India questions WHO methodology for estimating Covid-19 mortalities
India on Saturday questioned the World Health Organization’s methodology for estimating COVID-19-related mortalities in the country, saying the use of such mathematical modeling cannot be applied to estimate deaths. death figures for such a vast nation in geographic size and population.
The Union Health Ministry issued a statement in response to a New York Times article titled India Is Stalling WHO’s Efforts to Make Global Covid Death Toll Public dated April 16, saying the country has repeatedly shared its concerns with the global health body regarding the methodology. used.
India has had regular and extensive technical exchanges with the World Health Organization (WHO) on the matter. The analysis, which uses mortality figures directly obtained from a set of Tier I countries, uses a mathematical modeling process for Tier II countries (which includes India), the ministry said.
“India’s fundamental objection was not the result (whatever it may have been) but rather the methodology adopted for the same.
“The model yields two very different sets of excess mortality estimates when using data from Tier I countries and when using unverified data from 18 Indian states. Such variation in the estimates raises concerns about to the validity and accuracy of such a modeling exercise,” the ministry said in the statement.
According to the Ministry of Health, India has shared its concerns over the methodology with other member states through a series of official communications, including six letters to WHO (17 November, 20 December 2021 December 28, 2021; January 11, 2021). 2022; February 12, 2022; and March 2, 2022) and virtual meetings held on December 16, 2021, December 28, 2021, January 6, 2022, February 25, 2022 and the regional SEARO webinar held on February 10, 2022.
During these exchanges, specific questions were raised by India as well as other Member States – China, Iran, Bangladesh, Syria, Ethiopia and Egypt – regarding the methodology and the use of unofficial datasets.
The concern specifically relates to how the statistical model projects estimates for a country of India’s geographic size and population and also fits in with other countries that have a smaller population, the statement said.
Such a one-size-fits-all approach and patterns that are true for smaller countries like Tunisia may not be applicable to India with a population of 1.3 billion.
“The WHO has not yet shared the confidence interval of the current statistical model between the different countries,” the statement said.
“India asserted that if the model is accurate and reliable then it should be authenticated by running it for all Tier I countries and if the outcome of such exercise can be shared with all Member States,” he said. he declared.
The model assumes an inverse relationship between monthly temperature and monthly average deaths, which has no scientific basis for establishing such a particular empirical relationship.
India is a country of continental proportions, climatic and seasonal conditions vary greatly from state to state and even within a state and as a result all states have widely varying seasonal patterns.
“Thus, estimating national-level mortality based on this data from 18 states is not statistically proven,” the statement said.
The 2019 Global Health Estimates (GHE) on which the modeling for Tier II countries is based is itself an estimate. The current modeling exercise appears to provide its own set of estimates based on another set of historical estimates, while ignoring data available with the country, the statement said.
“It is unclear why GHE 2019 was used to estimate expected death figures for India, whereas for Tier 1 countries their own historical datasets were used where repeatedly highlighted that India has a robust data collection and management system,” he said.
In order to calculate the distribution of deaths by age and sex for India, WHO determined standard patterns for age and sex for countries with reported data (61 countries) and then generalized them. to other countries (including India) that did not have such distribution in India. their mortality data.
Based on this approach, the age and sex distribution of predicted deaths in India was extrapolated based on the age and sex distribution of deaths reported by four countries (Costa Rica, Israel, Paraguay and Tunisia), it said. the ministry in the press release.
Among the covariates used for the analysis, a binary measure of income was used instead of a more realistic scaled variable. Using a binary variable for such a large measurement can lend itself to magnifying the magnitude of the variable.
The WHO reported that a combination of these variables was found to be the most accurate in predicting excess mortality for a sample of 90 countries and 18 months (January 2020-June 2021). The detailed rationale for how the combination of these variables turns out to be the most accurate has yet to be provided by the WHO, the statement noted.
“The test positivity rate for Covid in India has never been uniform across the country at any time. But this variation in Covid positivity rate in India has not been considered for modeling purposes.
“Further, India has undertaken COVID-19 testing at a much faster rate than WHO has advised. India has maintained molecular testing as the preferred testing methods and has only used Rapid Antigen ‘for screening purposes. Whether these factors were used in the model for India is still unanswered,’ the statement read.
Lockdown involves a lot of subjective approach (like closing schools, closing workplaces, canceling public events) to quantify. But, it is actually impossible to quantify various containment measures in this way for a country like India, as the stringency of such measures has varied greatly even between states and districts in India. Therefore, the approach followed in this process is highly questionable.
“Furthermore, the subjective approach to quantifying such measurements will always involve a lot of biases which will surely not present the real situation. The WHO has also agreed on the subjective approach of this measurement. However, it is still used,” says the press release.
According to the statement, during interactions with the WHO, it was also pointed out that some fluctuations in official reporting on COVID-19 data from some of the Tier I countries, including the United States, Germany and France. , challenged knowledge of the epidemiology of the disease.
The additional inclusion of a country like Iraq which is experiencing a protracted complex emergency in Level I countries raises doubts about WHO’s assessment in categorizing countries into Level I/II and his assertion about the quality of mortality reports from these countries.
“While India has remained open to collaboration with the WHO, as datasets like these will be useful from a policy-making perspective, India believes that further clarity on the methodology and clear evidence of its validity are essential for policy makers to feel confident in any use of this data.”
“It is very surprising that although the New York Times was allegedly able to obtain the alleged excess mortality figures from COVID-19 with respect to India, it was unable to learn the estimates for other countries!” the statement added.
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