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“Millions more people have died from COVID-19 than official records indicate.”

Statement from Dr. Adam Karpati, Senior Vice President, Public Health Programs at Vital Strategies, on the World Health Organization’s announcement of excess mortality estimates during the COVID-19 pandemic:

“The World Health Organization today revealed that excess mortality estimates of the number of deaths globally from COVID-19 in 2020 indicate a staggering 3 million lives lost—1.2 million more than official records indicate.

As the world grapples with COVID-19, loss of life is a clear and tragic indicator of the pandemic’s toll. Reliable mortality data—understanding how, where and when people have died—is invaluable for governments as they coordinate response measures. Enumeration of all deaths, when compared to what is called ‘historically expected mortality,’ or the number of people that were expected to die over a given period of time, produces a picture of ‘excess mortality.’ In 2020, the tremendous increase in deaths compared to historical trends, provides a better understanding of the impact of COVID-19, whether people died directly of COVID-19 or of other related causes due to disruptions in health and social systems. This data provides a better understanding of the true toll of COVID-19 rather than relying solely on deaths determined by test-confirmed COVID-19 cases and deaths.

As a tool for understanding the scale of COVID-19 and other crises, excess mortality is most easily interpretable when baseline mortality data exists. In many low- and middle-income countries, civil registration and vital statistics systems are not yet capable of producing timely total mortality statistics with high levels of population coverage. We therefore urge governments to prioritize strengthening these systems to ensure that all deaths—and their causes—are routinely and continuously counted.”

Additional background:

Civil registration and vital statistics (CRVS) is one central tool at the root of good governance. Across the globe, birth and death certificates represent the key to unlocking countless social benefits. In addition, the vital statistics generated by well-functioning civil registration systems are crucial to sound policy development in health and other sectors. Understanding who is dying within a population—and from what—serves as vital input into policies that address pressing public health issues and for implementing targeted, life-saving interventions in times of crises.

A challenge throughout the pandemic has been the underreporting of COVID-19 cases and deaths. Factors contributing to this include the scarcity of testing, absence of medical professionals to medically certify causes of deaths and incomplete CRVS systems. A focus on confirmed and suspected deaths furthermore misses out on those deaths indirectly caused by COVID-19, such as when strained health systems are unable to provide sufficient care as well as deaths stemming from COVID-19’s interactions with noncommunicable diseases such as cancer, heart disease, diabetes and others.

Excess mortality is a method of calculating the number of deaths, in a particular place over a specific period, compared to the number of deaths expected for the same time and place based on historical averages. In Brazil, this calculation of excess deaths indicated a staggering picture of the toll COVID-19. Nationally, it is estimated that there were 275,587 excess deaths in 2020, a 22% increase from the historical norms. In 2021, this figure is 65% through April, meaning there were 211,847 excess deaths during this period. Furthermore, an excess mortality analysis revealed stark inequalities in how the pandemic has affected the population—36,000 more Black and Brown people died than the white population in 2020. This represents an 18% excess mortality among white people, compared to 28% among Black and Brown people.

The WHO report includes estimates for the Region of the Americas and the European Region. No estimates are yet available for the African Region, the Eastern Mediterranean Region, the South-East Asia Region and the Western Pacific Region, highlighting the need to strengthen civil registration and vital statistics systems in these geographies.

About Vital Strategies’ work in civil registration and vital statistics and data use for policymaking:

Vital Strategies is an implementing partner in the Bloomberg Philanthropies Data for Health Initiative, a global effort supported by Bloomberg Philanthropies and the Australian Department of Foreign Affairs and Trade. It provides technical assistance to low- and middle-income countries worldwide to improve public health data systems at the national level, including improving civil registration and vital statistics systems, maximizing the use of data to enhance public health policymaking and decision-making, establishing and strengthening national cancer registries and more. 

For more information about Vital Strategies’ work in this area, please visit:  

Media Contact

Christina Honeysett,