The global death toll has been severely under-reported, the World Health Organization says.

WHO estimates that 14.9 million direct and indirect deaths occurred from SARS-CoV-2 in 2020 and 2021 – almost three times the 5.4 million reported by governments around the world.

The undercount is the result of a lack of COVID-19 testing and death certification, said William Msemburi, technical officer at WHO.

Seventy countries do not produce cause-of-death certificates and even before the pandemic, six in every 10 deaths went unreported, he said.

Of the excess deaths around the world, 68 per cent are concentrated in just 10 countries: Brazil, Egypt, India, Indonesia, Mexico, Peru, Russia, South Africa, Turkey, and the US.

Middle-income countries accounted for 81 per cent of the excess deaths, while high-income countries accounted for 15 per cent and low-income countries 4 per cent. Men made up a larger proportion of deaths from COVID-19 (57 per cent) than women (43 per cent).

The estimates of excess deaths were roughly in line with official tallies in the US, where WHO modelled 932,458 excess deaths, and in Brazil, where it modelled 681,267. But in India, WHO’s models estimated 4,740,894 excess deaths, nearly triple the figure in government reports.

The report has caused controversy in India, where the government has challenged WHO’s figures.