Foreword 3

Acknowledgements 4

Acronyms and abbreviations 8

Executive summary 9

1 Long COVID is a lasting, burdensome consequence of the pandemic 11

1.1. Estimating the true burden of long COVID remains challenging 11

1.2. Long COVID affects people, health systems and economies 12

1.3. This report examines the socio-economic impact and policy responses to long COVID across OECD and EU Member countries 12

References 13

2 Long COVID impacts health systems and the economies 14

2.1. The economic impact of long COVID is substantial, and mainly stems from the indirect costs from reduced productivity and participation in the workforce 15

2.2. Estimating the socio-economic costs of long COVID in OECD and EU countries requires certain modelling assumptions 19

References 22

Notes 25

3 In the next decade, long COVID could cost health systems 11 billion dollars annually and cut annual GDP by 0.2% 26

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 27

3.2. Long COVID accounted for about USD 53 billion in direct healthcare expenditure in 2021 28

3.3. Long COVID could cost OECD health systems up to 11 billion dollars each year 29

3.4. Long COVID led to an almost 1% reduction in labour force across OECD and EU Member countries in 2021 30

3.5. In 2021, long COVID cost EU and OECD economies over half a trillion dollars 31

3.6. Long COVID could reduce GDP by up to 0.2% each year in OECD and EU economies 32

3.7. Overall, the socio-economic impact of long COVID is comparable to that of other major chronic conditions, and is likely to be und erestimated 33

References 34

4 Surveyed OECD countries have advanced initiatives for recognition and surveillance of long COVID, but progress remains uneven 35

4.1. Agreeing on a standard definition of long COVID is a key step to understanding the burden caused by the condition 36

4.2. The majority of surveyed OECD countries use the WHO definition for long COVID in 2025 36

4.3. Recognition of long COVID in children and adolescents is lacking in many countries 37

4.4. Eleven OECD countries reported using International Classification of Diseases diagnostic coding for long COVID 38

4.5. Chronic fatigue syndrome and depressive disorder are often used as alternatives for diagnostic coding to long COVID 39

4.6. Surveillance of long COVID cases is largely dependent on administrative data and research studies 40

4.7. Financial protection against the medical costs of long COVID is mainly provided by universal healthcare systems 43

4.8. Sickness and disability coverage for long COVID generally falls under general social welfare rather than being specifically linked to the condition 43

References 44

5 National strategies to address long COVID with dedicated funding are lacking 47

5.1. Few countries have a national plan or strategy in place to address long COVID 48

5.2. Interministerial management can ensure a broader range of support for addressing the social and economic consequences of long COVID 50

5.3. Scientific committees can inform evidenced-based policies for long COVID 51

5.4. No health funding is allocated specifically to long COVID management in most countries 52

5.5. Engagement of people living with long COVID is key for aligning research priorities, resources and services with patient needs 54

References 56

6 Most countries have developed clinical guidelines for effective management of long COVID, however few have official care pathways 57

6.1. Most countries developed specialised long COVID clinics during the pandemic, but some have since adapted their approach 58

6.2. Clinical guidelines promote standardised and evidence-based care 59

6.3. Half of countries include pharmacotherapy in long COVID guidelines 61

6.4. Official care pathways for long COVID exist in less than half of countries 62

6.5. Training on long COVID for healthcare workers is lacking in most countries 63

References 65

7 Countries face challenges in addressing long COVID and need to strengthen their policy response across health and social care systems 68

7.1. Countries face multiple challenges in addressing the burden of long COVID 69

7.2. Countries need national clinical guidelines, clear referral pathways and evidenced-based policy recommendations 70

7.3. Notable progress on long COVID recognition and research has been made, but work remains to improve responses at the national level 71

References 72

8 Effective long COVID response requires a co-ordinated approach encompassing prevention, harmonisation of practice and people-centred models of care 73

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 74

8.2. Notable progress on long COVID recognition and research has been made, but work remains to improve responses at the national level 74

8.3. The long COVID response requires a co-ordinated health policy encompassing prevention, harmonisation of practice and people-centred models of care 75

8.4. Addressing long COVID is also an opportunity to advance the resilience and people centredness agendas in EU and OECD health systems 76

References 81