The U.S. COVID-19 death count for 2021 is more than double the toll the pandemic exacted last year, according to government data and Johns Hopkins University. More than 770,000 have died this year, compared to the roughly 385,000 deaths from 2020. The climb is due in part to the spread of the Delta variant and the refusal of millions of Americans to not be vaccinated, even as the shots have proven to be safe and effective at reducing severe illness and death.

“Heading into this year, we knew what we needed to do, but it was a failure of getting it done,” Abraar Karan, an infectious-diseases doctor at Stanford University, told The Wall Street Journal. The saddening milestone was reached a day after the CDC gave the final approval necessary for COVID vaccine boosters to be administered.