BANGKOK (AP) — The official global death toll from COVID-19 eclipsed 6 million on Monday — underscoring that the pandemic, now entering its third year, is far from over.

The milestone, recorded by Johns Hopkins University, 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.

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 1.5 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.

Edouard Mathieu, head of data for the Our World in Data portal, said that — when countries’ excess mortality figures are studied — as many as nearly four times the reported death toll have likely died because of the pandemic.

An analysis of excess deaths by a team at The Economist estimates that the number of COVID-19 deaths is between 14.1 million and 23.8 million.

“Confirmed deaths represent a fraction of the true number of deaths due to COVID, mostly because of limited testing, and challenges in the attribution of the cause of death,” Mathieu told The Associated Press. “In some, mostly rich, countries that fraction is high and the official tally can be considered to be fairly accurate, but in others it is highly underestimated.”

The United States has the biggest official death toll in the world, but the numbers have been trending downward over the last month.

The world has seen more than 445 million confirmed COVID-19 cases, and new weekly cases have been declining recently in all regions except for the Western Pacific, which includes China, Japan and South Korea, among others, the World Health Organization reported this week.

Global vaccine disparity continues, with only 6.95 per cent of people in low-income countries fully vaccinated, compared to more than 73 per cent in high-income nations, according to Our World in Data.

In a good sign, at the end of last month Africa surpassed Europe in the number of doses administered daily, but only about 12.5 per cent of its population has received two shots.

The Africa Centers for Disease Control and Prevention is still pressing for more vaccines, though it has been a challenge. Some shipments arrive with little warning for countries’ health systems and others near the expiration date — forcing doses to be destroyed.

Eastern Europe has been particularly hard hit by the omicron variant, and with the Russian invasion of Ukraine, a new risk has emerged as hundreds of thousands of people flee to places like Poland on crowded trains. Health officials there have been offering free vaccinations to all refugees, but have not been making them test upon arrival or quarantine.