Counting the dead
The world is doing a terrible job at figuring out who lives and dies.
Last week, the World Health Organisation published its calculations of how many people died during the covid-19 pandemic. It says there were about 15m “excess” deaths thanks to the pandemic. Most of these were directly caused by the virus but not reported. That is an extra 9.5m over what had been the official number. These WHO estimates chime with excess death estimates made by various other groups, including The Economist and IHME.
What all these estimates have in common is that they find that many times more people died of covid than official numbers suggest. In some countries, the difference between what was reported, and the true number of deaths, is not very large. However, in far too many places the information gap is huge.
At the root of much of the uncertainty is the fact that around the world many countries do a terrible job of counting who has died. At the start of the pandemic, six of every deaths were not registered. And more than 70 countries were not producing accurate causes of death.
The way that the WHO (and The Economist) estimated excess deaths was by looking at countries where deaths were well known and figuring out the relationship between that number and other country-specific statistics. These might be demographics, containment measures, historical rates of disease, temperature, diagnostic availability etc etc. If you model the relationship between covid deaths and other variables, you can use this model to predict deaths in countries where deaths are not well counted. You may still have a wide error range on that number, but you have an estimate.
What is mindblowing is just how many countries have failed to record such a basic piece of data. Who is dying isn’t only of great significance to public health but it also has implications for the economy. Who is dying, and why, are some of the most useful and valuable health data out there. And morally it is hard to justify overlooking it.
This situation cannot be allowed to continue. If governments know who is dying, how and where, they can do a far better job of saving lives. During the pandemic data on deaths would tell you where oxygen, vaccines, or staff may be needed. Or where the vulnerable are, and how best to save them. Outside a pandemic, data on deaths tells governments whether more people are dying from malaria or diabetes or cancer.
It is impossible to spend or invest properly in health without this sort of basic health data. Without it, countries will continue to misinvest and underinvest in health. And if that isn’t a moral concern, it certainly should be a financial one. Of those excess deaths, 81% were in middle-income countries—many in India. These countries can not only afford to do better, they cannot afford to let this valuable data vanish any longer.
With much talk about how to prepare for the next pandemic there are hopes for a treaty, new financial instruments, and for global pathogen sequencing. All of these things may indeed be needed. Some may even happen. But it is hard to think of a more basic, and essential, investment for any individual country to make in preparation for the next pandemic, or disease outbreak. We must register deaths globally. It has to be a new health priority coming out of the pandemic.