Almost three times as many people have died as a result of COVID-19 as the official data show, according to a new World Health Organization (WHO) report, the most comprehensive look at the true global toll of the pandemic so far.
There were 14.9 million excess deaths associated with COVID-19 by the end of 2021, the UN body said on Thursday. The official count of deaths directly attributable to COVID-19 and reported to WHO in that period, from January 2020 to the end of December 2021, is slightly more than 5.4 million.
"The full death toll associated directly or indirectly with the COVID-19 pandemic between January 1, 2020 and December 31, 2021 was approximately 14.9 million (range 13.3 million to 16.6 million)," the UN health agency said.
The WHO's excess mortality figures reflect people who died of COVID-19 as well as those who died as an indirect result of the outbreak, including people who could not access healthcare for other conditions when systems were overwhelmed during huge waves of infection. It also accounts for deaths averted during the pandemic, for example because of the lower risk of traffic accidents during lockdowns.
But the numbers are also far higher than the official tally because of deaths that were missed in countries without adequate reporting. Even pre-pandemic, around 6 in 10 deaths around the world were not registered, WHO said.
The WHO report said that almost half of the deaths that until now had not been counted were in India. The report suggests that 4.7 million people died there as a result of the pandemic, mainly during a huge surge in May and June 2021.
The Indian government, however, puts its death toll for the January 2020-December 2021 period far lower: about 480,000. WHO said it had not yet fully examined new data provided this week by India, which has pushed back against the WHO estimates and issued its own mortality figures for all causes of death in 2020 on Tuesday. WHO said it may add a disclaimer to the report highlighting the ongoing conversation with India.
The WHO panel, made up of international experts who have been working on the data for months, used a combination of national and local information, as well as statistical models, to estimate totals where the data is incomplete – a methodology that India has criticized.
However, other independent assessments have also put the death toll in India far higher than the official government tally, including a report published in Science which suggested three million people may have died of COVID in the country.
Other models have also reached similar conclusions about the global death toll being far higher than the recorded statistics. For comparison, around 50 million people are thought to have died in the 1918 Spanish Flu pandemic, and 36 million have died of HIV since the epidemic began in the 1980s.
Samira Asma, WHO assistant director general for data, analytics and delivery for impact, who co-led the calculation process, said data was the "lifeblood of public health" needed to assess and learn from what happened during the pandemic, and called for more support for countries to improve reporting.
"Too much is unknown," she told reporters in a press briefing.
Deaths due to impact
The figures, termed as excess mortality, are calculated as the difference between the number of deaths that occurred and the number that would have been expected in the absence of the pandemic, based on data from earlier years.
Excess mortality includes deaths directly due to COVID-19 disease, and indirectly due to the pandemic's impact on health systems and society.
It also factors in deaths averted during the pandemic, such as a lower risk of work-related fatalities or road accidents.
WHO declared COVID an international public health emergency on January 30, 2020, after cases of the new coronavirus spread beyond China.
Countries worldwide reported 5.42 million COVID-19 deaths to WHO in 2020 and 2021 -- a figure that today stands at 6.24 million, including deaths in 2022.
The Geneva-based organization has long said the true number of deaths would be far higher than just the recorded fatalities put down to COVID infections.
Deaths linked indirectly to the pandemic are attributable to other conditions for which people were unable to access treatment because health systems were overburdened by the crisis.
That could include delays to surgical operations, or chemotherapy for cancer patients.
Understanding the crisis
WHO said that most of the excess deaths -- 84 percent -- were concentrated in south and southeast Asia, Europe and the Americas.
Indeed, 10 countries alone accounted for 68 percent of all excess deaths: Brazil, Egypt, India, Indonesia, Mexico, Peru, Russia, South Africa, Turkey and the United States.
High-income countries accounted for 15 percent of the excess deaths; upper-middle-income nations 28 percent; lower-middle-income states 53 percent; and low-income countries four percent.
The global death toll was higher for men than for women -- 57 percent male and 43 percent female.
And 82 percent of the excess deaths were estimated to be people aged over 60.
"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," WHO chief Tedros Adhanom Ghebreyesus said.
Asma said measuring excess mortality was vital to understanding the pandemic, with the numbers informing policymakers so they can take action to reduce death rates and prevent future crises.
Many countries do not have the capacity for reliable mortality surveillance and therefore do not generate the data needed to work out excess mortality rates.
WHO believes that generally, six in 10 deaths worldwide are not formally recorded.
WHO said the 14.9-million figure was produced by leading world experts who developed a methodology to generate estimates where data is lacking.