New Delhi: World Health Organization Director-General Dr Tedros Adhanom Ghebreyesus is on a three-day trip to India and, Tuesday, tweeted his thanks for a “warm welcome” from the government after landing in Gujarat’s Rajkot the previous night.
Dr Tedros is scheduled to attend events with Prime Minister Narendra Modi across the latter’s home state, including laying the foundation stone of the WHO Global Centre for Traditional Medicine (GCTM) in Jamnagar, which was done Tuesday, and inauguration of the Global AYUSH Investment and Innovation Summit.
“This is a truly global project… This means that India will go to the world and the whole world will come to India,” the WHO chief said at the GCTM ceremony, while the PM noted Dr Tedros’s “affection for India”.
Beneath these niceties, however, all is not well between the top world health body and the Indian government. And it’s out in the open.
The two have been at odds over the Covid mortality rate in India, with a WHO analysis putting the figure at “more than 4 million” while the government’s official toll is 5,20,000, or just over half a million.
The health ministry Saturday issued a tough statement in response to an article titled ‘India Is Stalling the WHO’s Efforts to Make Global Covid Death Toll Public’, published in The New York Times. The Indian side questioned the methodology used by the WHO to estimate coronavirus deaths in the country.
“It is very surprising that while The New York Times purportedly could obtain the alleged figures of excess Covid-19 mortality in respect to India, it was ‘unable to learn the estimates for other countries’,” the sharp Indian statement read, adding that “India has shared its concerns with the methodology along with other member states through a series of formal communications including six letters issued to WHO”.
The other move that has caused much discomfort in India is that the WHO, earlier this month, suspended the supply of India-made Covaxin through UN procurement agencies, and recommended that countries using the vaccine take action “as appropriate”.
According to sources, while India is hopeful that the Covaxin imbroglio will resolve itself over time, it is the matter of Covid death estimates that has left health officials smarting.
In a recent meeting, Health Minister Mansukh Mandaviya expressed his displeasure about the issue in no uncertain terms, a source said.
“The minister was visibly upset when he said that if ICMR (Indian Council of Medical Research) or any other Indian institute does not go about estimating excess mortality in the US, Italy or any other foreign country, why should foreign institutes bother themselves with India’s death numbers,” the source explained.
Government officials also believe that the reports in global media on Covid mortality estimates for India are “deliberate leaks” by the WHO. “This has been going on for a long time. We did not choose to go to town on this. But they have clearly been talking to foreign publications,” an official said.
A WHO official who did not wish to be identified told ThePrint over WhatsApp messages that the estimates are yet to be released.
ThePrint reached both the WHO headquarters and WHO’s South-East Asia Region Office (WHO SEARO) over email for comments on the issue, but received no response. There was no response either to a WhatsApp message to WHO’s South-East Asia Regional Director Dr Poonam Khetrapal Singh.
Speaking in private, senior functionaries in the Ministry of Health call the WHO modelling projections a “typical” foreign conspiracy to defame India.
“They do not understand our country. They had predicted that India would have death and devastation throughout the pandemic and now that we have proved them wrong, they cannot digest it. It is a conspiracy to malign us. The fact that we did not go with a begging bowl to the world, did so well both on vaccinations and disease control is something that they are finding tough to stomach,” said a functionary who did not want to be named.
That is why, the officials said, India’s rebuttal to the alleged estimates came in strong statistical terms rather than the usual official language that is used in press releases.
India has been vociferous in its protests to the WHO about the modelling projections, and said in its rebuttal statement that the matter was raised through six letters issued to WHO (on 17 November, 20 December and 28 December 2021, and 11 January, 12 February and 2 March 2022); virtual meetings held on 16 December and 28 December 2021, and 6 January and 25 February 2022; as well as the SEARO Regional Webinar held on 10 February 2022.
An expert retorts
One of the experts associated with WHO’s mortality estimation exercise, Jonathan Wakefield, Monday tweeted a retort to India’s rebuttal of the NYT report.
Wakefield is professor of Statistics and Biostatistics at University of Washington, which has published papers earlier on India’s Covid mortality estimates, but had them debunked by the Indian government, and whose top experts are part of the WHO panel looking at excess mortality during the pandemic.
Wakefield also tweeted some excerpts from a yet-to-be published paper looking at all-cause mortality in different countries.
“For India, we use a variety of sources for the registered number of deaths at the state and union-territory level. The information was either reported directly by the states through official reports and automatic vital registration, or by journalists who obtained death registration information through Right To Information requests (the Supplementary Materials of the full paper, contains full details). We stress that for India the global predictive covariate model is not used and so the estimates of excess mortality are based on data from India only,” reads the extract from the upcoming paper ‘Estimating Country-Specific Excess Mortality During the Covid-19 Pandemic’ that the professor uploaded.
Last month, another study led by the Institute for Health Metrics and Evaluation at University of Washington published in The Lancet estimated that the highest numbers of cumulative excess deaths due to Covid-19 were estimated in India at 40.7 lakh (37.1–43.6 lakh).
India followed own path
It is not that everything was hunky dory between New Delhi and Geneva earlier either. India, through the two pandemic years, often chose to sidestep WHO advice and carved out its own path, which was often contrary to the world health body’s recommendations at that point of time.
From its reluctance to conduct large-scale testing for Covid, to the early travel restrictions to and from China, and then the quick lockdown, India built its own battle strategy during the global pandemic.
WHO’s advice as articulated by its chief on 16 March 2020, was “test, test, test”. On 22 March that year, the DG of ICMR, Dr Balram Bhargava, retorted: “There will be no indiscriminate testing. Isolation, Isolation, isolation.”
India also braved much criticism for its recommended preventive use of the rheumatoid arthritis drug hydroxychloroquine for healthcare workers and caregivers, and also started using HIV drugs lopinavir and ritonavir as therapeutics for Covid patients early on in the pandemic, even though WHO guidelines at that point clearly said that evidence was lacking for any specific treatment for the viral illness. The medicines eventually proved to be ineffective for Covid.
Among the WHO guidance documents for countries is a fairly elaborate one on how to reach out to and plan for marginalised groups, including migrants. But India apparently ignored this when it announced a countrywide lockdown on 25 March 2020, with a four-hour notice to the public.
India did take recourse to WHO guidance when it suited the country. In the second half of 2021, when many countries were rolling out third and some even fourth booster vaccine shots, India repeatedly cited WHO’s stance on boosters to defend its own.
There have been other instances when India has gone out of its way for WHO. In an unusual move, the Dr Balram Bhargava authored Going Viral — on the development of Covaxin — was released in Geneva with top WHO officials in attendance, at a time when the vaccine itself was still awaiting inclusion in the EUL list
High hopes on Covaxin
The other festering issue between the WHO and India has been Covaxin.
On suspension of supplies of Covaxin, the WHO stated this was being done to allow the manufacturer to upgrade facilities and address deficiencies found in an inspection.
The vaccine, developed as a joint venture between the ICMR and Hyderabad-based Bharat Biotech, has been a matter of much pride for the Indian government.
According to Bharat Biotech officials, the shortcomings flagged by WHO in the inspection may take up to six months to fix. Officials in the Ministry of Health are, however, hopeful of an early resolution to the matter and quick resumption of global supplies of the vaccine.
“The WHO has sent a small query, which is normal whenever inspections are undertaken. We are constantly monitoring the situation and Bharat Biotech has assured us that they will rectify the issue quickly and respond to the WHO within 15 days,” a top health ministry functionary had told ThePrint earlier this month.
The WHO had given emergency use approval to Covaxin in November, with the approval process being long and complicated, and even PM Modi pushing the vaccine’s case.
‘Little doubt that deaths were undercounted’
Covaxin’s troubles with WHO and the ongoing bitter exchanges over Covid death estimates make it easy to forget that one of the senior-most people in the WHO’s present dispensation is an Indian.
Former Director General of ICMR Dr Soumya Swaminathan, who moved to the WHO in 2017 and is currently the chief scientist there, has so far maintained a studied silence on the death estimates.
Throughout her tenure at the WHO, Dr Swaminathan has, in her utterances, struck a balance. “I have to work with the ICMR,” she has replied on multiple occasions when probed for comments.
When asked whether India, through this public tussle with the WHO, had reached out to Dr Swaminathan, a senior official said “it does not concern her department”.
On the counting of Covid deaths, Gautam Menon, professor of physics and biology at Ashoka University, said “we need to come to terms with the toll for many reasons, including our responsibility to those who lost loved ones during the pandemic”.
Advising that India “needs to collect data better”, he pointed out: “According to India’s submissions to WHO, we are still not in community transmission. How can we say that when 80-90 per cent of the country has been infected, according to reasonable estimates as well as serosurvey data collected by the government”
“As for the question of mortality, counting deaths is a sensitive issue throughout the world. It is natural for governments to worry about models whose conclusions portray them in a bad light. But for India the difference is quite stark. The model estimates are more than the official estimates by a factor of 8,” he said.
Menon added: “We need to come to terms with the toll for many reasons, including our responsibility to those who lost loved ones during the pandemic, but who do not reflect in official statistics. But also so that in future we ensure we collect data better, to make sure it’s trustworthy. We should incentivise data collection in a way that it is authentic. All of the estimates for Covid deaths in India have been pieced together using indirect methods. One can raise questions about those, but there is little doubt that deaths were undercounted. It happened all over the world. There is no shame in that. Indian government should welcome approaches that attempt to calculate Covid 19 mortality more accurately, while raising legitimate scientific questions about methodology, if they are warranted.”
(Edited by Nida Fatima Siddiqui)