Global excess deaths associated with COVID-19, January 2020 - December 2021

The monitoring of excess mortality provides us with a more comprehensive understanding of the impact of COVID-19 beyond the number of COVID-19 deaths reported by countries. The World Health Organization (WHO) is tracking global excess mortality as the pandemic evolves over time to reveal a picture of its full impact and burden on countries, health systems and individuals.

Excess mortality associated with COVID-19 is used to quantify the direct and indirect impacts of the pandemic. 'Excess mortality' is defined as the difference between the total number of deaths that have occurred and the number of deaths that would have been expected in the absence of the pandemic i.e. a no-COVID-19 scenario.

Understanding the excess mortality:

• Excess mortality includes deaths attributable directly to COVID-19 that were counted and reported to WHO by countries.
• It also includes deaths attributable directly to COVID-19 that were not counted or reported by countries.
• It also includes deaths indirectly associated with COVID-19, due to other causes and diseases, resulting from the wider impact of the pandemic on health systems and society.
• It is minus any deaths that would have occurred under normal circumstances but were averted due to pandemic-related changes in social conditions and personal behaviors e.g. less traffic deaths or influenza deaths due to local lockdowns and less travel.

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The global excess mortality associated with COVID-19 was 14.91 million in the 24 months between 1 January 2020 and 31 December 2021, representing 9.49 million more deaths than those globally reported as directly attributable to COVID-19.

The impact of the pandemic has been over several waves with each characterized by unique regional distributions, mortality levels and drivers. Twenty countries, representing approximately 50% of the global population, account for over 80% of the estimated global excess mortality for the January 2020 to December 2021 period. These countries are Brazil, Colombia, Egypt, Germany, India, Indonesia, the Islamic Republic of Iran, Italy, Mexico, Nigeria, Pakistan, Peru, the Philippines, Poland, the Russian Federation, South Africa, the United Kingdom of Great Britain and Northern Ireland, Turkey, Ukraine, and the United States of America (USA). We are able to observe the evolution of the pandemic over these 24 months as different regions and countries were impacted by and responded to the threat of COVID-19.

Excess mortality cannot be derived for all countries when using standard methods because of gaps in the underlying data. Therefore, statistical methods are required to derive the expected and total deaths based on the levels of data available for countries; this is why these figures are called 'estimates'.

The methodology for generating the estimates adopts a statistical method called a Poisson regression model and has been developed in collaboration with the United Nations Department of Economic and Social Affairs (UN DESA) and an appointed Technical Advisory Group for COVID-19 Mortality Assessment.

Our estimates have a range of uncertainty per country and that level of uncertainty is directly related to a country's reporting capacity and variable data quality. As we chart the range between the upper and lower bounds of uncertainty for WHO regions, we are able to observe the relative availability of data for each region and how data gaps disproportionately impact some parts of the world more than others. If the uncertainty bounds are larger, this indicates that there is less available data and therefore, a corresponding greater degree of uncertainty. These ranges in uncertainty serve to highlight the ongoing need and work of WHO, as we partner with countries to strengthen national Health Information Systems, Civil Registration and Vital Statistics Systems and reporting of causes of death, and integrated surveillance systems to help improve data availability and close 'data gaps'.