Title page 1

Contents 6

Foreword 4

Acknowledgements 5

Acronyms and abbreviations 9

Executive summary 10

1. Long COVID is a lasting, burdensome consequence of the pandemic 12

1.1. Estimating the true burden of long COVID remains challenging 12

1.2. Long COVID affects people, health systems and economies 13

1.3. This report examines the socio-economic impact and policy responses to long COVID across OECD and EU Member countries 13

References 14

2. Long COVID impacts health systems and the economies 15

2.1. The economic impact of long COVID is substantial, and mainly stems from the indirect costs from reduced productivity and participation... 16

2.1.1. Long COVID generates substantial direct medical costs 16

2.1.2. The indirect costs of long COVID are a major burden for OECD and EU Member countries 17

2.1.3. The true costs of long COVID are best measured in macroeconomic terms 19

2.2. Estimating the socio-economic costs of long COVID in OECD and EU countries requires certain modelling assumptions 20

2.2.1. Epidemiological assumptions 21

2.2.2. Direct healthcare costs assumptions 22

2.2.3. Labour-force and productivity assumptions 22

2.2.4. Sensitivity analyses 22

References 23

Notes 26

3. In the next decade, long COVID could cost health systems 11 billion dollars annually and cut annual GDP by 0.2% 27

3.1. Long COVID peaked during the pandemic, but is set to remain a prevalent condition in the post-pandemic years across OECD and EU countries 28

3.1.1. In 2021, prevalence of long COVID was estimated at 5.3% of the total population in OECD and EU countries 28

3.1.2. Depending on the future dynamics of COVID-19, long COVID prevalence could stabilise around 1% of the population in the coming years 28

3.2. Long COVID accounted for about USD 53 billion in direct healthcare expenditure in 2021 29

3.3. Long COVID could cost OECD health systems up to 11 billion dollars each year 30

3.4. Long COVID led to an almost 1% reduction in labour force across OECD and EU Member countries in 2021 31

3.5. In 2021, long COVID cost EU and OECD economies over half a trillion dollars 32

3.6. Long COVID could reduce GDP by up to 0.2% each year in OECD and EU economies 33

3.7. Overall, the socio-economic impact of long COVID is comparable to that of other major chronic conditions, and is likely to be underestimated 34

References 35

4. Surveyed OECD countries have advanced initiatives for recognition and surveillance of long COVID, but progress remains uneven 36

4.1. Agreeing on a standard definition of long COVID is a key step to understanding the burden caused by the condition 37

4.2. The majority of surveyed OECD countries use the WHO definition for long COVID in 2025 37

4.3. Recognition of long COVID in children and adolescents is lacking in many countries 38

4.4. Eleven OECD countries reported using International Classification of Diseases diagnostic coding for long COVID 39

4.5. Chronic fatigue syndrome and depressive disorder are often used as alternatives for diagnostic coding to long COVID 40

4.6. Surveillance of long COVID cases is largely dependent on administrative data and research studies 41

4.7. Financial protection against the medical costs of long COVID is mainly provided by universal healthcare systems 44

4.8. Sickness and disability coverage for long COVID generally falls under general social welfare rather than being specifically linked to the condition 44

References 45

5. National strategies to address long COVID with dedicated funding are lacking 48

5.1. Few countries have a national plan or strategy in place to address long COVID 49

5.2. Interministerial management can ensure a broader range of support for addressing the social and economic consequences of long COVID 51

5.3. Scientific committees can inform evidenced-based policies for long COVID 52

5.4. No health funding is allocated specifically to long COVID management in most countries 53

5.5. Engagement of people living with long COVID is key for aligning research priorities, resources and services with patient needs 55

References 57

6. Most countries have developed clinical guidelines for effective management of long COVID, however few have official care pathways 58

6.1. Most countries developed specialised long COVID clinics during the pandemic, but some have since adapted their approach 59

6.2. Clinical guidelines promote standardised and evidence-based care 60

6.3. Half of countries include pharmacotherapy in long COVID guidelines 62

6.4. Official care pathways for long COVID exist in less than half of countries 63

6.5. Training on long COVID for healthcare workers is lacking in most countries 64

References 66

7. Countries face challenges in addressing long COVID and need to strengthen their policy response across health and social care systems 69

7.1. Countries face multiple challenges in addressing the burden of long COVID 70

7.2. Countries need national clinical guidelines, clear referral pathways and evidenced-based policy recommendations 71

7.3. Notable progress on long COVID recognition and research has been made, but work remains to improve responses at the national level 72

References 73

8. Effective long COVID response requires a co-ordinated approach encompassing prevention, harmonisation of practice and people-centred... 74

8.1. The economic costs of long COVID to OECD and EU societies are substantial, and are likely to remain so in the coming decade 75

8.2. Notable progress on long COVID recognition and research has been made, but work remains to improve responses at the national level 75

8.3. The long COVID response requires a co-ordinated health policy encompassing prevention, harmonisation of practice and people-centred... 76

8.3.1. More efforts should be made to prevent long COVID through COVID-19 vaccination and non-pharmaceutical interventions 76

8.3.2. Harmonising implementation of standard definitions and disease coding for long COVID would strengthen countries' responses 76

8.3.3. Health systems should expand people-centred care pathways 76

8.3.4. Recognition and support to patients remains a key pillar in addressing long COVID 77

8.3.5. Research funding should be maintained and the research agenda informed by patients 77

8.3.6. International collaboration in sharing health initiatives has great potential, which remains mostly untapped 77

8.4. Addressing long COVID is also an opportunity to advance the resilience and people centredness agendas in EU and OECD health systems 77

8.4.1. Long COVID is a striking reminder of the importance of the people-centred agenda and the role that patient organisations can play 77

8.4.2. Addressing long COVID contributes to fostering health-system resilience 81

References 82

Boxes 12

Box 1.1. What is known about the causes, symptoms and occurrence of long COVID? 12

Box 2.1. Cost-of-illness studies have monetised the productivity losses associated with long COVID 18

Box 2.2. Presenteeism and unpaid work are the hidden productivity losses of long COVID 18

Box 2.3. The OECD SPHeP framework: A tool to assess the medium- and long-term effects of top public health threats, including long COVID 20

Box 4.1. The United States has led on long COVID recognition, surveillance and research through the Researching COVID-19 to Enhance... 43

Box 5.1. Germany and the Netherlands co-ordinate scientific research and support initiatives for long COVID at the national level 50

Box 6.1. The United Kingdom has been proactive in developing guidelines and resources for long COVID 61

Box 6.2. Prevention of long COVID can be promoted as a key benefit of COVID-19 vaccination policy 62

Box 6.3. The WHO Academy will host an online long COVID training course for healthcare workers 66

Box 8.1. Patients have shaped long COVID like no other disease before 78

Box 8.2. The PaRIS survey revealed worse physical and mental health patient-reported outcomes for patients with long COVID 79