COVID-19 Futures: A Framework for Exploring Medium and Long-Term Impacts

Background: Considering the possible trajectories of the COVID-19 pandemic is important to inform both short- and long-term responses and to prepare for pandemics of the future. We describe a framework to explore four possible futures of the COVID-19 pandemic over the next five years, examining how each could play out globally.Methods: We have defined four futures based on the biology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its human host, and the scientific responses to it. Rather than predictions, these futures represent plausible possibilities and are used as a framework to help explore what could happen. To investigate the impacts of these four futures in a global context we created five archetypal settings with different social, economic, and political characteristics. We overlaid the four futures across the five settings, taking into consideration how SARS-CoV-2 may spread, and behavioural, political and economic factors.Findings: SARS-CoV-2 is not globally eradicated within five years in any of these futures, although community transmission could be eliminated within certain national boundaries. Some people and settings are disproportionately adversely affected due to existing and emerging vulnerabilities, but nowhere is unaffected, and all areas are susceptible to the arrival of new infections whilst there are ongoing outbreaks elsewhere. Countries face their own challenges and choices as the world learns to live with COVID-19, particularly in how vaccines, antivirals and non-pharmaceutical interventions (NPIs) are deployed.Interpretation: More broadly, we explore the profound and long-lasting ways in which the pandemic and response to it will shape the world’s health, economy, politics and societies. We identify critical lessons learned from these futures so that the profound disruption of COVID-19 can be used as an opportunity to learn, reform and act to create better global outcomes.Funding: The collaborators in this project did not receive specific funding.Declaration of Interests: J. Farrar is a member of the UK Scientific Advisory Group for Emergencies. B. Grenfell is a member of the Royal Society’s Data Evaluation and Learning for Viral Epidemics (DELVE) group. D. Sridhar is a member of the Scottish Government COVID-19 Advisory Group and the DELVE group. All other authors declare no competing interests