WHO: Excess deaths from COVID-19 pandemic 3 times more than reported

The World Health Organization said overall deaths caused by the COVID-19 pandemic are nearly 10 million higher in the first two years after the onset of the pandemic than what was officially reported. This is nearly three times the reported deaths.

Countries around the world reported 5.4 million COVID-19 deaths to WHO between January 2020 and December 2021 but the agency instead places the overall death toll — which includes deaths indirectly caused by COVID-19 — at about 14.91 million deaths.

The figures, released today, were the first excess mortality figures published by WHO for all member states.

This was a calculation of excess mortality — looking at the difference between a baseline rate of about 5 million deaths per month, which is based on deaths from pre-pandemic years, and the heightened deaths that occurred during the pandemic, according to Dr. William Msemburi, technical officer of the department of data and analytics at WHO.

Reported COVID-19 deaths were included, as well as deaths directly linked to COVID-19 that were not reported, and deaths not directly linked to the disease but due to the pandemic’s wider impacts on health systems and society.

“The health system actually has not been adequately able to respond because it has been overwhelmed by the COVID deaths,” Dr. Somnath Chatterji, senior adviser at WHO's department of data and analytics, said during a press briefing Wednesday. “Many people who would ordinarily not have died during this period have died because of the disruption.”

It also includes a subtraction of deaths that were averted during the pandemic, such as motor vehicle accidents.

“Excess death is a method widely considered an accurate metric and helps in providing a more complete picture of the pandemic,” said Dr. Samira Asma, assistant director-general for data, analytics, and delivery for impact at WHO, adding that more accurate figures help guide public health policies and interventions.

“When we underestimate, we may under-invest, and when we undercount, we may miss targeting the interventions where they are needed most,” she said.

Twenty countries account for over 80% of the estimated excess mortality due to COVID-19 globally between January 2020 and December 2021: Brazil, Colombia, Egypt, Germany, India, Indonesia, Iran, Italy, Mexico, Nigeria, Pakistan, Peru, the Philippines, Poland, Russia, South Africa, the United Kingdom, Turkey, Ukraine, and the United States.

Ten of these countries account for about 68% of excess deaths. Middle-income countries account for 81% of the global excess deaths and WHO’s Southeast Asia region, which includes India, leads with the largest discrepancy between reported and excess deaths — 6 million.

When looking at the ratio of reported cases to excess cases, the top countries are Burundi, Niger, Chad, Tajikistan, and the Democratic Republic of Congo, according to Msemburi. Burundi, which leads this list, only reported 14 COVID-19 deaths over that period. WHO counted over 9,300 excess deaths in Burundi for those two years.

Fifty-seven percent of the deaths were men and 82% of excess deaths are estimated to be above the age of 60, Chatterji said.

India’s pushback

Devex broke the story at the end of March that these figures were pending publication. It also reported the Indian government pushed back on their release. The government asked WHO to publish the figures only after a decade had passed.  

India had reported 481,000 COVID-19 deaths between 2020 and 2021. But WHO has estimated excess mortality at 4.74 million, almost 10 times the number reported by the Indian government — 830,000 of these deaths were in 2020 and the rest in 2021.

The Indian government has disputed WHO’s estimates. India’s Health Ministry released a statement in April that said Bangladesh, China, Egypt, Ethiopia, Iran, and Syria have also raised questions about WHO’s methodology and the use of “unofficial sets of data” for its mortality estimates. 

Steve MacFeely, WHO’s director of data and analytics, refuted this and said that India is the only country that raised objections to the methodology. Preempting the release of WHO’s data, the Indian government released its own figures on Tuesday, which said the country had about 475,000 more deaths in 2020 than the year before.

“It will take us some time to take a careful look [through India’s released figures] with what our estimates are and run it through the model,” WHO’s Asma said.

“We have consistently engaged and are engaging, as we speak with colleagues from India — to respond to the questions and come to an understanding,” she added. “Hopefully, we will find a mutual consensus with regard to the different estimates. Not only WHO and the India estimates, but also there are others that have also produced these estimates.”

Uncounted deaths

The figures released are still only an estimate because so many of the world’s countries have severely inadequate data collection systems. In preparing these estimates, data was only available from about half the countries around the world, Chatterji said, meaning that modeling was used to fill in gaps. The methodology was developed by a technical advisory group convened by WHO and the United Nations Department of Economic and Social Affairs. 

Before the pandemic, an estimated 60% of deaths were unregistered, with over 70 countries not producing cause of death statistics, MacFeely said.

“In the 21st century, this is really a shocking statistic,” he said, adding that the pandemic has highlighted the importance of “significantly greater investment” in civil registration, vital statistics, and health information systems.

"All is not good in the world of data. Too much is unknown; there are too much delays,” Asma said.

“Data sharing is an important area during peacetime and during health emergencies,” she added. “Data is important to save lives and to promote health.”

WHO will publish an update to these estimates, including data up to the end of June, later in the year, MacFeely said.