Covid-19 Global Outcomes Scenarios Project 4th Annual Meeting of European Members of the ISC

11 June 2021 http://www.freeDr Ines-powerpoint Hassan,-templates Senior-design.com PM, ISC COVID-19 Outcomes Scenarios Project

The ISC, WHO, UNDRR has launched a COVID-19 project to outline a range of scenarios over the next 3-5 years that aim to assist our understanding of the options for achieving an optimistic and fair end to the pandemic. Why? This unprecedented pandemic has surprised the global community

Covid-19 pandemic has been met by unequal responses in different countries & has led to unequal health & economic impacts

Despite rapid scientific progress on the development of Covid-19 vaccines, treatments, diagnostics & in understanding the most impactful measures, there is still uncertainty about how the pandemic will evolve

What emerges next will depend on multiple factors, including the evolution of SARS-CoV-2, government responses, the level of global cooperation, ongoing progress in vaccine development, and citizen behaviour

Most key actors are focused on short-term pandemic outcomes, but decisions made today will have an impact on long-term , economic and inequality outcomes Article in Must prepare for future challenges & opportunities WHO = The World Health Organization; UNDRR = United Nations Office for Disaster Risk Reduction Project Goals

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To assist and inform policy & public To understand the impact of these To identify evidence-based understanding of plausible mid- and scenarios. decision pathways that would long-term Covid-19 outcome encourage positive outcomes scenarios and minimize negative outcomes

Understand which vectors of Understand how the nature of global uncertainty and which decisions and diplomatic cooperation may Understand what strategies and made by individual actors today can impact health outcomes, inequalities policies will lead to the best have broader consequences for the and the economy over the next 3-5 attainable outcomes global evolution of the pandemic in years the next few years Understand how Covid-19-related policy decisions of policy actors might impact long term consequences, e.g. global health outcomes, inequalities and the economy in 3-5 years Mapping Covid-19 outcome scenarios in next 3-5 years

There are a range of possible outcomes

“One World” “Divided World”

Worst Best Case Unknown Unknown Unknown Unknown Case Scenario scenario scenario scenario scenario Scenario

• Vaccines are effective against • Viral mutations that escape new variants immunity emerge repeatedly • Viral control is effective around • Only rich countries can world manufacture or buy vaccines • Virus is endemic and off the • Disease disrupts how countries agenda as a determinant of operate, e.g. health system , global and regional decision work, social life, travel policies making etc.

Goal is to understand the range of possible scenarios & impact they will have on health outcomes, inequalities and economy and factors that will shift the achieved outcome more or less favourably Example (incomplete) list of vectors of uncertainty Stakeholders Priority Vectors of Uncertainty? Outcomes

Global/regional vaccine diplomacy Pandemic escalation

Economic stimulus packages Accelerated geopolitical tensions Global Government Viral evolution Actors De-globalisation/global Vaccine/Dx/PPE mnf and supply strategy cooperation Big People & Health Business Society systems Education strategy Variance in vaccine diplomacy Election outcomes Virus Decline/growth in Other economy/debt crisis Multilateral decision-making/international law Worsening population Social cohesion health

Increase in health Other, e.g. other emergencies, media, misinformation, demography, farming practices etc. inequalities Project Team

Tech. Advisors Project Executive Team Oversight Panel

Peter Gluckman Peter Piot GHGP Team Salim Abdool Karim Christiane Woopen Heidi Hackmann (NZ ) (UK, Belgium) Scenarios/ (SA) (Germany) Project Oversight Science advisory/ Microbiology/ Policy dev. ID Epi/Public health Medical ethicist diplomacy Public health Claudio Struchiner Chris Bradley Geoffrey Boulton Craig Calhoun David Spiegelhalter Mathieu Denis (Brazil) Scenario (UK) (USA) (UK) Project Oversight Mathematical development Geoscience Sociology Statistics modelling/ ID pop.

Anne Bardsley David Kaplan David Skegg Aminata Sall Diallo Lucia Reisch Soumya Alison Meston Ines Hassan Scenario Economics/ (NZ) (Senegal) (Denmark) Swaminathan Comms+ Project Lead development interviews Epi/public health Physiology Economics (WHO)*

George Gao (China) Ismail Serageldin GESDA contact Miia Ylöstalo- Megha Sud Chor Pharn Lee Virology/ (Egypt) Mami Mitzutori Scenario Joubert Interviews TBD Researcher Government immunology/ Int. development (UNDRR)* development Admin support strategy Public health /economics Anjana Singh Eric Goosby Elizabeth Jelin Ian Goldin (Nepal) Researcher Researcher (USA) (Argentina)) Economics Microbiology/ Public health Sociology Public health

Working Group

ISC *Observers Target Audience

Influential actors: • ISC Members • Civil society through ISC Members? • Global actors (OECD, WEF, BMGF) • Other scientific groups

Decision makers: • Governments • Global agencies (WHO, UNDRR, , IMF, GAVI) Proposed Process Developing Covid-19 endgame scenarios for the next 3-5 years

Phase 1a: Scenario Scoping Phase 1b: Scenario Setting & Regional Insights Phase 2: Decision Pathways

Goals: Goals: • Identify the factors and stakeholders that/who will • Understand regional dynamics/priorities Goals: have an impact on Covid-19 outcomes on a national, • Rank global/national actors and environmental factors • Identify potential global/national regional and global level in next 3-5 yrs based on potential impact on outcome scenarios strategy/policies for agreed scenarios to • Outline current Covid-19 strategies employed by these • Agree on key uncertainties/certainties per actor for key encourage positive global health outcomes, stakeholders and indicators (warning signs) of future factors/actors inequalities and the economy. approach • Rank key vectors of uncertainty • Understand cost/time/science know-how • Classify world into a 3-4 groups based on • Develop scenarios based on combination of key factors needed for each policy Covid-19 approach • Pressure-test decision-pathways against set • Get some insight into which factors are most critical Method: scenarios • Understand uncertainties/certainties per • Regional and global workshops (Consensus factor/stakeholder building/Delphi process) • Outline range of outcome scenarios • Driver mapping (secondary research and workshop) Method: • Axes of uncertainty (workshop) • Policy development (interviews and Method: • Scenario building workshop) • Horizon Scanning (secondary research) • Policy Stress Testing (workshop and Output: • simulations) Expert Interviews (X 40-50) • A set of well-developed priority vectors of uncertainty • Systems Mapping and outcome scenarios • Issues Paper Output: Output: • A set of high-level policy and system change • Initial insight into what Covid-19 future might look like recommendations across the globe Mar to Jun 2021 Jul to Sep 2021 Mar- Sep 2021 Activity Mar Apr May Jun Jul Aug Sep Oct

• Oversight Panel Meetings

Meetings • Phase 1a: Scenario Scoping - Interviews Deliverables - Online survey - Analysis Comms

• Phase 1b: Scenario Setting - Regional workshops Project Timelines

• Phase 1c: Systems Mapping & Impact Evaluation

• Phase 2: Decision pathways

• Communication Strategy - Blogs - Interim report - Final report - Narratives - Documentary - Op-eds • Stakeholder Engagement • Government officials • Diplomats • Multilateral actors Engaging Key Stakeholders

Governments: Global agencies Global and diverse leadership Foresight (WHO, UNDRR, community planning, World Bank, diplomats* IMF, GAVI)

Scientists, policymakers, ISC members, diplomats, big business, global Civil Society other scientific thinkers including ISC Members Organizations groups

ISC Members Understand and get consensus on: Collaborate: •• CriticalProvidedstakeholdersintroductionsand environmental • Contributed to interviews • Share global lessons on future covid-19 factors planning •• Contributed to survey Uncertainties in decision making • Use insights in local decision-making • Worst case, best case most likely and today other outcome scenarios • Advocate for an approach that will • Policies & strategies to achieve best achieve not just good national outcomes, possible outcomes but global outcomes too *Foreign Ministries S&T Advice Network (FMSTAN) – INGSA Government Advisors/Officials

• Convened a meeting of government advisors/officials working on national long-term covid-19 planning on 22nd April 2021 • Group are very keen to get involved in the Covid-19 Outcomes Scenario Project • The group will meet regularly to share local and regional lessons and thoughts on long-term scenarios Government officials/advisors involved to date: • Group is limited to date. We are keen to invite equivalents in other countries. Introductions and • Chor Pharn Lee, Principal Strategist, Centre for participation are welcome Strategic Futures, Singaporean Government • Daniel Kleinberg, • Marianne Emler, Scottish Government Covid-19 Advisory Group Louis Charles Viossat, Inspectorate general for social affairs, French Government Recommendation: Insights for planning must coincide with the election cycle. • Hans Christian Hangman, Senior Advisor & Head of Need to capture insights for min in 2 years Strategic Analysis, Swedish Foreign Ministry • Devi Sridhar, , Scottish Government Covid-19 Advisory group Emerging Scenarios*- in the next 3-5 years *Based on 13 interviews only

Health Governance Geostrategic Economic Social Medium clock cycle+ Medium clock cycle+ Slowest clock cycle+; issues overlooked Fasted Clock cycle; prioritized today

• No long-term lessons learnt from this pandemic; new • Economic impact remains, leading to inflation infectious diseases will spread • Covid-19 increasingly politicized • Economic relief packages, enormous debt, • Social (including isolation, mental health illness • Virus is endemic. Science will be able to contain the • Growing nationalism with increasing challenges for tourism/hospitality will and education loss) and economic effects of virus and its mutations despite periodic outbreaks. autocratic/ authoritarian governments continue to burden for a long time. pandemic still ongoing resulting in a disconnected High levels of vaccination, but, there will be society • Increased distrust in institutions/government • If no investments are made into long-term unevenness in how countries manage this and in • Little global unity and growing nationalism will - Younger generation particular impacted vaccine access. resulting in decline in democratic activity and infrastructure or if there will be capital market lead to division between countries (i.e. • Change in working environments (home offices) the creation of new parties gambling there will be a financial crisis. This • Science denialism/vaccine hesitancy remains where it inequalities regarding vaccine manufacturing, exists today will impact emerging markets most • A deficit of care in all parts of society (health - Misinformation/disinformation will closed borders) system, care homes, family, community) will lead • There may well be restrictions as countries that impact this further • Countries with k shaped economies will result • Health nationalism and crisis means less focus to more forced migration contain the virus seek to reduce contacts with virus in increasing inequalities. Lower middles class hot spots. Use of vaccine passports will be the norm. - Will result in reduced coalition on climate change and global solutions • Increase in poverty hit hard • Continued vaccine hesitancy in vulnerable groups between (EU) countries • Inequalities will increase (gender issues increasing, Scenarios • Change in working environments (home office)

Most Likely Likely Most • Collapsing health care systems in parts of the world • High levels of national centralisation new vulnerable (the young), and current (access/HCWs) (investment and response); Disempowerment • Poverty increasing everywhere. Relief vulnerable populations) • Indirect mortality and morbidity from e.g. of local government packages will cushion the crisis but will not • Decreased social contact malnutrition lead to any substantive future growth.

• Ongoing pandemic with new variants mutations, which leads to • Economic slowdown and disrupted education closed borders, increased inequalities • Public health measures fuel variant mutation causes unemployment which leads to with • Collapsing health care systems in parts of the world long-term impact on mental health and GDP. • Social issues worsening (including isolation, • Another epidemic/natural• This disaster further is escalate an pandemic old version. • In addition to issues in most likely scenario mental health illness and education loss) • Institutions collapse – governments become • Only rich countries will have access to vaccines and boosters. • Need for police state like systems of • Gender inequalities/violence increases There will be cost, IP, and supply challenges. increasingly ineffective • The regions least affected by the pandemic will • There will be restrictions as countries that contain the virus seek enforcement that collides with democracy suffer the most and be the last to recover. • A lost generation who stopped attending • Intensification of electronic surveillance – we to reduce •contacts withMultiple virus hot spots. In addition, elaboratescenarios may exist in each box• Covid-19 is a stressor at the level in Expect a long L shaped recovery. school, impacting social skills. forms of testing, quarantine and sanitation; varying requirements are down that path already but COVID across the globe; intricate corridors and bubbles. intensifies this. This is most likely in Africa. international relations. • An increasingly divided world; increasing • Huge challenge• in managingIn flowsthe of people withfinal varying levels ofoutput we will not use the terms• Reduction best in international and solidarity worst case• Social scenarios. and political conflicts are already Instead, ainequalities, set of (gender issues increasing, new vaccination • Social unrest/populist uprisings

Scenarios vulnerable (the young), and current vulnerable • and vulnerability. • Western hegemony falling away. War as a intensifying. Likely to increase in the future Worst Case Worst • A broad array of animals carry SARS viruses, and the Covid 19 possibility and in turn limit prospects for growth. Very populations) hosts plausible scenarios will be outline. high preponderance of youth – restless and • Decline in life expectancies; °health indicator thrown back for decades limited economic prospects. • °Increased maternal mortality

• Virus is endemic with low mutation rates. Manufacturers are able to produce and • There is no “back to normal”, but rather an adaption to new circumstances • Global community comes together to “build distribute booster-vaccines. Oral vaccine forward better”, including fixing institutional • Big powers buy into real multilateral reforms. available, which improves uptake deficiencies. • Rich nations fully fund vaccine production and Reformed WHO/ or new global organization set-up to prepare for pandemics • US, Chinese, EU, Japan, UK, Russia and in knowledge sharing in LIC strategic alliance to finance • Higher commodity prices with the surplus • Government and civil society will mobilise being invested productively. • Increased community action and support • Regional vaccine manufacturing hubs • and coordinate broad bio R &D developed/enhanced resources to reinforce local institutions • Increasing investment in regions like Africa – • Care is central to social and population health • Increased taxes for the wealthy • Global cooperation on vaccine distribution, particular In technology areas: resulting in strategies • Health systems strengthened /horizontal other public good and technology to tackle key • Removal of grey area where corruption higher yields approaches that don’t silo disease areas issues such as climate change and other

implemented flourishes Scenarios Best Case Best diseases • More resources available for public purposes. • Open transparent science increases trust in • Public institutions invest in health and crises public health measures • Movements increase to work for more management Short-term responsive and effective govt. Medium-term Long-term Thank you!