Augment state capacity

Actual death toll of pandemic will always be contested

An estimate by researchers associated with the World Health Organization (WHO) of the death toll from the Covid-19 pandemic in India has raised several questions in the country. Although the purpose of the exercise was to obtain a figure for the global death toll, the Indian government has objected to the numbers relating to excess mortality in India during the pandemic years, and has reportedly sought to delay the release of the estimate. It appears that the WHO estimate, using secondary data, estimated the likely number of excess deaths at 4.7 million during the pandemic. This is a very heavy death toll, and it is on the high side compared to other such estimates of excess mortality. There are thus legitimate questions that can and should be asked about the methodology underlying these statistics, and this estimate should not be taken as the last word on the subject.
 

Yet the deeper question raised by these estimates has as yet gone unanswered. There is no doubt that India’s official death toll, which is about one-tenth of the WHO’s estimates, includes severe under-counting. It is reasonable to argue that the Indian state failed to properly count both the number of cases and the number of deaths. This is completely in keeping with known gaps in the death registration system that existed even prior to the pandemic. These gaps will have become worse when the system was placed under pressure during the various waves of infection. Indian state capacity has always been limited. Since the Indian state struggles to get basic things done even at times that could be considered normal, it is hardly surprising that it will make larger errors during an unprecedented pandemic. The actual death toll in India over the pandemic is something that might never be conclusively known — or, for that matter, officially admitted. But this doubt should not hold back scrutiny of how state systems performed or how they can be improved. Whatever the actual number is does not detract from the basic fact that India’s state capacity, whether in counting the dead or in preserving lives, has been found wanting once again.

It is not necessary, therefore, to waste too much time on dissecting the WHO’s figures and other such estimates — and there will be many in the months and years to come. Instead, that energy should be spent on addressing the lessons of the pandemic for the public health system and for the civil registration system. The latter is stuck in the past, with very little space for technological intervention and e-governance. Modern digital methods should help ensure the government’s information is more up to date and can be widely shared. Investment in public health is a longer-term and a knottier problem, but not one that can be put off any longer. Short cuts like depending on private health care while under-providing for publicly funded health insurance are not going to work much longer. India is now at the per capita income level where other countries, such as Thailand a few decades ago, created a universal public health care system. The time is overdue for such reform in India as well.