The U.S. still leads the world in the number of coronavirus cases and deaths, but while the pandemic is showing signs of slowing here, other nations remain in desperate conditions.

On Thursday, Brazil became the second nation to surpass 400,000 COVID deaths, according to Johns Hopkins University of Medicine. Only the U.S. has more, with more than 575,000 dead since the pandemic began more than a year ago. Approximately 100,000 people have died in Brazil over the last month.

Brazil’s Health Ministry registered more than 4,000 deaths on two days early in the month, and its seven-day average topped out at above 3,100. That figure has tilted downward in the last two weeks, to less than 2,400 deaths per day, though on Thursday the Health Ministry announced another 3,001 deaths, bringing Brazil’s total to 401,186.

Local health experts have celebrated the recent decline of cases and deaths, plus the eased pressure on the Brazilian health care system — but only modestly. They are apprehensive of another wave of the disease, like those seen in some European nations, due to a premature resumption of activity in states and cities combined with slow vaccination rollout.

Less than 6% of Brazilians have been fully vaccinated against COVID-19, according to Our World in Data, an online research site. President Jair Bolsonaro, who is now being investigated by a Senate panel over his administration’s handling of the crisis, has repeated he will be the last to get a shot and he has attacked mayors and governors who enforce restrictions to control the virus’ spread.

Shortly after the grim landmark was published, Bolsonaro said in a live broadcast on his social media channels that “a big number of deaths has been announced,” adding that he is “sorry for every death.” But he repeated his stance against social distancing measures.

“I pray to God so there is not a third wave” of the coronavirus, the president said. “But if the lockdown policies continue this country will be dragged to extreme poverty.”

Globally, more than 150 million COVID cases have been reported, with India trailing the U.S. in that category. India has tried to fight skyrocketing coronavirus infections by increasing its production of vaccines and banning their export, cutting off supplies to neighbors such as Bangladesh and Nepal as they struggle with infection surges of their own.

These nations have imposed lockdowns as residents of big cities flee to the countryside seeking safety. They are also turning to China and Russia for vaccines in a desperate effort to deal with a pandemic that is becoming bigger and deadlier across South Asia.

Although new, more transmissible variants appear to be partly behind the surge, experts say other factors are contributing, including large holiday gatherings and growing fatigue with social distancing and mask wearing.

Elsewhere, Europe’s economy shrank 0.6% in the first three months of the year as slow vaccine rollouts and extended lockdowns delayed a hoped-for recovery, and underlined how the region is lagging other major economies in rebounding from the coronavirus pandemic.

The fall in output for the 19 countries that use the euro currency was smaller than the 1% contraction expected by economists but still far short of the rebound underway in the United States and China, two other pillars of the global economy.

Figures announced Thursday showed the U.S. economy grew 1.6% during the first quarter, with business supported by strong consumer demand. On an annualized basis, the U.S. grew 6.4%.

In Europe, the second straight quarter of falling output confirms the region is in a double-dip pandemic recession after a rebound in growth in the third quarter. Two quarters of falling output is one definition of a recession.

France showed unexpected growth of 0.4% compared to the quarter before, while the main negative surprise came in Germany, the continent’s largest economy. Activity there shrank by a larger-than-expected 1.7% as the manufacturing sector was hit by disruption of parts supplies on top of the hit to services and travel from pandemic-related restrictions on activity.

French authorities are anticipating the COVID-19 outlook in the country to be better next month, when a greater proportion of the population will be vaccinated. The government is slowly starting to lift partial lockdowns, despite still-high numbers of coronavirus cases and hospitalized COVID-19 patients. President Emmanuel Macron said Thursday that the outdoor terraces of France’s cafes and restaurants will be allowed to reopen on May 19 along with museums, cinemas, theaters and concert halls under certain conditions.

Worry about a potential second straight lost vacation season has clouded the outlook for Mediterranean countries Italy, Spain and Greece, which rely heavily on tourism. Greece has lifted quarantine restrictions on visitors from EU countries and will allow restaurants and cafes to reopen for outdoor service from May 3. Travel receipts there sank 75% last year.

Economists said they expected an upturn in the coming weeks as vaccinations accelerate. The International Monetary Fund forecasts growth of 4.4% for the eurozone for all of this year. Thus far, Europe’s unemployment rate has increased only gradually to 8.1% in March, thanks to extensive furlough support programs that help companies keep workers on. The U.S. saw its jobless rate fall to 6.0% after spiking as high as 14.8% during the worst of the pandemic.

A major factor holding back the recovery in Europe is the slow vaccine rollout, which has led to prolonged lockdowns. Another is less fiscal support for the economy from new government spending. U.S. President Joe Biden’s $1.9 billion relief package, coupled with spending from earlier support efforts, will mean additional cash support of about 11-12% of annual economic output for this year, according to economists at UniCredit bank. By contrast, the European fiscal stimulus amounts to about 6% of gross domestic product, even after Europe’s more extensive social safety net is factored in.

China was hit first by the pandemic but got it under control through strict public health measures and was the only major economy to grow in 2020. The U.S. was hard hit by the virus but has rolled out vaccinations at a rapid pace.