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Relatives mourn during the burial of Covid-19 victim Maria Joana Nascimento at Vila Formosa Cemetery, in the outskirts of São Paulo, Brazil on August 6, 2020. (Photo: Nelson Almeida/AFP via Getty Images)

Relatives mourn during the burial of Covid-19 victim Maria Joana Nascimento at Vila Formosa Cemetery, in the outskirts of São Paulo, Brazil on August 6, 2020. (Photo: Nelson Almeida/AFP via Getty Images)

WHO Says Pandemic Has Killed 15 Million People—Nearly 3 Times More Than Reported

"We have to hold policymakers accountable" for the "staggering number" of lives lost during the first two years of the ongoing Covid-19 pandemic, said one United Nations official.

Kenny Stancil

The World Health Organization on Thursday announced that nearly 15 million people died as a direct or indirect result of the coronavirus pandemic in 2020 and 2021—almost three times as many as officially reported.

Data submitted by governments to the WHO indicated that Covid-19 had killed roughly 5.4 million people around the globe by the end of last year. But according to the WHO's new 2020 and 2021 estimate of "excess mortality"—how many more people died worldwide than would be expected in the absence of the pandemic—the first two years of the ongoing public health emergency led to approximately 14.9 million excess deaths.

"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," WHO Director-General Tedros Adhanom Ghebreyesus said in a statement.

Samira Asma, WHO assistant director-general for Data, Analytics, and Delivery, called the measurement of excess mortality "an essential component" of understanding the full impact of the pandemic.

As the United Nations health body explained:

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). 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.

Most of the excess deaths (84%) are concentrated in South-East Asia, Europe, and the Americas. Some 68% of excess deaths are concentrated in just 10 countries globally. Middle-income countries account for 81% of the 14.9 million excess deaths (53% in lower-middle-income countries and 28% in upper-middle-income countries) over the 24-month period, with high-income and low-income countries each accounting for 15% and 4%, 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% male, 43% female) and higher among older adults.

In addition to "knock-on effects, like people being unable to access hospitals for the care they needed," the WHO's estimate of excess mortality "also accounts for poor record-keeping in some regions, and sparse testing at the start of the crisis," BBC News reported Thursday. "But the WHO said the majority of the extra 9.5 million deaths seen above the 5.4 million Covid deaths reported were thought to be direct deaths caused by the virus, rather than indirect deaths."

WHO said that Covid-19 contributed to the deaths of 4.7 million people in India in 2020 and 2021, most of them occurring during the devastating Delta wave there last May and June. That's nearly a third of the global total and almost 10 times higher than official figures suggest. Only Egypt had a higher ratio of excess deaths to reported Covid-19 deaths.

Authorities in India have disputed the WHO's estimate, citing "concerns" about the methodology, but "other studies have come to similar conclusions about the scale of deaths in the country," BBC noted.

"Because of limited investments in data systems in many countries, the true extent of excess mortality often remains hidden," said Asma. "These new estimates use the best available data and have been produced using a robust methodology and a completely transparent approach."

Ratio of excess deaths to reported Covid deaths - BBC News

That the Covid-19 pandemic resulted in close to 15 million excess deaths globally in 2020 and 2021 is "a tragedy," Asma told BBC.

"It's a staggering number and it's important for us to honor the lives that are lost, and we have to hold policymakers accountable," said Asma.

"If we don't count the dead," she added, "we will miss the opportunity to be better prepared for the next time."

To control for variations in national population size, the WHO also analyzed the number of excess deaths per 100,000. Excess mortality rates, the agency said, provide "a more objective picture of the pandemic than reported Covid-19 mortality data."

The United States, which just surpassed one million official Covid-19 deaths on Wednesday, had an excess mortality rate in 2020 and 2021 of 140 per 100,000—well above the global average of 96 per 100,000, and approaching India's rate of 171 per 100,000. The pandemic has also hit Peru, Russia, South Africa, Brazil, and Turkey particularly hard.

Excess mortality rates in 2020 and 2021 - BBC News

Together with the United Nations Department of Economic and Social Affairs (UN DESA), the WHO said that it "developed an innovative methodology to generate comparable mortality estimates even where data are incomplete or unavailable." The agency added that this "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."

"Data deficiencies make it difficult to assess the true scope of a crisis, with serious consequences for people's lives," said Stefan Schweinfest, director of statistics at UN DESA. "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."

The U.N.'s latest report on excess mortality comes one day before a World Trade Organization council is expected to vote on a corporate-friendly alternative to India and South Africa's popular proposal to waive the intellectual property monopolies that are preventing generic manufacturers from boosting the production of lifesaving vaccines, tests, and treatments.

"How can it be that in the face of a global pandemic that has taken 15 million lives and destroyed billions more livelihoods, in two years the WTO cannot get out of the way of global access to medicines that governments paid pharmaceutical firms billions to develop and distribute?" Lori Wallach, director of Rethink Trade at the American Economic Liberties Project, asked earlier this week.


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