As of 31 December 2020, COVID-19 had infected over 82 million people and killed more than 1.8 million worldwide. But preliminary estimates suggest the total number of global “excess deaths” directly and indirectly attributable to COVID-19 in 2020 amount to at least 3 million, 1.2 million higher than the official figures reported by countries to WHO.

With the latest COVID-19 deaths reported to WHO now exceeding 3.3 million, based on the estimates produced for 2020, we are likely facing a significant undercount of total deaths directly and indirectly attributed to COVID-19.

The term “excess deaths” describes deaths beyond what would have been expected under “normal” conditions. It captures not only confirmed deaths, but also COVID-19 deaths that were not correctly diagnosed and reported as well as deaths attributable to the overall crisis conditions. This provides a more comprehensive and accurate measure when compared with confirmed COVID-19 deaths alone.

For example, some countries only report COVID-19 deaths occurring in hospitals or the deaths of people who have tested positive for COVID-19. In addition, many countries cannot accurately measure or report cause of death due to inadequate or under-resourced health information systems.

The pandemic has likely increased deaths from other causes due to disruption to health service delivery and routine immunizations, fewer people seeking care, and shortages of funding for non-COVID-19 services. The second WHO “pulse survey” of 135 countries in March 2021 highlighted persistent disruptions at a considerable scale over one year into the pandemic, with 90% of countries reporting one or more disruptions to essential health services.

COVID-19 disproportionately impacts vulnerable populations

COVID-19 has exposed persistent inequalities by income, age, race, sex and geographic location. Despite recent global health gains, across the world people continue to face complex, interconnected threats to their health and well-being rooted in social, economic, political and environmental determinants of health.

The pandemic has also revealed significant gaps in country health information systems. While high-resource settings have faced challenges related to overstretched capacity and fragmentation, weaker health systems risk jeopardizing hard-won health and development gains made in recent decades.

Data from the COVID-19 World Symptoms survey shows a decline in preventive behaviours such as physical distancing, mask wearing and hand washing as household overcrowding increases. Among people living in uncrowded households, 79% reported trying to physically distance themselves compared with 71% in moderately overcrowded and 65% in extremely overcrowded households. Similar trends were observed for hand washing and mask-wearing, underscoring vulnerabilities due to socioeconomic status.

Before COVID-19 the world was making progress towards global health goals – but not fast enough

The World Health Statistics 2021 report presents the most up-to-date data and trends on more than 50 health-related indicators for the Sustainable Development Goal and WHO’s Triple Billion targets.

The data shows that global life expectancy at birth has increased from 66.8 years in 2000 to 73.3 years in 2019, and healthy life expectancy has increased from 58.3 years to 63.7 years. But even before the pandemic struck, progress was too slow and uneven to meet many targets including reduced premature mortality from noncommunicable diseases, tuberculosis and malaria incidence, and new HIV infections.

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