The official global death toll from COVID-19 is on the verge of eclipsing 6 million—underscoring that the pandemic, now in its third year, is far from over.

The milestone is the latest tragic reminder of the unrelenting nature of the pandemic, even as people are shedding masks, travel is resuming, and businesses are reopening around the globe. The death toll, compiled by Johns Hopkins University, stood at 5,996,882 as of Sunday morning and was expected to pass the 6 million mark later in the day.

Remote Pacific islands, whose isolation had protected them for more than two years, are just now grappling with their first outbreaks and deaths, fueled by the highly contagious omicron variant.

Hong Kong, which is seeing deaths soar, is testing its entire population of 7.5 million three times this month as it clings to mainland China’s “zero-COVID” strategy.

As death rates remain high in Poland, Hungary, Romania, and other Eastern European countries, the region has seen more than 1 million refugees arrive from war-torn Ukraine, a country with poor vaccination coverage and high rates of cases and deaths.

And despite its wealth and vaccine availability, the United States is nearing 1 million reported deaths on its own.

Death rates worldwide are still highest among people unvaccinated against the virus, said Tikki Pang, a visiting professor at the National University of Singapore’s medical school and co-Chair of the Asia Pacific Immunization Coalition.

“This is a disease of the unvaccinated—look what is happening in Hong Kong right now, the health system is being overwhelmed,” said Pang, the former director of research policy and cooperation with the World Health Organization. “The large majority of the deaths and the severe cases are in the unvaccinated, vulnerable segment of the population.”

It took the world seven months to record its first million deaths from the virus after the pandemic began in early 2020. Four months later another million people had died, and 1 million have died every three months since, until the death toll hit 5 million at the end of October. Now it has reached 6 million—more than the populations of Berlin and Brussels combined, or the entire state of Maryland.

But despite the enormity of the figure, the world undoubtedly hit its 6 millionth death some time ago. Poor record-keeping and testing in many parts of the world has led to an undercount in coronavirus deaths, in addition to excess deaths related to the pandemic but not from actual COVID-19 infections, like people who died from preventable causes but could not receive treatment because hospitals were full.