An ambitious effort by the World Health Organization to calculate the global death toll from the coronaviruses has found that more people died than previously thought.
The release of the staggering estimate, the result of more than a year of research and analysis by experts around the world and the most comprehensive look at the lethality of the epidemic to date, has been delayed for months because of objections from India.
More than a third of the additional nine million deaths are estimated to have occurred in India, where the government of Prime Minister Narendra Modi has stood by its own count. According to people familiar with the numbers who were not authorized to disclose them, India has the highest toll in the world. The Times couldn't find the estimates for other countries.
The W.H.O. calculation combined national data on reported deaths with new information from localities and household surveys, and with statistical models that aim to account for deaths that were missed. Most of the difference in the new global estimate represents previously uncounted deaths, the bulk of which were directly from Covid; the new number also includes indirect deaths, like those of people unable to access care for other ailments because of the Pandemic.
The global data is essential for understanding how the Pandemic has played out and what steps could be taken to mitigate it in the future. The United Nations Statistical Commission, the world body that gathers health data, is in turmoil because of India's refusal to cooperate.
It is important for global accounting and the moral obligation to those who have died. The Centre for Global Health Research in Toronto is a member of the expert working group supporting the W.H.O.
demographers, public health experts, statisticians and data scientists were assembled by the W.H.O. to try to take the true measure of the Pandemic. The Technical Advisory Group has been working with other countries to piece together the most complete accounting of the dead.
More than 10 people were spoken to by The Times. The W.H.O. had planned to make the numbers public in January but the release has continually been pushed back.
Three people familiar with the matter said that a few members of the group warned the W.H.O. that if they didn't release the figures, the experts would.
A W.H.O. spokeswoman told The Times that they aim to publish in April.
The release of the data has been slightly delayed according to Dr. Asma, the W.H.O.'s assistant director general for data, analytics and delivery for impact.
The W.H.O.'s methodology is flawed according to India. The process did not hold scientific rigor and rational scrutiny as expected from an organization of the stature of the World Health Organization.
The Ministry of Health in New Delhi did not respond to questions.
The new W.H.O. numbers show that India is not alone in undercounting deaths.
Many countries have struggled to calculate the impact of the Pandemic. Even in the most advanced countries, she said, it is challenging.
She said that India brought a large team to review the W.H.O. data analysis because it wanted the model to be as transparent as possible.
India's work on vaccination has been praised by experts around the world, but its public health response to Covid has been criticized for overconfidence. In January of 2021, Mr. Modi claimed that India had saved humanity from a big disaster, and a couple of months later, his health minister declared that the country was in the middle of Covid-19.
Science in India has become politicized. In February, India's junior health minister criticized a study published in the journal Science that estimated the country's Covid death toll to be six to seven times greater than the official number. In March, the government questioned the methodology of a study that estimated India's deaths at four million.
Bhramar Mukherjee is a professor of biostatistics at the University of Michigan School of Public Health and has been working with the W.H.O. You can't just say I'm not going to accept it.
For the past two years, India has not submitted its total mortality data to the W.H.O., but the organization's researchers have used numbers from at least 12 states, which experts say show at least four to five times.
The initial presentation of the W.H.O. global data was ready in December, according to Jon Wakefield, a professor of statistics and biostatistics at the University of Washington who played a key role in building the model used for the estimates.
India was unhappy with the estimates. The paper is a lot better now that we have done all sorts of sensitivity analyses, because we have gone too far in terms of model checks.
The numbers show the difference between the deaths that occurred and the deaths that would have been expected. The W.H.O. calculations include deaths from Covid, deaths of people complicated by Covid, and deaths of people who did not have Covid but needed treatment. The expected deaths that did not occur because of Covid restrictions are taken into account.
Calculating excess deaths is not easy. The W.H.O. has had to use modeling to round out the picture because some countries have only partial data. Almost all of the countries in sub-Saharan Africa do not collect death data and the statisticians have had to rely on modeling.
According to Dr. Asma of the W.H.O., nine out of 10 deaths in Africa and six out of 10 globally are not registered, and more than half the countries in the world do not collect accurate causes of death. She said that the starting point for this kind of analysis is a guesstimate.
The experts in the advisory group used statistical models and made predictions based on country specific information such as containment measures, historical rates of disease, temperature and demographic to assemble national figures and, from there, regional and global estimates.
The data is uncertain in other large countries, like India.
Russia's ministry of health reported 300,000 Covid deaths by the end of 2021, but the Russian national statistics agency found excess mortality of more than one million people. The group said that Russia objected to the number but did not try to stall the release of the data.
China does not publicly release mortality data, and some experts have raised questions about under reporting deaths at the beginning of the outbreak. China has reported a low number of deaths from the virus.
Some of the world's strictest lockdowns have had an impact on public health, and China has kept its caseloads at a lower level than most countries. One of the few studies to examine China's excess mortality using internal data, conducted by a group of government researchers, showed that deaths from heart disease and diabetes spiked in Wuhan during the two-month lockdown. The researchers said that the increase was most likely due to inability or reluctance to seek help at hospitals. The death rate in the first quarter of 2020 was 50 percent higher than expected.
India's attempt to stall the report's release makes it clear that the Modi government is interested in the data.
The World Mortality Dataset, built and maintained by an Israeli economist, is challenging for governments when they show high excess deaths.
The reporting was contributed by Vivian Wang.
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