Global mortality trends in the last 12 months

Global mortality trends point to continued high levels of excess mortality in the last 12 months and suggest that the pandemic is not over

This post provides a rundown of global mortality trends over the last 12 months. We will describe cumulative trends in counts and rates of reported COVID-19 deaths and estimated excess deaths, identifying global trends, trends by World Bank income group and the Top 50 countries for each.

Contents

Why 12 months?

The relatively short window of 12 months has a number of advantages. They all center on the fact that the pandemic has evolved in many dimensions and that patterns of a too distant past may no longer be relevant to interpret current events.

Consider for example:

  • Strains. The 12-month window helps focus on the viral strain most prevalent rather than mixing in pathogens from long ago. The current focus is on Omicron-related fatalities, not the ancestral strain or Delta for instance.
  • Testing. Testing regimens may differ drastically over time. The current period is one of more limited testing frequency given availability of home tests and properties of Omicron amidst a more widely immunized population. 
  • Vaccines and treatments. We’re in a very different spot today in terms of the availability of vaccines and treatments, which complicates comparisons with earlier periods. 
  • India May 2021.  By focusing on the last 12 months, we exclude the oversized effects of India May 2021 on the global numbers and can highlight better the patterns of the more recent past. 

Mortality counts

We start our rundown of global mortality trends with an examination of the number of fatalities because they matter the most in our book. Count every single fatality because a life lost is a life lost regardless of borders! Mortality rates afford a relative perspective and the trouble with them is that they tend to obfuscate the main locus of the pandemic’s global impact, especially with respect to populous developing countries. 

Let’s turn to the numbers now.

Global mortality trends

Over the last 12 months, the world has accumulated a reported 1,340,000 COVID-19 deaths and an estimated 5,160,000 excess deaths. Over this period, we saw an inflection point around April 2022 when the pace of increase in mortality slowed considerably. 

Trends by income group

HICs dominated the globally reported numbers of COVID-19 deaths., followed in order by UMICs, LMICs and LICs. These rankings are rather different for estimated excess deaths, which were driven mostly by LMICs, followed by UMICs, HICs and then LICs. 

Note also the gap between the two mortality concepts. The gap is the largest in absolute terms for LMICs, then UMICs, HICs and LICs. In relative terms, the gap is the most considerable for LICs, which start off from a position close to zero for reported COVID-19 deaths.

Top 50 countries

Which countries have had the highest cumulative counts over the last 12 months for COVID-19 and excess deaths? The charts below show the Top 50 with countries grouped by World Bank income group. 

For reported COVID-19 deaths, the three countries that accumulated the most fatalities over the last 12 months are: US (291,000 fatalities), Russia (106,000) and Brazil (74,000).

For estimated excess deaths, the top three countries are India (953,000 fatalities), China (486,000) and Russia (304,000)

Mortality per capita

Next let us describe the relative mortality picture with fatalities normalized by each country’s population. While such metric does not lend itself to an accurate assessment of the pandemic’s overall impact, it is nevertheless useful in assessing pandemic performance at the level of a country or group of countries. And it helps assess the intensity of pandemic mortality relative to a specific population.

Global mortality trends

Over the last 12 months, the accumulated global mortality rate was a reported 17 COVID-19 fatalities per 100,000 people and an estimated 66 excess deaths also per 100,000.

Trends by income group

The cumulative mortality rates by income group show different rankings than those for counts due to the large differences in population size. We traditionally see that reported COVID-19 death rates are highest in HICs, followed by UMICs, LMICs and then LICs. This has been the case also over the last 12 months.

Estimated excess death rates produce a different ranking. HICs have currently the highest excess rates, closely followed by other income groups. LMICs are second and UMICs and LICs are similar. 

Top 50 countries

Which countries have had the highest cumulative mortality rates over the last 12 months? We focus again on the Top 50 for COVID-19 and excess death rates, with countries grouped by World Bank income. 

For reported COVID-19 deaths, the top three countries with the highest cumulative rate over the last 12 months are: Greece (151), Croatia (148and Trinidad and Tobago (140), all expressed per 100,000 people.

For estimated excess deaths, the top three countries are Lithuania (256), Bulgaria (218) and Serbia (215), all again per 100,000 people

The pandemic is not over

The patterns of cumulative mortality show that the pandemic is far from over. We continue to see a large gap between reported COVID-19 and estimated excess deaths. Excess death counts are, as expected, much larger in the developing world, which is far more populous than the group of high-income countries. We also continue to see elevated excess death rates, where over the last 12 months high-income countries seem to have taken the lead, but the rest of the world is following closely.

While excess death rates have declined considerably, they remain at high levels. This is easily established by comparing the current level of excess deaths with the patterns that we have been used to before the pandemic. The chart above expresses current weekly excess deaths as a share in 2019 all-cause deaths and compares it with the share of the top cause of death also in 2019 all-cause deaths. As we can see, excess deaths currently exceed all the deaths that could be attributed to the #3 cause of death prior to the pandemic.  

Another reason for remaining vigilant and exercising the necessary precautions is that the world remains incompletely and unequally vaccinated. As of today, we count 2.4 billion unvaccinated people, of whom 90% live in the developing world (UMICs, LMICs and LICs) and 70% in the poorer half of the world (the LMICs and LICs). The map shown above is a cartogram that shows where the unvaccinated live as land mass is distorted to represent the absolute count of those who have not received a single shot yet. The 10 countries that have the largest unvaccinated population are also highlighted (along with Australia and New Zealand to mark them more clearly on the map).

But this is not all. Among those previously vaccinated, many are not up-to-date on vaccination. This is reflected in the chart above which shows that global booster coverage (the dot in the first bar) is abysmally low. This is consistent with how the global booster campaign is doing. Compared to the first cycle (the primary vaccination campaign), booster vaccination progress is much slower and also more unequal. 

In sum, this is not the time to declare the pandemic as over. Global mortality patterns suggest so. We continue to see high levels of excess deaths and the fact that globally excess deaths exceed the #3 cause of death prior to the pandemic should be a cause for concern.

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