India opposes the WHO’s COVID-19 toll calculation methodology

The Union Health Ministry said on Saturday that India has been in regular and in-depth technical exchanges with the World Health Organization (WHO) on the issue of collecting and making public the COVID-19 death toll in the country, in response to an April 16 New York Times article titled India Is Stalling the WHO’s Efforts to Make Global Covid Death Toll Public.

The Ministry said in a statement that the analysis uses a mathematical modeling technique for Tier II countries while using mortality numbers directly collected from a Tier I group of countries (which includes India).

“India’s main concern has not been with the outcome (whatever that outcome may have been), but with the methodology used to arrive at that outcome,” it stated.

The Ministry went on to say that India, along with the other Member States, had expressed their dissatisfaction with the methodology in a series of formal communications, including six letters to the WHO (on November 17; December 20, 2021; December 28, 2021; January 11, 2022; February 12, 2022; and March 2, 2022), as well as virtual meetings on December 16, 2021; December 28, 2021; January 6, 2022; February 25, 2022, and the SEARO Regional Webinar on February 10, 2022.

China also raised questions along with India

During these discussions, India, along with the other Member States, including China, Iran, Bangladesh, Syria, Ethiopia, and Egypt, raised specific questions about the methodology and use of unofficial data sets.

“The concern is primarily about how the statistical model forecasts estimates for a country of India’s size and population, as well as other countries with lower populations.” “A one-size-fits-all approach and models that are true for smaller nations like Tunisia may not be applicable to India, which has a population of 1.3 billion,” it stated, adding that the WHO had yet to disclose the confidence interval for the current statistical model across countries.

When using data from Tier I countries, the model produced two very different sets of excess mortality estimates, according to the report, and when using unverified data from 18 Indian states, the model produced two very different sets of excess mortality estimates.

The large range of projections prompted questions about the modeling exercise’s validity and accuracy, according to the report. “India has stated that if the model is accurate and dependable, it should be validated by running it for all Tier I nations, with the results shared with all Member States.”

While India remained open to partnering with the WHO because data sets like these are useful for policymakers, the Ministry stated that in-depth clarity on methodology and explicit verification of its validity were necessary for policymakers to feel confident about the use of such data.

The Ministry went on to say that while The New York Times claimed to have been able to obtain the reported extra COVID-19 death data for India, it was “unable to learn the estimates for other countries.”

Meanwhile, The Hindu emailed the WHO, inquiring about the criteria employed and whether India should be classified as a Tier II country. “We are currently finalizing these estimates and will publish them shortly,” it responded.

“The estimates were generated with the participation of a Technical Advisory Group of worldwide specialists who assisted in the development of a robust methodology and the best estimates based on all available data.” We had comprehensive conversations with all countries, including detailed explanations of the methodologies and data utilized in the estimations.”

The Health Ministry also stated that the model used assumed an inverse relationship between monthly temperature and monthly average deaths, despite the fact that there was no scientific evidence to support such an odd empirical relationship.

“India is a continent in its own right.” Because climatic and seasonal conditions fluctuate greatly between states and even within a state, all states have a wide range of seasonal patterns. As a result, projecting national level mortality based on statistics from these 18 states is statistically untested, according to the Ministry. 

It went on to say that the Global Health Estimates (GHE) 2019, on which the Tier II country modeling was based, was an estimate. “It was also emphasized during conversations with WHO that some fluctuations in official reporting of COVID-19 data from some Tier I nations, including the United States, Germany, France, and others, defied knowledge of disease epidemiology.” The inclusion of a country like Iraq, which is in the midst of a long-term complex emergency, among Tier, I countries casts doubt on WHO’s a classification of countries as Tier I/II and assertions about the quality of mortality reporting from these countries, according to the Health Ministry.

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