SharecloseShare pageCopy linkAbout sharingImage source, Getty ImagesThe US is approaching one million Covid deaths – the highest total officially recorded anywhere in the world.But a new report from the World Health Organization (WHO) shows several other countries recorded more deaths above their normal levels than the US over the last two years.So does the US really have the highest Covid death toll, and by what measure? US deaths above global averageThere’s no international standard for measuring deaths or their causes, and countries record deaths in different ways, which makes comparison difficult.But experts say one of the most accurate measures is how many extra deaths are recorded in a country above the number that would have been expected to die in an average year.Many countries publish excess death data, but some poorer nations don’t or do it far less frequently.The WHO has published a report calculating every country’s excess death count for 2020 and 2021.This measure takes into account deaths not directly due to Covid, but as a consequence of the pandemic, such as people being unable to access hospitals for the care they needed.It also accounts for poor record-keeping in some regions.The report concludes that, although the US was not the worst hit country in the world by this measure, it remained in the top five in terms of overall numbers of deaths.According to the WHO, in 2020 and 2021 the US recorded more than 930,000 excess deaths, behind India (4.7m), Russia (1.1m) and Indonesia (1m).The WHO’s numbers are largely consistent with statistics from the Economist which run into 2022, as well as other excess death studies.When adjusted for population size, the US slips down the rankings with 140 excess deaths per 100,000 people. But it remains a long way above the global average of 96 per 100,000 – and it’s also one of the worst performing among the most developed nations. Prabhat Jha, an epidemiologist who worked on the WHO report, says: “The US has about a 15% undercount using excess deaths compared to official Covid deaths – that’s mostly a result of some of the early problems that occurred with nursing home deaths being missed.””On the whole the US isn’t missing many deaths compared with, say, India,” he adds.WHO: India’s Covid-19 toll highest in the worldWhat about the official Covid death numbers?The US has recorded the most deaths from coronavirus in the world – over 300,000 more than the next closest country, Brazil.But the US has a larger population than many other countries.When you look at the same top 10 countries in per capita terms, the US is below both Brazil and Peru for recorded Covid deaths.Overall the US ranks 18th in the world in recorded Covid deaths per capita, according to Johns Hopkins University data.”Short term I think the per capita confirmed death rate is a pretty good indicator” says Justin Lessler, professor of epidemiology at the University of North Carolina.”The US is not the highest, but it’s certainly on the higher end.”Experts say it’s also important to take the average age of a country’s population into account.”We should compare with countries which have similar age structures as we know Covid has a higher fatality rate in the elderly – so we should compare apples to apples,” says Bhramar Mukherjee, professor of epidemiology at the University of Michigan.When comparing with Spain, UK, and France, as well as neighbouring Canada – developed countries with similarly aged populations to the US – the US has performed worse.”A lot of the European countries – like the UK, France and Spain – are reasonable to compare, and they’ve had lower per capita death rates. It’s not night and day, but the US is on the upper end of that spectrum,” says Professor Lessler.Read more from Reality CheckSend us your questions

SharecloseShare pageCopy linkAbout sharingimage copyrightGetty ImagesPresident Joe Biden is urging Americans to get jabbed as the country’s vaccination rollout slows down.Infections are rising across the country, and in some states fewer than half of residents have received their first dose.We’ve looked into where vaccinations are lagging, and why this might be.US falling behindSupply isn’t generally a problem in the US, and anyone over the age of 12 is eligible to receive an authorised vaccine.But after being one of the world leaders in vaccine uptake until the middle of April, the US vaccination rate has slowed down.The US now lags behind neighbouring Canada in terms of doses administered as share of total population, as well as the UK, Italy and Germany.It’s still ahead of some other major economies, such as Japan, but the vaccination rate in the US is dropping off as it climbs elsewhere.The US still hasn’t reached the target set by President Biden of 4 July for getting 70% of those over 18 vaccinated with at least one shot – currently around 68% of adults have received their first dose.New infections have more than doubled in the US in the past month – and according to the US Centers for Disease Control and Prevention, the vast majority of new cases and deaths are among the unvaccinated.What states are lagging behind?States in the south of the US tend to have the lowest vaccine uptake.Mississippi and Louisiana have the lowest – both with less than 40% of residents having received at least one dose.North-eastern states tend to have among the highest vaccine uptake – with about 75% of people in Vermont and Massachusetts receiving at least one dose.Professor Peter Hotez, a vaccine expert at the Baylor College of Medicine, says: “It’s practically halted in the southern states – despite the widespread availability of the vaccine, we have a sharp divide.””In the southern states, and in the mountain west states, most of older adults are vaccinated but a lot of the younger ones are not – and that’s where the big gap lies.”image copyrightGetty ImagesData shows that in states such as Mississippi, Alabama and Louisiana, around 80% of people over 65 are vaccinated, but only around 40% of under-65s are.In contrast, in Vermont and Massachusetts almost everyone over 65 has received at least one dose, as have almost 80% of those under 65.Why has uptake slowed down?In the middle of April, the US was administering more than three million doses a day, but it is now down to about 500,000 a day.This is partly because there aren’t as many people to vaccinate – the UK has also seen its vaccination rate drop off, although not as rapidly as the US.And the UK and other developed countries have typically reached a larger share of their population before their vaccination rate has dipped.Experts say there is a lack of urgency among some healthy young people in the US, who aren’t in a rush to get a vaccine.Concern about vaccine safety and resistance to the idea of having vaccines are also issues.image copyrightGetty ImagesDr Jennifer Kates, vice-president of the Kaiser Family Foundation, which monitors vaccine sentiment, says: “Some people raise safety concerns, and say they may be more likely to get vaccinated when a vaccine is fully approved vs just authorized.” The vaccines used in the US are not yet formally approved, but have received emergency authorisation due to the urgency of the pandemic.Dr Kates adds: “A persistent share of about 20% are hold-outs, who say they won’t get vaccinated at all, or only will if required by their employer.”The Biden administration has blamed online misinformation in large part for the resistance to vaccines.The White House surgeon general has said: “It’s one of several reasons why people are not getting vaccinated, but it’s a very important one, because of what we know from polls.”We’ve reported on many examples of misinformation spreading online throughout the pandemic – such as the baseless theory that the vaccine is being used to microchip and track people.A recent poll suggests some of these unfounded claims have taken hold – with one in five Americans believing the microchip theory.Polling also suggests resistance to vaccinations is divided down political lines – with almost 30% of Republicans saying they will not get vaccinated, compared with just 4% of Democrats.Twitter suspends Marjorie Taylor Greene over ‘misleading’ Covid postsBiden rows back on Facebook ‘killing people’ commentThis would partly explain why vaccine uptake is lower in southern states, which are typically home to more Republican voters. image copyrightGetty ImagesProf Hotez says: “The biggest reason from my perspective is defiance along a political divide.”The messaging coming from conservative news outlets and conservative members of Congress is if you’re a young person you don’t need it because the death rates are low and vaccines are being used as an instrument of control by the liberals.”But there are also access issues for some people.Dr Kates says: “Despite supply not being an issue, there are still people who face barriers to getting vaccinated – not sure they can get time off work, lack of transportation, and the worry that they might have to pay.”Federal rules say Americans shouldn’t have to pay anything for vaccines, regardless of their immigration or health insurance status.Read more from Reality CheckSend us your questions