As the global COVID-19 death toll surpassed five million this week, infectious disease and public health experts say it's a grim reminder of how the virus devastates vulnerable populations around the world, including in Canada.
They say the need to address problems in long-term care, as well as broader health inequities, will be among the legacies of the pandemic, which killed approximately 29,000 people in Canada as of Monday.
The country's role in lessening the COVID-19 burden globally by donating excess vaccines will be another.
"There have been a good number of COVID deaths since January 2021, and that's really a different era of this disease," said Dr. Zain Chagla, an infectious disease specialist with McMaster University.
"We're (eventually) going to realize how many people actually died in this era — where COVID was a vaccine-preventable disease but global access was fairly minimal."
Canada committed in December 2020 to donating the equivalent of at least 200 million vaccine doses to COVAX by the end of 2022.
The country had donated 3.4 million vaccine doses through COVAX as of Monday, with an additional 762,000 doses of the Oxford-AstraZeneca product donated through direct arrangements with Latin American and Caribbean countries. The government announced Saturday it would donate another 10 million doses of the Moderna vaccine to COVAX, plus $15 million to help make mRNA vaccines in Africa.
Chagla said Canada's donation goal might become harder to achieve as more Canadians begin to qualify for third doses.
Last week, the National Advisory Committee on Immunization recommended provinces roll out third jabs of mRNA vaccines to select groups, including seniors older than 70, front-line health workers and those who previously received two doses of the AstraZeneca vaccine.
While Chagla said breakthrough infections can be troublesome for the elderly and those with medical conditions, he said Canada likely doesn't need to extend third-dose eligibility to the general population yet.
"It becomes a slippery slope," he said. "Do we want to be remembered as the country that boosted their populations' immunity ... in the context of huge burdens of COVID (globally)?
"Obviously, that has implications for us ending this pandemic."
Dr. Lynora Saxinger, an infectious disease expert with the University of Alberta, said she'd delay her own third dose if it meant a health-care worker in another country could get their first jab.
She added that most Canadians likely wouldn't need a boost within the next several months but if Canada gets enough supply, it could offer boosters and commit to its COVAX donation goal at the same time.
Still, Saxinger called the vaccine equity and global access dilemma "the next big challenge."
"There are moral and ethical reasons (for ensuring vaccine equity), but the other selfish reason is that places with ongoing transmission ... are places where variants are likely to arise."
Saxinger said Canada also needs to apply lessons from mistakes made earlier in the pandemic to potential future waves of COVID-19 or other viruses.
She said some provinces failed to protect long-term care residents during the second wave, even after seeing the devastation of the first wave, and didn't act quickly to offer paid sick leave for employees who couldn't afford to miss a day of work to get tested or vaccinated.
"There's a lot of emerging infectious diseases that could possibly happen and if we don't learn the lessons from this one, I think that would be tragic," she said.
Seniors, particularly those in long-term care, represented most of Canada's COVID-19 deaths in the first and second waves while essential workers bore the brunt of third-wave deaths.
Dr. Barry Pakes, a global health expert with the University of Toronto, said that has been the theme throughout most of the world, but it played out differently depending on the country.
He notes that 8,100 COVID-19 deaths in Israel were relatively low compared to the country's case counts, which he says was because of their younger population. In the United States, where private health care limits access and a large segment of the population didn't comply with lockdown measures, deaths were much higher at 740,000.
Pakes added that lessons should be taken from Canada's staggering death count in long-term care and among essential workers, but the problems highlighted by the COVID-19 pandemic were already known to public health.
"We knew that staffing and overall funding (in long-term care) was inadequate to protect those most vulnerable from exactly what happened," he said. "So I would say those lessons were emphasized further in the pandemic and hopefully they'll be acted on."
Pakes said it's also worth remembering that the global COVID-19 death toll is likely much higher than the official five-million count.
He said some estimates double that figure, without taking into account indirect deaths, such as cancer patients who had surgeries delayed or car crash victims who couldn't get intensive care beds when health-care systems were overwhelmed across the world.
Chagla said those figures are likely impossible to calculate on a worldwide scale.
"But I imagine the global burden is significantly higher," he said.
This report by The Canadian Press was first published Nov. 1, 2021.
Melissa Couto Zuber, The Canadian Press