Adopting rapid mortality surveillance in post-Covid era

The Covid-19 pandemic is challenging country mortality surveillance systems in unprecedented ways, while also highlighting the necessity for accurate, timely and reliable mortality data. Prior to the pandemic, many countries in Asia and the Pacific already struggled to collect and produce high-quality and reliable statistics on deaths, and causes of deaths, within their populations. But as the pandemic continues, some countries are turning to stop-gap measures to collect reliable data in a timely manner and using the pandemic as an opportunity to reassess and strengthen their mortality surveillance systems.

Without high quality data on communities impacted by the virus, local decision-makers are unable to direct resources to the most vulnerable. Implementing rapid mortality surveillance and improving the quality of death statistics-including causes of death- therefore has never been more relevant as the global community calculates and responds to the toll of the virus' impact.

But what exactly is rapid mortality surveillance? Vital Strategies defines rapid mortality surveillance as "a system for generating daily or weekly counts of total mortality by age, sex, date of death, place of death, and place of usual residence." Moreover, the "basic concept of rapid mortality surveillance adds to the international architecture of population health surveillance and civil registration and vital statistics (CRVS) systems".

Rapid mortality surveillance bolsters availability and quality of critical data in CRVS systems unable to universally register deaths nationwide. Well-functioning CRVS systems have a death registration component with universal coverage and a cohesive process for death notification working across national territories. However, in less developed CRVS systems, rapid mortality surveillance enables countries to "fill the gap" with reliable and timely data while accelerating efforts to improve CRVS systems so they are resilient to future shocks.

Consequently, the purpose of rapid mortality surveillance is to provide decision-makers with "insights into the full magnitude of the health consequences of an epidemic (beyond case counts and mortality counts based on lab diagnosis), and into disparities in disease burden across geographic and demographic groups". Once established, rapid mortality surveillance provides critical information by generating mortality data from two main sources. The first is facility-based surveillance, including hospitals or even cemeteries and crematoria. And the second is community-based surveillance, which can be linked to the active notification of vital events in the community as part of large-scale CRVS improvement efforts.

To enable countries to establish rapid mortality surveillance on a local level, multiple organisations, including Vital Strategies, World Health Organisation (WHO), and United Nations Economic and Social Commission for Asia and the Pacifice (UNESCAP) developed the Technical Package for Rapid Mortality Surveillance and Epidemic Response, along with the tools to analyse and detect possible excesses in the levels of all-cause mortality.

While rapid mortality surveillance is a critical tool in times of crisis like the Covid-19 pandemic, it is not intended to be used as a permanent measure. Instead, the fundamental objective is to impart the value of this information and empower countries to progress toward a more permanent solution. It does this by equipping the CRVS system to accomplish mortality surveillance continuously, while simultaneously striving for high levels of completeness and coverage. Such tracking based on routine systems with high completeness levels is already taking place in Australia, Japan, New Zealand, the Republic of Korea, and Thailand.

Given the pandemic's sudden impacts, many countries emphasized an emergency response over long-term institutionalization. While the Rapid Mortality Surveillance Technical Package is suited to this approach, it also enables countries to go beyond the emergency response mode and build mortality surveillance systems that meet goals aligned with country priorities and international or regional standards, such as the 2030 Agenda for Sustainable Development and the Regional Action Framework for CRVS in Asia and Pacific. In other words, while rapid mortality surveillance may fill the gaps in an underdeveloped CRVS system, it simultaneously provides a solid platform upon which countries can build a universal and responsive death registration system.

Currently, a number of ESCAP member states, including Bangladesh, are working to establish rapid mortality surveillance as a means for generating high-quality mortality data. As part of ESCAP's Asia-Pacific Stats Café Series, Vital Strategies and Bangladesh highlighted the lessons learned from this valuable tool and describe how they are using the rapid mortality surveillance to generate high-quality statistics to get everyone in the picture.

The piece first appeared in UNESCAP blog which was prepared with assistance and input from Mr Philip Setel and Mr Martin Bratschi. www.unescap.org/blog