WHO’s Methodology Has Been Robust’ 

News: Recently, the World Health Organisation estimated the excess mortality caused by the pandemic 

What is the scope of WHO’s estimate? 

WHO is measuring the excess mortality to understand the net effect of a pandemic.

Here, excess mortality means the difference between what would have been expected to be the mortality if there had been no pandemic as compared to the actual mortality occurring which include covid deaths, deaths due to the disruption of other essential health services and worsening of social determinants like poverty.  

India’s institutional measures for recording death 

The Civil Registration System (CRS): It is organised by the Registrar General of India (RGI), and is uniformly operated across India. The states are required to implement it, and they don’t have any flexibility.  

Issues in CRS: This system faces a number of issues. The death registration in CRS is weak. In fact, the certification of cause of death is as low as 21%. 

India’s Sample Registration System (SRS): 

It is implemented by RGI to overcome weaknesses in CRS and get a better sense of mortality in India. Therefore, people are sent to survey villages, to verify death registration, search for missing deaths and explore causation. By convention, it is considered to be the gold standard for mortality. 

Issues: India’s Sample Registration System (SRS) is the main source of mortality data. However, SRS usually comes out after a two-year lag. Therefore, unfortunately, SRS data is not available for 2020 and 2021.  

What are the issues in the estimation of excess mortality?

As per SRS and CRS report in 2019, Only 13 states and 4 UTs recorded 100% reporting which did not include large and populous states. Therefore, we cannot rely upon the death reporting done during covid when there was so much disruption.  

Another important issue is that the Covid deaths were collected through a parallel system (collected directly from district administrators reporting it from laboratories and from hospitals), not through the civil registration and vital statistics system. Therefore, they had no cross-reference with the rest of the system. Like CRS and SRS.  

Why WHO approach and its estimation about the bulk of the excess deaths in 2021 is correct? 

There are numerous direct and indirect effects of using the excess mortality indicator. For example, it helps to take into account mortality which occurs due to indirect causes. Therefore, the WHO’s methodology has been robust. If anything, it’s an underestimate. 

The WHO has used death data from those states which have put the death data in the public domain. Thereafter, WHO has extrapolated the data for the whole country.  

WHO’s numbers are in sync with at least five other studies. They have all come to similar conclusions.  

Way Forward 

Government should release its own estimate of excess mortality data as soon as possible. The data should not remain confined to the government itself.  

The best way to validate it is to triangulate it across different methods. That holds out the validity of WHO’s study.