COVID-19 may now be the sixth deadliest epidemic in history after the WHO reveals death toll is likely triple the official count

The number of people who died as a result of the coronavirus pandemic by the end of last year was nearly 15 million—triple the amount previously thought, according to new estimates by the World Health Organization.

The new 14.9 million figure is calculated based on the number of excess deaths, or the difference between the average death rate recorded before the pandemic and the number of deaths that occurred during.

Excess mortality includes deaths directly linked to COVID-19 through infection of the disease and indirectly from the pandemic’s impact on health care systems and society.

Previous estimations by the WHO reported only 5.4 million people deaths.

“These sobering data not only point to the impact of the pandemic but also to the need for all countries to invest in more resilient health systems that can sustain essential health services during crises,” WHO Director-General Tedros Adhanom Ghebreyesus said in a statement.

Through the new WHO calculations, an estimated 13% more deaths occurred than normally expected over two years, making the coronavirus pandemic the sixth deadliest epidemic in human history.

COVID-19 overtook the Third Plague Pandemic, which claimed 12 million lives in 1855 and now only trails the bubonic plague (200 million), smallpox (56 million), the Spanish flu (40 million to 50 million), the plague of Justinian (30 million to 50 million,) and the HIV/AIDS epidemic (25 million to 35 million).

The data in detail

The data was extracted across two years from the pandemic—from January 1, 2020, to December 31, 2021—and found the total number of deaths to be between 13.3 million and 16.6 million.

Worse impacted were middle-income countries, which accounted for 81% of the 14.9 million excess deaths.

The World Bank defines middle-income countries as nations with a per capita gross national income between $1,026 and $12,475.

Deaths were most common among males, who accounted for 57% of total deaths, as opposed to 43% for females.

Most deaths they found were concentrated in Southeast Asia, Europe, and the Americas.

Only 10 countries, including the U.S., India, and Russia, accounted for 68% of the deaths recorded.

The WHO suggests that 4.7 million people in India died as a result of the pandemic—with almost half of the deaths that until now had not been counted located there.

This is in stark contrast to the 480,000 figure put forward by the Indian government.

Similar estimates have been reported elsewhere.

Researchers at the University of Washington’s Institute for Health Metrics and Evaluation estimated in a March study published in the Lancet that the number of excess deaths by the end of 2021 was 18 million. The paper argued the lack of access to COVID-19 tests, patchy records of causes of death, and political incentives to undercount hindered an accurate count of deaths.

“Because of limited investments in data systems in many countries, the true extent of excess mortality often remains hidden,” said Samira Asma, Assistant Director-General for Data, Analytics, and Delivery at WHO.

“Data is the foundation of our work every day to promote health, keep the world safe, and serve the vulnerable,” Ibrahima Socé Fall, assistant director-general for Emergency Response, said.

This story was originally featured on Fortune.com