The government has not ruled out the possibility of the role of global pharmaceutical majors influencing the World Health organisation (WHO) report that suggested that 4.7 million (47 lakh) people died in India as a result of the Covid-19 pandemic against the official tally of 4.8 lakh during the January 2020-December 2021 period.
In a serious charge against the global health watchdog, top sources in the government said that global pharma majors, who were denied entry to the Indian anti-Covid vaccine market, could be behind the report that adopted a “faulty methodology” to project a higher death toll in India.
The WHO report titled ‘Global excess deaths associated with COVID-19 (modelled estimates)’ stated that most of the excess deaths (84%) were concentrated in South-East Asia, Europe, and the Americas. Around 68% of the excess deaths were concentrated in just 10 countries. Middle-income countries accounted for 81% of the 14.9 million excess deaths (53% in lower-middle-income countries and 28% in upper-middle-income countries) over 24 months, with high-income and low-income countries accounting for 15% and 4%, respectively.
Terming the report “mischievous”, government sources said attempts were being made to release the report since November last year, ahead of the crucial assembly elections in five states. “There was apprehension in the government that the report with the exaggerated death toll was an attempt to malign it and its efforts against the pandemic before the crucial elections. There is a feeling that pharma majors who were denied entry into the Indian market could be the moving force behind the effort,” an official said.
After the WHO released the report, the Government of India objected to the methodology used to project excess mortality estimates.
The Opposition led by Rahul Gandhi had earlier attacked the government for under-reporting the deaths in India.
India strongly challenged the WHO report that on May 5 claimed that the country accounted for a significantly higher Covid-19 death toll than specified in official figures.
The statement released by the government read: “Despite India’s objection to the process, methodology and outcome of this modelling exercise, WHO has released the excess mortality estimates without adequately addressing India’s concerns."
'MULTIPLE AMENDMENTS TO WHO REPORT'
Interestingly, top government sources said that the WHO amended the death toll several times during the November 2021-May 2022 period as India was posing a strong challenge. A WHO source confirmed that between November 2021 and May 2022, the Indian health ministry had fired nine letters to the organisation, challenging the mathematical model and the criteria, under which India was being evaluated
Sources said that India’s first challenge through a letter was sent to the WHO on November 17, 2021, followed by eight others (on December 20, 2021, December 28, 2021, January 11, 2022, February 12, 2022, March 2, 2022, March 14, 2022, April 28, 2022, and May 2, 2022).
The Centre sent the letters after receiving a tip in late October 2021 that the WHO was planning a report with doubtful methodology to project a higher-than-reported death toll during the pandemic way.
The Centre responded by challenging the WHO and rallying nations to exert pressure on the global health body. Sources said that there were five virtual meetings between Indian health authorities and WHO representatives (on December 16, 2021, December 28, 2021, January 16, 2022, February 25, 2022, and February 10, 2022, at the SEARO Regional Webinar).
“At these meetings, we strongly questioned the manner in which the RTI pleas, newspaper reports and portal data was extrapolated to project a death rate way higher than the actual. We questioned the sources of information, the method, and the credibility of the data used to arrive at the death toll,” an official said.
'INDIA CAN'T BE CATEGORISED WITH SMALLER NATIONS'
The Centre strongly opposed the categorisation of India with small African nations in the methodology. As many as 16 countries are said to have rallied around India’s opposition against the WHO methodology.
Referring to the report, which contains nationwide data on births and deaths, the statement read: “These reports are in the public domain. India firmly believes that such robust and accurate data generated through the legal framework of a member state must be respected, accepted, and used by WHO rather than relying on less accurate mathematical projection based on unofficial sources of data."
Another official said, “The WHO clubbed all countries in two categories: One category was for those that maintained proper registration of deaths and the other for those where registration was not there. India was kept in the second category.”
Government sources said that the WHO released the report on May 5 despite the entire record of death registration provided by the Registrar General of India (RGI) to back India’s stand that death registration has been mandatory in India since 1969 and currently, 99.9% of deaths are registered.
The official said, “On May 3, 2022, India officially communicated to WHO that the RGI has released all-cause mortality figures for the year 2020 and requested the WHO to utilize the official set of data for reporting the pandemic mortality and refrain from publishing data based on estimates.”
“There were other serious flaws in the methodology. Not once did the WHO clarify the categorisation of countries under Tier-1 and Tier-2. India continuously asked the global body to explain why we were being bracketed with countries like Paraguay, small African nations, and countries smaller than even the states in India,” the officials said.
In the first few letters, India raised multiple concerns over the process followed, methodology adopted, selection of data sources for estimation, and the outcome of such a modelling exercise, particularly with respect to India.
The key concern raised by India included: “How can a statistical model be used for calculating excess mortality for a country of geographical size and a population of India when the trajectory of the pandemic has varied across periods and within various parts of the country.”
NO JUSTIFICATION FROM WHO
India said that WHO was attempting a one-size-fits-all approach, which may be true for smaller countries, but not for India with a population of 1.4 billion.
Government sources said that over months, India contested the widely varying sets of estimates of excess mortality. India also objected to the use of data from 17 Indian states obtained through state portals and through RTIs filed by journalists instead of obtaining the same through official channels of the Government of India.
Flagging the fluctuations in official reporting of Covid-19 data from some of the tier-I countries, including the USA, Germany, France, et al, which defies epidemiological patterns observed globally, the Centre asked for justification for classifying these countries under Tier-I and India under tier-II. Sources said that no justification was received from WHO.
For Tier II countries, the modelling exercise used a set of historic estimates, disregarding the data available with the country to arrive at the present estimates.
India as a country, with a population of continental proportions, highlighted that using a binary measure of income instead of a more realistic graded variable would lead to amplifying the value of the variable, which in turn, would lead to incorrect estimates.
Dismissing the WHO report, a senior health ministry official said, “In one model, India's age-sex distribution of predicted excess deaths was extrapolated based on the age-sex distribution of excess deaths reported by four countries (Costa Rica, Israel, Paraguay and Tunisia). No satisfactory justification for the same was given.”
When India asked the WHO to run their model on all tier-I countries to prove its validity and share the details with member states, the global health body stated that they did not collect such information from these nations.
The Centre said the WHO tried to justify their model by mentioning other models, which also used “nationally representative telephonic survey” as an approach to calculate their estimates.
India is said to have categorically stated that such a justification is not accepted and WHO is expected to follow robust scientific processes on the issue.
CENTRE RALLIES STATES AGAINST WHO DEATH CLAIMS
To create a credible domestic counter against the WHO claims Health Minister Mansukh Mandaviya organised a chintan shivir or brainstorming session in Gujarat. Health ministers of 27 states, including those from the ones whose data was used by the WHO, attended the meeting. The state health ministers strongly contested the WHO’s claim and pushed for a resolution against the report.
These included health ministers from many Opposition-ruled states. The meet passed a resolution stating that the “CCHFW is deeply disappointed by WHO’s modelling based exorbitant estimates of excess mortality in India during the pandemic. These estimates are drawn from flawed mathematical assumptions are unacceptable and the conference rejects the estimates of excess deaths during the pandemic published by WHO.”
The Centre now plans to send this resolution to the who to add to its counter.