A new report by John Hopkins University has tallied the total global death rate from Covid-19 at 5 million, less than two years into a crisis that has devastated the world.

According to the report, the United States, Britain, Brazil and the European Union, which makes up for one-eighth of the world’s population account for nearly half of all reported deaths. The U.S. alone has recorded over 745,000 lives lost, more than any other nation.

“This is a defining moment in our lifetime,” said Dr. Albert Ko, an infectious disease specialist at the Yale School of Public Health. “What do we have to do to protect ourselves so we don’t get to another 5 million?”

The death toll is about equal to the populations of US cities Los Angeles and San Francisco combined. It also rivals the number of people killed in battles among nations since 1950, according to estimates from the Peace Research Institute Oslo. Globally, COVID-19 is now the third leading cause of death, after heart disease and stroke.

The staggering figure is almost certainly an undercount because of limited testing in lower income countries, especially in Africa.

Hot spots have shifted over the 22 months since the outbreak began, turning different places on the world map red. Now, the virus is pummeling Russia, Ukraine and other parts of Eastern Europe, especially where rumors, misinformation and distrust in government have hobbled vaccination efforts. In Ukraine, only 17% of the adult population is fully vaccinated; in Armenia, only 7%.

Africa remains the world’s least vaccinated region, with just 5% of the population of 1.3 billion people fully covered.

“This devastating milestone reminds us that we are failing much of the world,” U.N. Secretary-General António Guterres said in a written statement. “This is a global shame.”