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An ambitious effort by the World Health Organization to calculate the global death toll from the coronavirus pandemic has revealed that far more people have died than previously believed – nearly 15 million at the end of 2021, more than double the official total of six million. reported by countries separately.

However, the publication of the startling estimate, the result of more than a year of research and analysis by experts around the world, and the most comprehensive review to date into the lethality of the pandemic, was delayed for months due to objections from India. It objects to the calculation of how many of its citizens have died and is trying to prevent it from being made public.

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’s own count was about 520,000. According to people who know the numbers and are not authorized to explain, WHO will show that the death toll in the country is at least four million, giving India the highest figure in the world, they said. The Times was unable to learn the estimates for other countries.

The WHO calculation combined national data on reported deaths with new information from residential and household surveys and statistical models aimed at accounting for missed deaths. Most of the difference in the new global estimate represents previously uncounted deaths, most of which are directly due to Covid; The new number includes indirect deaths, such as people unable to access care for their other ailments due to the pandemic.

The delay in releasing the figures is significant because global data are crucial to understanding how the pandemic has developed and what steps might mitigate a similar crisis in the future. It has wreaked havoc in the normally solemn world of health statistics – a feud unfolding in anodyne language at the United Nations Statistical Commission, the world body that collects health data, encouraged by India’s refusal to cooperate.

“It’s important for global accounting and moral obligation to the deceased, but also very important practically. If there are subsequent waves, then truly understanding the death toll is key to knowing whether vaccination campaigns are working,” said Dr. Prabhat Jha. “And it is important for accountability.”

To try to get the true measure of the impact of the pandemic, WHO gathered a collection of experts, including demographers, public health experts, statisticians and data scientists. As is known, the Technical Advisory Group collaborates between countries to try to put together the most complete accounting of pandemic deaths.

The Times spoke to more than 10 people familiar with the data. WHO had planned to release the numbers to the public in January, but the statement has been consistently published. pushed back.

Recently, several members of the group warned WHO that experts would do it themselves if the organization didn’t release the figures, three familiar with the matter.

“We aim to publish in April,” WHO spokesperson Amna Smailbegovic told The Times.

WHO’s deputy director general of data, analytics and deployment for impact and helping lead computing, Dr. Samira Asma said the release of the data was “a little delayed”, but that it was “just because we wanted to be sure”. Everyone’s opinion is taken.”

India insists that WHO’s methodology is flawed. “India considers the process neither collaborative nor adequately representative,” the government told the United Nations Statistics Commission in February. He also argued that the process “lacks the scientific rigor and rational scrutiny one would expect from an organization like the World Health Organization.”

The Ministry of Health in New Delhi did not respond to requests for comment.

India is not alone in undercounting pandemic deaths: The new WHO figures also reflect the undercount in other populous countries such as Brazil and Indonesia.

Dr. Asma noted that many countries are struggling to accurately calculate the impact of the pandemic. “I think it’s hard when you look under the hood,” he said, even in the most developed countries. He said that at the start of the pandemic, there were significant differences in how quickly different US states reported deaths, with some still collecting data via fax.

India said it had brought in a large team to review the WHO data analysis and said it was glad the agency did so because it wanted the model to be as transparent as possible.

India’s work on vaccination has won the praise of experts around the world, but its public health response to Covid has been criticized for overconfidence. Mr Modi boastful He said in January 2021 that India had “saved humanity from a great disaster”. A few months later, the health minister of the country “In the last game of Covid-19.” laxity, causing wrong steps and attempts by the authorities to silence critical voices within elite institutions.

science in india increasingly politicized. during the pandemic. In February, India’s young health minister criticized a study published in the journal Science This estimates that the number of Covid deaths in the country is six to seven times higher than the official figure. in March, the government questioned methodology of a published study Lancet This estimated India’s deaths at four million.

“I personally felt that science should always be answered with science,” said Bhramar Mukherjee, professor of biostatistics at the University of Michigan School of Public Health, who worked with WHO to review the data. “If you have an alternative guess through rigorous science, you have to produce it. You can’t say, ‘I won’t accept it.'”

India has not submitted total death data to WHO for the past two years, but the organization’s researchers used numbers collected from at least 12 states, including Andhra Pradesh, Chhattisgarh and Karnataka, which experts say show at least four to five times more. Deaths as a result of Covid-19.

Jon Wakefield, professor of statistics and biostatistics at the University of Washington, who played a key role in creating the model used for predictions, said the first presentation of WHO global data is ready in December.

“But then India was not happy with the forecasts. So we then did all kinds of sentiment analysis, the paper is actually much better because of that wait, because we went overboard with the model checks and did our best to give the data we had.” Dr. Wakefield said. “And we’re ready to go.”

The numbers represent what statisticians and researchers call an “excessive mortality rate”—the difference between all deaths that occur and those expected to occur under normal circumstances. WHO’s calculations include deaths directly caused by Covid, human deaths caused by conditions complicated by Covid, and deaths by those who do not have Covid but need treatment for which they were unable to receive treatment because of the pandemic. Calculations also take into account expected deaths that did not occur due to Covid restrictions, such as those from traffic accidents.

Calculating over-deaths globally is a complex task. Some countries closely monitored mortality data and immediately submitted them to WHO. Others provided only partial data and the agency had to use modeling to complete the picture. And there are many countries, including almost all in sub-Saharan Africa, that do not collect mortality data and that statisticians have to rely entirely on modelling.

WHO’s Dr. Asma noted that nine out of 10 deaths in Africa and six out of 10 deaths worldwide are unregistered, and more than half of the world’s countries do not collect the exact causes of death. This means that even the starting point for this type of analysis is an “estimate”. “We have to be humble about it and say we don’t know what we don’t know.”

To generate mortality estimates for countries with partial or no death data, experts in the advisory group used statistical models and made estimates based on country-specific information such as containment measures, historical morbidity rates, temperature and demographics to aggregate national figures, and from there, regional and global forecasts.

Besides India, there are other major countries for which the data is uncertain.

Russia’s health ministry had reported 300,000 Covid deaths by the end of 2021, and that’s the number the government gave WHO. this is reportedly close to that of the WHO draft. Group members said Russia disputed that number, but made no effort to stop the data being released.

China, where the pandemic started, does not publicly release death data, and some experts have raised questions about underreporting of deaths, particularly at the start of the outbreak. China has officially reported fewer than 5,000 deaths from the virus.

While China has indeed kept its caseloads at much lower levels than most countries, it has done so in part with some of the world’s strictest quarantines – with its own impact on public health. Somebody a few studies To examine China’s excess mortality rate using internal data conducted by a group of government researchers, it showed that deaths from heart disease and diabetes increased during the two-month quarantine in Wuhan. The increase was most likely due to the inability or unwillingness to seek help in hospitals, the researchers said. They concluded that the overall death rate in Wuhan was about 50 percent higher than expected in the first quarter of 2020.

India’s effort to delay publication of the report makes it clear that the pandemic data is a sensitive issue for the Modi government. “This is an unusual step,” said Anand Krishnan, professor of community medicine at the All India Institute of Medical Sciences in New Delhi, who also worked with WHO to review the data. “I don’t remember a time in the past when he did that.”

Ariel Karlinsky, an Israeli economist who created and maintains the World Deaths Dataset and worked with the WHO on the numbers, said governments were challenged when they showed high excess mortality. “I think it’s very reasonable for people in power to fear these consequences.”

Vivian Wang contributing reporting.