COVID: millions of older people have died without being counted

The WHO global estimates on excess deaths during the COVID-19 pandemic raise many uncomfortable truths about how we as a global community value the lives of older people and those in low- and middle-income countries. Why do we allow our global leaders to continually fail to turn rhetoric on solidarity and equity, both between and within countries, into reality?

 

The recently-released data rebuts any idea that those in low- and middle-income countries have been less affected by COVID-19. Instead, it finally makes visible what those working with older people in these countries have seen with their own eyes: millions have been dying without even being counted.

Far from being less affected, the WHO estimates that 85% of excess mortality during the pandemic has been in low- and middle-income countries, totalling a staggering 12.7 million deaths. Almost the same percentage of these deaths (83%) have been among older people.

 

The findings confirm what has been universally known since the beginning of the pandemic: that older age groups are most at risk of serious illness and death from COVID-19. And yet, rather than protecting and promoting older people’s equal right to health and to life, millions of older women and men have been left behind in responses and treated as if expendable.

 

The first global COVID-19 humanitarian response plan failed to explicitly include older people as one of the groups most at risk. And the current vaccine rollout is now failing many of those aged over 60 in low- and middle-income countries, where millions remain unvaccinated.

 

It is clear in these failed responses, that the risk posed by the virus to older age groups has been exacerbated by ageist attitudes which have constituted a death sentence for many older people.

 

And let’s be clear: these were not people who “would have died soon anyway”, an often repeated and ageist assumption made by many during the pandemic. Excess mortality, by its very nature, measures those deaths that are over and above what would be expected in a ‘no pandemic’ scenario. Many of those older people who died may have lived five, 10, 20 years or more – in one study published in the BMJ, additional years of life lost in 31 countries in 2020 alone were estimated at more than 28 million and concentrated among older people. The loss of these individuals to their families and communities is unquantifiable.

These excess deaths reveal more than estimates of the uncounted deaths directly caused by COVID-19: they also highlight the wider impact of the pandemic on people’s lives. They bring into sharp relief the depth of global inequalities in systems and services that support our resilience across the life course, including in later life.

 

These inequalities, like the devastating death toll as Dr Jeremy Farrar has emphasised, are not inevitable. Perhaps the most heart-wrenching element of all of this this is that collectively we have the money, knowledge, tools and technologies we need to end the pandemic and to build more resilient and fair systems for people of all ages – if we choose to.

 

But today, inequalities revealed by COVID-19 are continuing. While some countries have declared the end of COVID-19, many are still grappling with its impact. 

 

Millions in low- and middle-income countries are still unable to access COVID-19 vaccines, tests and treatments. The recent third round of the WHO COVID-19 Pulse Survey shows health and care systems remain unable to move beyond the acute phase of the pandemic – with services for older people some of the most affected. All the while, economic inequalities are becoming even more extreme, as highlighted by actors including Oxfam and the World Bank, making ‘build back better’ a distant dream for the majority of people.

The question now is whether these truly shocking numbers – an official count of the millions who lost their lives – will make a difference?

 

If it is going to, people at all levels must use this as a call to action to unite and exert pressure on governments to ensure the inequalities revealed by the pandemic are not allowed to be exacerbated exponentially.

 

Global leaders must stop talking about equity and solidarity and use the levers they have – political, economic and social – to achieve it.

 

This means investing in what will deliver this equity: in strong and resilient communities and systems – from universal health coverage and social protection – to those that effectively address climate change and support broader pandemic preparedness and response. At their very core, they must be guided by equity – as a principle and an outcome, not just as an empty word.

 

People must be placed before profit and health and wellbeing across the life course must be prioritised. And we must ensure that the most basic human rights of each one of us are upheld everywhere, at all ages, whether we are in a global pandemic or not.

 

 

By Camilla Williamson, Healthy Ageing Adviser at HelpAge International.