The methods were developed by the Technical Advisory Group for COVID-19 Mortality Assessment and rely on a statistical model derived using information from countries with adequate data; the model is used to generate estimates for countries with little or no data available.

New estimates from the World Health Organization (WHO) show that the full death toll associated directly or indirectly with the COVID-19 pandemic between 1 January 2020 and 31 December 2021 was approximately 14.9 million (or almost 1.5 crore people).

According to WHO, the numbers of people who died due to COVID-19 in 2020 and 2021 hover anywhere between 13.3 and 16.6 million. In short, this is almost thrice the number of deaths attributed to the disease so far.

The full death toll associated directly or indirectly with the COVID-19 pandemic is defined as an excess mortality, experts explain, reasoning that many deaths attributable to the pandemic were not counted as COVID-19 deaths.

Excess mortality is calculated as the difference between the number of deaths that have occurred and the number that would be expected in the absence of the pandemic based on data from earlier years. Excess mortality includes deaths associated with COVID-19 directly (due to the disease) or indirectly (due to the pandemic’s impact on health systems and society).

“These sobering data not only point to the impact of the pandemic but also to the need for all countries to invest in more resilient health systems that can sustain essential health services during crises, including stronger health information systems,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.

Deaths linked indirectly to COVID-19 are attributable to other health conditions for which people were unable to access prevention and treatment because health systems were overburdened by the pandemic. The estimated number of excess deaths can be influenced also by deaths averted during the pandemic due to lower risks of certain events, like motor-vehicle accidents or occupational injuries, the global health body said in its statement.

Includes India

Most of the excess deaths (84 per cent) are concentrated in South-East Asia, Europe (in WHO administrative parlance, a region including India), and the Americas. Some 68 per cent of excess deaths are concentrated in just 10 countries globally.

Middle-income countries account for 81 per cent of the 14.9 million excess deaths (53 per cent in lower-middle-income countries and 28 per cent in upper-middle-income countries) over the 24-month period, with high-income and low-income countries each accounting for 15 per cent and 4 per cent, respectively.

The estimates for a 24-month period (2020 and 2021) include a breakdown of excess mortality by age and sex. They confirm that the global death toll was higher for men than for women (57 per cent male, 43 per cent female) and higher among older adults. The absolute count of the excess deaths is affected by the population size.

The number of excess deaths per 100,000 gives a more objective picture of the pandemic than reported COVID-19 mortality data.

“Death is of course an important health outcome, and measurement of excess mortality is an essential component to understand the impact of the pandemic. Shifts in mortality trends provide decision-makers information to guide policies to reduce mortality and effectively prevent future crises. Because of limited investments in data systems in many countries, the true extent of excess mortality often remains hidden,” said Dr Samira Asma, Assistant Director-General for Data, Analytics and Delivery at WHO.

“These new estimates use the best available data and have been produced using a robust methodology and a completely transparent approach.”

Based on data

The production of these estimates is a result of a global collaboration supported by the work of the Technical Advisory Group for COVID-19 Mortality Assessment and country consultations. The group, convened jointly by the WHO and the United Nations Department of Economic and Social Affairs (UN DESA), consists of many of the world’s leading experts, who developed an innovative methodology to generate comparable mortality estimates even where data are incomplete or unavailable.

“Data is the foundation of our work every day to promote health, keep the world safe, and serve the vulnerable. We know where the data gaps are, and we must collectively intensify our support to countries, so that every country has the capability to track outbreaks in real-time, ensure delivery of essential health services, and safeguard population health,” said Dr Ibrahima Socé Fall, Assistant Director-General for Emergency Response.

This methodology has been invaluable as many countries still lack capacity for reliable mortality surveillance and therefore do not collect and generate the data needed to calculate excess mortality. Using the publicly available methodology, countries can use their own data to generate or update their own estimates.

Stefan Schweinfest, Director of the Statistics Division of UN DESA, added: “Data deficiencies make it difficult to assess the true scope of a crisis, with serious consequences for people’s lives. The pandemic has been a stark reminder of the need for better coordination of data systems within countries and for increased international support for building better systems, including for the registration of deaths and other vital events.”