Covid-19’s true toll on India

India is no stranger to political controversies. At least half a dozen rage in its fractious public life at any time. But perhaps the most unseemly recent dispute has been the current one over the country’s Covid-19 mortality figures.

The pandemic hit India hard, particularly during the second wave in April–June 2021, when people were dying from Covid-19 in hospital waiting rooms and carparks, while others succumbed due to a lack of medical oxygen. Countless funeral pyres glowed in the darkness along the banks of the Ganges, even as some poor families, unable to afford a funeral, wrapped their loved ones in shrouds and sent them floating down the river.

But, despite widespread anecdotal evidence of a catastrophic pandemic death toll, official Indian figures told a different, although still alarming, story. Prime Minister Narendra Modi’s government estimated that, between the start of the pandemic in January 2020 and March 2022, just over half a million deaths were attributable to Covid-19. Many Indian journalists were sceptical, pointing out that the official figure was well below even the number of compensation payouts made by state governments to the families of Covid-19 victims. The respected British medical journal The Lancet published a study suggesting that India’s numbers were a gross undercount. But the government stood its ground.

It took an explosive report from the World Health Organization earlier this month to blow the lid off the government’s claims. Using the measure of ‘excess deaths’—based on pre-pandemic mortality rates in the same area—the WHO estimated the number of Covid-19 deaths in India at 4.7 million. That was nearly 10 times higher than the government was prepared to admit and accounted for almost a third of the estimated 15 million pandemic deaths globally.

The government, which had at first tried unsuccessfully to stall the adoption of the report, denounced it, citing concerns about the WHO’s methodology. But, given that lower Covid-19 mortality figures are an essential part of the government’s messaging, the denials were widely seen as an attempt to counter unfavourable publicity about its management of the pandemic.

India is an important member of the WHO, and its health minister chaired the body’s executive committee during the first year of the pandemic. It is safe to assume that, as a United Nations organisation, the WHO has no desire to score political points against the government of a leading member state. But the need to have an accurate Covid-19 mortality count so that the world can prepare better for the next pandemic obliged the organisation to ignore the sensitivities of national governments and issue its report. (Several other calculations and surveys had reached similar conclusions about the scale of Covid-19 mortality in India, with estimates putting the death toll at 3–5 million.)

Ironically, the WHO’s figures nonetheless confirm that India did not do all that badly relative to other countries in tackling the pandemic. Although India’s Covid-19 fatality rate of 1.2% of confirmed cases is the seventh highest globally, the country does not figure in the top 100 in terms of deaths per million population. It’s possible that many more people in India were infected than diagnosed, and that the true fatality rate is therefore lower, even if the absolute numbers are high as a result of India’s large population.

It would therefore have been better for the government to accept the WHO’s figures and frame them as relatively good news, rather than kicking up a controversy that has put it in an unflattering light internationally. By challenging a well-established methodology used by epidemiologists worldwide, the government has triggered much more discussion of the inadequacies of India’s civil registration system, its reporting of infections and deaths, and the credibility of its official statistics more generally.

India should have admitted that the draconian, Chinese-style lockdown the government imposed when the pandemic began in 2020 paralysed much administrative activity, including the reporting and registration of deaths (not just from Covid-19). Field surveys were not conducted and statistical sampling was based on inadequate data. While things improved in that regard in 2021, shifting patterns of lockdowns and the severity of the second wave also interfered with the maintenance of accurate records. The government could simply have asked the WHO to include a footnote in the report explaining that, for these reasons, the organisation’s estimates of Covid-19 deaths in India were based on a modelling exercise.

Instead, Indian officials made the preposterous claim that 99.9% of all Covid-19 deaths to date were registered in 2020, and that the increase in ‘excess deaths’ really reflects an improvement in registration. This is so palpably untrue as to cast doubt on the government’s overall trustworthiness.

A country whose statistics were once considered a model for the developing world has embarrassingly been portrayed as one whose official numbers are tailored to suit the government’s preferred narrative. Amid widespread international scepticism about the integrity of India’s official mortality data, the WHO has relegated India to a category of countries whose Covid-19 numbers must be estimated through statistical models instead.

Life and death cannot be a matter of opinion. Accurate mortality figures enable a country to understand the scale of a tragedy, honour the dead, compensate the living and better gauge what kind of measures will be required to prepare for future public-health crises.