India has been under the radar for possibly under-reporting the number of deaths during the COVID-19 pandemic in the past year. According to a new study, the death toll in India can be as high as 4.9 million in excess increasing the global official death tally.

The report by the Center for Global Development, a think tank in Washington co-authored by Abhishek Anand, Justin Sandefur and India’s former chief economic adviser Arvind Subramanian looks at the number of excess deaths. It includes all causes in India between January 2020 and June 2021, and compares it to recent years.

The World Health Organization (WHO) already estimated several weeks ago that the global death toll of COVID-19 pandemic may be two to three times higher than reported. This means that countries with the ability to test and report effectively may still have discrepancies in their numbers. India, on the other hand, is limited in its ability to track the number of infections and deaths due to technical, logistical and cultural reasons.

As reported by National Public Radio (NPR), Dr. Aniket Sirohi, a municipal health official in south Delhi counted 702 deaths on a day in mid-April, and shared this up the chain of command. He later said that the government reported at least 20% lower death figures for his region. He stated that this disparity may be due to “administrative chaos.” NPR also reported on some local media tracking in Gujarat, where 689 bodies were cremated or buried under COVID-19 protocols in a day in mid-April and the government’s official death toll tally for that day was 78. Whether these numbers are lost due to inefficiency, stress from high population, limitations with unavoidable factors in a developing economy, political games, or a combination of everything, the country needs to reassess the situation in every way possible.

Under counting COVID-19 deaths is not limited to India. According to Ali Mokdad of the Institute for Health Metrics and Evaluation (IHME), the official toll in the United States is 500,000 but the real number is closer to 700,000. He added that excess deaths may reflect not only who died of the virus, but those who might have died due to reduced access to treatment for other issues during lockdowns.

There is growing emphasis on working towards better surveillance and reporting with the pandemic. Focusing on countries like India, where the discrepancy in reporting can be in the millions, is a cause for major concern with regard to combating future pandemics. The report by Center for Global Development estimated that up to 2 million people may have died in the first wave in India, much higher than reported. The researchers stated that “not grasping the scale of the tragedy in real time in the first wave may have bred the collective complacency that led to the horrors of the second wave.”

As Dr. Soumya Swaminathan, chief scientist at the WHO tweeted, “[F]or every country, it’s important to capture excess mortality – only way to prepare the health system for future shocks & to prevent further deaths. It’s also why we need to invest in strong civil registration & vital statistics, so policies can be adjusted based on real data.”

The need for getting the right count on mortality has a humanitarian aspect as well.  Liana Rosenkrantz Woskie of the Harvard Global Health Institute said that getting the numbers right is also a way of imparting dignity to those who lost their lives and is fundamental to the grieving process for their family and friends.