The past 18 months have shown that accurately counting the dead is vital for protecting the living. At the outset of the pandemic, many countries lacked adequate registration systems, and others saw their processes break down under strain. This made it harder to track the spread of COVID-19 and deal with its consequences. Even in normal times, lack of data about deaths and their causes can seriously impede efforts to protect public health. Fixing this ought to be a global priority.
The past 18 months have shown that accurately counting the dead is vital for protecting the living. At the outset of the pandemic, many countries lacked adequate registration systems, and others saw their processes break down under strain. This made it harder to track the spread of COVID-19 and deal with its consequences. Even in normal times, lack of data about deaths and their causes can seriously impede efforts to protect public health. Fixing this ought to be a global priority.
Reliable information on mortality and morbidity can give warning of growing public health challenges, such as heart disease due to obesity and diabetes, or drug abuse. It can also help to flag racial and other disparities that highlight inequalities in housing, jobs and access to health care. The rate of deaths from COVID-19 has been significantly higher for Black Americans than white Americans, for instance; figures for the U.K. tell a similar story. In India, lack of data for rural areas early in the pandemic led to fatal complacency.
It’s safe to assume that deaths due to COVID have been, and continue to be, undercounted in much of the world. Nearly two-fifths of the world’s deaths are unregistered, and in Africa it’s the vast majority. Only 8% of reported deaths in low-income nations show a cause. In a crisis, even developed nations can fail to gather the information they need to respond effectively.
Technology is part of the answer. Online notification allowed countries such as Costa Rica to collect data as COVID-19 spread. Government agencies also need to get better at sharing information. Mobile phones and software make this feasible — but political will, appropriate incentives and investment are necessary as well. Local leaders need to understand the importance of accurate records; doctors need training in death certification; and policymakers need to know how to use the data. (Bloomberg Philanthropies works with organizations including Vital Strategies to support such efforts in countries such as Rwanda, which published its first vital statistics report last year.)
Major progress will take time, but stopgap measures can help in the interim. Rapid surveillance using hospitals and community centers allows better counts of fatalities, especially if officials and health professionals, not families, are made responsible for reporting. Over time, deaths in excess of trend can then be estimated. Household interviews (so-called verbal autopsies) and surveys can give a fuller picture. Such initiatives, already underway in many poor countries, deserve political and financial support. The cost can be low — a study in India estimated just 10 cents per capita per year.
The crucial thing is to understand just how valuable better global information on deaths would be. A combination of ad hoc progress in the short term, combined with a longer-term strategy to extend, improve and integrate this essential record-keeping, can equip policy makers with the information they need to save lives.
