India nowhere close to 99% of registered Covid-19 deaths: Epidemiologist Prabhat Jha

Epidemiologist Prabhat Jha from the University of Toronto was one of the members of the WHO Technical Advisory Group that oversaw the controversial report on excess Covid death. The report that says there have been more than 40 lakh excess deaths in India in the two pandemic years, has been trashed by the Union Health Ministry. But Jha and other academicians involved in writing and examining the report before its publication stand by its conclusion. His own study published in Science in January, concluded that India’s cumulative Covid-19 toll was 6-7 times higher than the official toll. Jha who had conducted the well-known Million Death Study in collaboration with the Registrar General of India spoke to DH’s Kalyan Ray on the WHO’s report and India’s Covid toll estimates. Excerpts:

Q: How accurate is India's Civil Registration System data? Does it capture all the deaths in a state?

A: India is nowhere close to 99 per cent of deaths registered. The Registrar General of India’s official total of deaths at about 8.3 million per year is well short of the 10 million per year that the UN/WHO and other demographers estimate for India. This is because the Sample Registration Survey on which the 8.3 million deaths is based has under-counts of about 14-15 per cent. Plus claiming 99 per cent coverage when in fact some of those were excess Covid-19 deaths makes no sense.

Q: The latest CRS report recorded 8.11 million deaths nationwide during 2020 and around 474,000 excess deaths over the previous year’s count of 7.64 million. The WHO estimate for India’s excess deaths in 2020 is around 830,000 - your comments?

A: The difference between CRS estimates of 8.1 million versus average of 2018 and 2019 (7.3 million) is 0.8 million excess deaths (11 per cent) excess, which is the same as WHO estimates for that year. Our national polling data, published in Science in January 2022 for only about 8 months in 2020 found 0.6 million deaths (9 per cent excess). So far from refuting the WHO numbers, the Health Ministry press release and CRS data corroborate it. Do the same steps for Maharashtra for 2020 and you get 19 per cent excess and as we all know, Maharashtra had among the worst of 2020 Covid scenarios. The WHO total for Covid-19 deaths in India are higher than ours (3.2-3.5 million) but consistent with nearly every study done using limited CRS data and some modelling.

Q: Going by the WHO report, India missed more than 90 per cent of deaths caused directly or indirectly by Covid - is such a wide "miss" possible?

A: Yes, such a huge total could have been easily missed by India, given that three million of 10 million deaths are simply not registered, and 8 million of these don't have causes of death assigned. The giant wave was in April-June 2021 where effectively for those months, death rates more than doubled, so that would easily add three million deaths to the expected total?

Q: Is there any scientific way to end this debate as modeling will always be questioned?

A: The government could release CRS data by month to explore this in detail, and of course should add a question on the 2022 Census- was there a death in 2020/21/22 in this household? If so, what was the age, sex and date of death? This would provide direct evidence on excess mortality in India.