New Delhi, April 17 : India has rejected a New York Times report claiming that new Delhi is stalling WHO’s efforts to make its Covid-19 death toll public, and questioned the methodology adopted for arriving at its figure of “excess” Covid deaths in a vast country like India. In an official statement, the Health Ministry said it has been “in regular and in-depth technical exchange with WHO on the issue”. It says the WHO’s analysis while it uses mortality figures directly obtained from Tier –I set of countries, “uses a mathematical modelling process for Tier II countries (which includes India)”. “India’s basic objection has not been with the result (whatever they might have been) but rather the methodology adopted for the same”. India’s response comes as Congress leader Rahul Gandhi on Sunday claimed that at least 40 lakh people died of Covid-19 in India due to the “negligence of the government” while sharing a screenshot of the New York Times report. Gandhi in a tweet said in Hindi: “Modiji neither tells the truth himself nor does he allow anyone else to speak it. They still lie that no one died due to oxygen shortage.” He sais he has already highlighted the large number of deaths related to coronavirus that were not being reported. “I had said earlier as well — due to the negligence of the government during the Covid pandemic, not 5 lakh, but 40 lakh Indians died,” he said. In the statement, the Health Ministry said India has shared its concerns with the methodology adopted along with other countries via six letters issued to WHO, including three letters issued this year, and virtual meetings held, and the SEARO Regional Webinar held on 10th February 2022. “During these exchanges, specific queries have been raised by India along with other Member States e.g. China, Iran, Bangladesh, Syria, Ethiopia and Egypt regarding the methodology, and use of unofficial sets of data”. India said the concern “specifically includes on how the statistical model projects estimates for a country of geographical size & population of India and also fits in with other countries which have smaller population”. “Such one size fit all approach and models which are true for smaller countries like T sia may not be applicable to India with a population of 1.3 billion”, it said, adding that WHO is yet to share the confidence interval for the present statistical model across various countries. It said the model “gives two highly different sets of excess mortality estimates” of when using the data from Tier I countries “and when using unverified data from 18 Indian States”. “Such wide variation in estimates raises concerns about validity and accuracy of such a modelling exercise”. “India has asserted that if the model accurate and reliable, it should be authenticated by running it for all Tier I countries and if the result of such exercise may be shared with all Member States”. The WHO model “assumes an inverse relationship between monthly temperature and monthly average deaths, which does not have any scientific backing to establish such peculiar empirical relationship”. “India is a country of continental proportions and climatic and seasonal conditions vary vastly across different states and even within a state, and therefore, all states have widely varied seasonal patterns. Thus, estimating national level mortality based on these 18 States data is statistically unproven.” It also said that the Global Health Estimates (GHE) 2019 on which the modeling for Tier II countries is based, “is itself an estimate”. “The present modeling exercise seems to be providing its own set of estimates based on another set of historic estimates, while disregarding the data available with the country.” “It is not clear as to why GHE 2019 has been used for estimating expected deaths figures for India, whereas for the Tier 1 countries, their own historical datasets were used, when it has been repeatedly highlighted that India has a robust system of data collection and management.” “In order to calculate the age-sex death distribution for India, WHO determined standard patterns for age and sex for the countries with reported data (61 countries) and then generalized them to the other countries (including India) who had no such distribution in their mortality data.” “Based on this approach, India’s age-sex distribution of predicted deaths was extrapolated based on the age-sex distribution of deaths reported by four countries (Costa Rica, Israel, Paraguay and T sia).” “Of the covariates used for analysis, a binary measure for income has been used instead of a more realistic graded variable. Using a binary variable for such an important measure may lend itself to amplifying the magnitude of the variable,” it added. “WHO has conveyed that a combination of these variables was found to be most accurate for predicting excess mortality for a sample of 90 countries, and 18 months (January 2020-June 2021). The detailed justification of how the combination of these variables is found to be most accurate is yet to be provided by WHO,” the ministry added. “The test positivity rate for Covid-19 in India was never form throughout the country at any point of time,” it said, adding that this aspect “was not considered for modeling purposes”. “Further, India has undertaken COVID-19 testing at much faster rate than what WHO has advised. India has maintained molecular testing as preferred testing methods and used Rapid Antigen as screening purpose only. Whether these factors have been used in the model for India is still unanswered,:” it added. It also accused the WHO of following a “subjective approach”, which it said ”will always involve a lot of biases which will surely not present the real situation”. “WHO has also agreed about the subjective approach of this measure. However, it is still used.” “While India has expressed above and such similar concerns with WHO but a satisfactory response is yet to be received from WHO.” It also said that “some fluctuations in official reporting of COVID-19 data from some of the Tier I countries including USA, Germany, France etc. defied knowledge of disease epidemiology”. It also questioned the inclusion of Iraq under Tier I countries, saying it “raises doubts on WHO’s assessment in categorization of countries as Tier I/II and its assertion on quality of mortality reporting from these countries”. “While India has remained open to collaborate with WHO as data sets like these will be helpful from the policy making point of view, India believes that in-depth clarity on methodology and clear proof of its validity are crucial for policy makers to feel confident about any use of such data. “It is very surprising that while New York Times purportedly could obtain the alleged figures of excess COVID19 mortality in respect to India, it was “unable to learn the estimates for other countries”!!” RN