence. The only option is to obfuscate, object to the methodology, and refuse to accept the analysis of experts.
Hubris can only be sustained by denying the inconvenient truth. But pragmatic lessons can only be learned by accepting the grim reality presented by the best experts in the world, and resolving to improve systems of death registration and certification throughout the country.
Lulled by an unexpectedly mild first wave, India was led into denial and complacency, paying a heavy price in the second wave. Now our denial, post hoc, of the real cost of the second wave renders it that much harder to make the changes needed to be better prepared for the next health emergency.
Update on May 13: In the context of the WHO's margin of error, a previous version of this report incorrectly said the real number could be between a lower estimate of 2.7 million and an upper estimate of 5.3 million. This has been corrected to 3.3 million and 6.47 million, respectively. The error is regretted.
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