A couple of weeks back in April, World Health Organization (WHO) chief Dr Tedros Adhanom Ghebreyesus was in India, inaugurating in Jamnagar, Gujarat,- the WHO Global Centre for Traditional Medicines. At the same event, Prime Minister Narendra Modi, fondly and perhaps in jest, also gave him a name, Tulsi Bhai, mentioning to the audience how Dr Tedros was from Ethiopia and understood Indo-Ethiopian friendship historically. Also, that Tulsi as a plant has been shown to have medicinal properties and used liberally in generations of Indian households, even for Covid-19 these past two years.
However, this week, 'Team Tulsi Bhai' (if one can call WHO that) has struck back by refusing to genuflect to Indian pressure not to publish its excess mortality report, as several in the international press reported. The WHO's excess mortality report, unfortunately, has now officially dealt India an unkind cut. The report shows that the global mortality toll of the pandemic has been 14.9 million, about 2.4 times the current mortality statistics being officially reported worldwide, with a grim 30 per cent of it coming from India alone. The ratio of excess deaths in 2020 & 2021 in the WHO report compared with reported deaths was highest in Egypt (11.6x), with Pakistan (8x) closely following India (9.9x), other population-dense countries like Indonesia (7.1x) and Bangladesh (5x) featuring in the top-5 too in what is, in essence, a sad scientific study.
Expectedly, Delhi's apparatchiks have lined up with gusto to refute the WHO study. Dr Randeep Guleria, the chief of All India Institute of Medical Sciences (AIIMS), one of the world's leading research and teaching hospitals, gave an interview defending the government of India's position. However, there is no countermodel from Dr Guleria and Team Delhi, nor any scientific study yet to refute Team Tulsi Bhai. Or even a response to earlier peer-reviewed findings published herein in reputed scientific journals like Science. Did the Indian government not have time last 12 months to set up a scientific board to study this, one wonders?
India's fast-declining media ecosystem, ravaged by global concerns of declining press freedom, has also started lining up op-eds with policy mumbo jumbos refuting the WHO report. As far as one can gather, there has not yet been one scientific pushback from the much-venerated domestic Indian scientific ecosystem.
However, to offer some scientific cues to them, one can draw lessons from the science of excess mortality studies that are themselves an evolving frontier. Past research in respected journals like Demography or American Journal of Epidemiology by Phelim Boyle, Peter Spreeuwenberg and coauthors has shown that more careful calibration of excess mortality statistics over time might scale down the death tolls in the case of the Great Irish Famine or the 1918 influenza pandemic. Perhaps so shall be the situation with Covid-19 tomorrow if there is a follow-up building on the WHO findings.
Meanwhile, Team Tulsi Bhai seems to have salvaged their declining global reputation during this pandemic a bit by showing gumption in pushing forward with this report despite unhappy countries like India. Yet, the report has been quiet about statistics from China, or even now, the fact that WHO's fact-finding mission still is vague about the sources of the virus does its reputation hardly any good service thus far.
Are nations going to learn from this WHO report beyond crying over spilt milk? Early indications don't seem to suggest so. Just a look at the recent national budgets of Egypt, India, Pakistan, Bangladesh and Indonesia hardly demonstrates any earnest intent or efforts to ramp up public health expenditure as a per cent of GDP. Nor does one see refreshed discussions officially around the future of universal healthcare coverage in these economies. Spending more on R&D and science as a per cent of GDP to build healthcare and biopharmaceutical innovation capacity continues to remain neglected, too, despite the emergent threat of zoonotic diseases in the Anthropocene.
That is one easy lesson from this pandemic for nations to take away if one had to consider the WHO excess mortality report as a gift. And maybe that's a pronouncement one can expect from Tulsi Bhai and his team next time WHO functionaries visit their new India centre for researching traditional medicines.
(The author is a health economist, a Reader in Economics of Innovation at SPRU-Sussex, University of Sussex, Visiting Fellow at Hoover Institution, Stanford University & Visiting Adjunct Professor in Economics at IIM-Ahmedabad, India.)
Disclaimer: The views expressed above are the author's own. They do not necessarily reflect the views of DH.