New Delhi: India on Saturday (April 16, 2022) questioned the methodology of the World Health Organization (WHO) to estimate the death toll from COVID-19 in the country, stating that the same Mathematical models cannot be used to estimate one’s mortality rate. A country like India whose geographical size and population is very large.
The Ministry of Health and Family Welfare said that India has shared its concerns with the methodology with other member states through a series of formal communications, including six letters issued to WHO.
Concerns in particular include how the statistical model projects estimates of India’s geographic size and population for the country and also fits in with other countries that have smaller populations.
The ministry said in a statement on April 16 in response to a New York Times article titled “India Is Stalling WHO’s Efforts to Make Global COVID Death Toll Public” World Has been in regular and intensive technical exchanges with Health Organization (WHO) on this issue.
The analysis, while using mortality data obtained directly from the Tier-I set of countries, uses a mathematical modeling process for Tier II countries (which includes India). India’s basic objection is not with the outcome (whatever it may be), but the methodology adopted for it.”
During these exchanges, specific questions have been raised about India’s use of informal sets of data along with other member countries such as China, Iran, Bangladesh, Syria, Ethiopia and Egypt.
“Concerns in particular include how the statistical model projects geographic size and population estimates for the country of India and also fits in with other countries that have smaller populations. Such a size fits all approach and model are perfect for smaller countries like Tunisia. This will not apply to India with a population of 1.3 billion.
The ministry said the model gives two vastly different sets of additional mortality estimates when using data from Tier I countries and unverified data from 18 Indian states. “Such wide variation in estimates raises concerns about the validity and accuracy of such modeling exercise,” it added.
The Health Ministry said, “India has emphasized that if the model is accurate and reliable, it should be validated by running it for all Tier I countries and if the result of such an exercise can be shared with all member states. The health ministry said.
The ministry further said that the model assumes an inverse relationship between monthly temperature and monthly average deaths, which has no scientific backing to establish such a peculiar empirical relationship. India being a country of continental proportions, the climate and seasonal conditions vary greatly across states and even within a state and, therefore, have widely varied seasonal patterns across states.
“Thus, estimates of national level mortality rates based on data from these 18 states are statistically unproven,” it said in a statement.
global health projections (GHE) 2019, on which the modeling for Tier II countries is based, is an estimate in itself. The current modeling exercise is providing its own set of estimates based on another set of historical estimates, disregarding the data available with the country, the statement said.
“It is not clear why GHE 2019 has been used to estimate the expected death figures for India, while for Tier 1 countries, their own historical datasets were used when it was repeatedly exposed. India has a robust system of data collection. and management,” it added.
To calculate the age-sex death distribution for India, WHO set standard patterns for age and gender for countries with reported data (61 countries) and then normalized them for other countries (including India) , which had no such distribution in India. their mortality data.
Based on this approach, the age-sex distribution of estimated deaths in India was derived based on the age-sex distribution of deaths reported by four countries (Costa Rica, Israel, Paraguay and Tunisia).
Of the covariates used for the analysis, a binary measure for income has been used instead of the more realistic categorical variable. Using a binary variable for such a significant measure can lend itself to increasing the magnitude of the variable.
WHO has conveyed that a combination of these variables was found to be most accurate in predicting excess mortality for a sample of 90 countries and 18 months (January 2020-June 2021). The detailed justification for how the combination of these variables is found to be most accurate remains to be provided by WHO.
The Health Minister said, “The test positivity rate for COVID-19 in India was not uniform across the country at any point of time. But, this change in the COVID-19 positivity rate within India was not considered for modeling purposes.”
In addition, India has conducted COVID-19 testing at a much faster rate than the WHO has advised. India has retained molecular testing as the preferred testing method and has used rapid antigen only for screening purposes. Whether these factors were used in the model for India is still unanswered, it added.
Prevention involves a lot of subjective approaches to measuring yourself (such as school closures, workplace closures, cancellation of public events, etc.). But, it is virtually impossible for a country like India to measure the various containment measures in this way, as the strictness of such measures varies widely across states and districts of India as well. Therefore, the approach adopted in this process is very questionable, it said.
“Furthermore, a subjective approach to quantifying such measures will always involve a lot of bias which will certainly not represent the true situation. WHO also agrees about the subjective view of this measure. However, it is still used,” it said.
It added that India has expressed the above and similar concerns to the WHO but has not yet received a satisfactory response from the WHO.
According to the Ministry of Health, during the interaction with WHO, it has also been highlighted that some fluctuations in official reporting of COVID-19 data from some Tier I countries including USA, Germany, France etc have contributed to the spread of the disease epidemic. The knowledge of science is disregarded. Further including a country like Iraq, which is going through an expanded complex emergency under Tier I countries, the WHO’s assessment in classifying countries as Tier I/II and its claims on the quality of mortality reporting from these countries casts doubt.
“While India has been open to collaborating with the WHO as such data sets would be helpful from a policy-making point of view, India believes that the in-depth clarity on the methodology and the clear evidence of its validity to policy makers It’s important to feel confident about. Any use of such data,” the statement further reads.
“It is very surprising that while The New York Times could reportedly obtain additional COVID19 mortality figures with respect to India, it was unable to “know estimates from other countries!!” added this.