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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Toward a Post-Pandemic World: Lessons from COVID-19 for Now and the Future: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26556.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Toward a Post-Pandemic World: Lessons from COVID-19 for Now and the Future: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26556.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Toward a Post-Pandemic World: Lessons from COVID-19 for Now and the Future: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26556.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Toward a Post-Pandemic World: Lessons from COVID-19 for Now and the Future: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26556.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Toward a Post-Pandemic World: Lessons from COVID-19 for Now and the Future: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26556.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Toward a Post-Pandemic World: Lessons from COVID-19 for Now and the Future: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26556.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Toward a Post-Pandemic World: Lessons from COVID-19 for Now and the Future: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26556.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Toward a Post-Pandemic World: Lessons from COVID-19 for Now and the Future: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26556.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Toward a Post-Pandemic World: Lessons from COVID-19 for Now and the Future: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26556.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Toward a Post-Pandemic World: Lessons from COVID-19 for Now and the Future: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26556.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Toward a Post-Pandemic World: Lessons from COVID-19 for Now and the Future: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26556.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Toward a Post-Pandemic World: Lessons from COVID-19 for Now and the Future: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26556.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Toward a Post-Pandemic World: Lessons from COVID-19 for Now and the Future: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26556.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Toward a Post-Pandemic World: Lessons from COVID-19 for Now and the Future: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26556.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Toward a Post-Pandemic World: Lessons from COVID-19 for Now and the Future: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26556.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Toward a Post-Pandemic World: Lessons from COVID-19 for Now and the Future: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26556.
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Page xvii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Toward a Post-Pandemic World: Lessons from COVID-19 for Now and the Future: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26556.
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Page xviii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2022. Toward a Post-Pandemic World: Lessons from COVID-19 for Now and the Future: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26556.
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Toward a Post-Pandemic World: Lessons from COVID-19 for Now and the Future PROCEEDINGS OF A WORKSHOP Elizabeth Ashby, Claire Biffl, and Megan Snair, Rapporteurs Forum on Microbial Threats Board on Global Health Health and Medicine Division PREPUBLICATION COPY—Uncorrected Proofs

THE NATIONAL ACADEMIES PRESS   500 Fifth Street, NW   Washington, DC 20001 This activity was supported by contracts between the National Acad- emy of Sciences and the Burroughs Wellcome Fund (1021631, 1022390), Johnson & Johnson (C2021020002), the New Venture Fund (NVF-NGDF- ­ NAT10-Subgrant-013446-2021-01-01), the U.S. Agency for Interna- tional Development (7200AA18GR00003), the U.S. Department of Defense (HU00012110002, HU00012210001), the U.S. Department of Health and Human Services (75A50119C00031, 200-2011-38807/75D30120F00084, 200-2011-38807/75D30121F00095, 1R13FD006897-01, HHSN263201800029I/ HHSN26300011), the U.S. Department of Homeland Security (70RSAT21G0 0000003/70RSAT21FR0000029), and the U.S. Department of Veterans Affairs (64836C25020P1830, 36C24518D0171/36C25021N0648). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.1 International Standard Book Number-13: 978-0-309-XXXXX-X International Standard Book Number-10: 0-309-XXXXX-X Digital Object Identifier: https://doi.org/10.17226/26556 This publication is available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http:// www.nap.edu. Copyright 2022 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2022. Toward a post-pandemic world: Lessons from COVID-19 for now and the future: Proceedings of a workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/26556. 1 The text was revised to correct for the complete list of sponsors for this activity. PREPUBLICATION COPY—Uncorrected Proofs

The National Academy of Sciences was established in 1863 by an Act of Con- gress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the char- ter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org. PREPUBLICATION COPY—Uncorrected Proofs

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process, and it represents the position of the National Academies on the statement of task. Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies. Rapid Expert Consultations published by the National Academies of Sciences, Engineering, and Medicine are authored by subject-matter experts on narrowly focused topics that can be supported by a body of evidence. The discussions contained in rapid expert consultations are considered those of the authors and do not contain policy recommendations. Rapid expert consultations are reviewed by the institution before release. For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo. PREPUBLICATION COPY—Uncorrected Proofs

COMMITTEE ON TOWARD A POST-PANDEMIC WORLD: LESSONS FROM COVID-19 FOR NOW AND THE FUTURE1 ELIZABETH D. HERMSEN (Co-Chair), Head, Global Antimicrobial Stewardship and Health Equity in Infectious Diseases, Merck & Co., Inc. RAFAEL OBREGON (Co-Chair), Country Representative, UNICEF Paraguay WILLIAM K. HALLMAN, Department Chair, Professor, Department of Human Ecology, Bloustein School of Planning and Public Policy, Rutgers University CHANDY C. JOHN, Director, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine KENT E. KESTER, Professor of Medicine, Uniformed Services University of the Health Sciences School of Medicine RIMA F. KHABBAZ, Director, National Center for Emerging Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention KUMANAN RASANATHAN, Unit Head for Equity and Health, Department of Social Determinants of Health, World Health Organization STEPHEN J. THOMAS, Chief, Division of Infectious Diseases, Director, Institute for Global Health and Translational Science, State University of New York Upstate Medical University MATTHEW ZAHN, Medical Director, Division of Epidemiology and Assessment, Orange County Health Care Agency (California) National Academies Staff JULIE LIAO, Director, Forum on Microbial Threats ELIZABETH ASHBY, Associate Program Officer CHARLES MINICUCCI, Research Assistant CLAIRE BIFFL, Research Assistant JUSTIN HAMMERBERG, Senior Program Assistant JULIE PAVLIN, Senior Board Director 1  The planning committee’s role was limited to planning the workshop, and the Proceed- ings of a Workshop was prepared by the workshop rapporteurs as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants and are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine, and they should not be construed as reflecting any group consensus. v PREPUBLICATION COPY—Uncorrected Proofs

FORUM ON MICROBIAL THREATS1 PETER DASZAK (Chair), President, EcoHealth Alliance KENT E. KESTER (Vice Chair), Professor of Medicine, Uniformed Services University of the Health Sciences School of Medicine RIMA F. KHABBAZ (Vice Chair), Director, National Center for Emerging Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention EMILY ABRAHAM, Director, External Affairs and Policy, Global Public Health at Johnson & Johnson KEVIN ANDERSON, Senior Program Manager, Science and Technology Directorate, U.S. Department of Homeland Security CRISTINA CASSETTI, Deputy Division Director, Division of Microbiology and Infectious Diseases (DMID), National Institute of Allergy and Infectious Diseases ANDREW CLEMENTS, Senior Scientific Advisor, Emerging Threats Division, Bureau for Global Health, U.S. Agency for International Development SCOTT F. DOWELL, Deputy Director for Surveillance and Epidemiology, Bill & Melinda Gates Foundation MARCOS A. ESPINAL, Director, Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization EVA HARRIS, Professor, Division of Infectious Diseases and Vaccinology; Director, Center for Global Public Health, University of California, Berkeley School of Public Health ELIZABETH D. HERMSEN, Head, Global Antimicrobial Stewardship and Health Equity in Infectious Diseases, Merck & Co., Inc. CHRISTOPHER R. HOUCHENS, Director, Division of Chemical, Biological, Radiological and Nuclear Countermeasures, Biomedical Advanced Research and Development Authority CHANDY C. JOHN, Director, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine and Riley Hospital for Children at IU Health MARK G. KORTEPETER, Vice President for Research, Professor of Preventive Medicine and Medicine, Uniformed Services University of the Health Sciences 1  The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution. vi PREPUBLICATION COPY—Uncorrected Proofs

MICHAEL MAIR, Acting Assistant Commissioner for Counterterrorism Policy; Acting Director, Office of the Chief Scientist, U.S. Food and Drug Administration JONNA A. K. MAZET, Vice Provost–Grand Challenges; Chancellor’s Leadership Professor of Epidemiology & Disease Ecology, University of California, Davis VICTORIA MCGOVERN, Senior Program Officer, Burroughs Wellcome Fund SALLY A. MILLER, Distinguished Professor of Food, Agricultural and Environmental Sciences in Plant Pathology, The Ohio State University, College of Food, Agriculture, and Environmental Sciences SUERIE MOON, Director of Research, Global Health Centre; Visiting Lecturer, Graduate Institute of International and Development Studies; Adjunct Lecturer, Harvard T.H. Chan School of Public Health RAFAEL OBREGON, Country Representative, UNICEF Paraguay KUMANAN RASANATHAN, Unit Head for Equity and Health, Department of Social Determinants of Health, World Health Organization GARY A. ROSELLE, Executive Director, National Infectious Disease Services Program, Veterans Health Administration, U.S. Department of Veterans Affairs PETER A. SANDS, Executive Director, the Global Fund to Fight AIDS, Tuberculosis and Malaria THOMAS W. SCOTT, Distinguished Professor, Department of Entomology and Nematology, University of California, Davis MATTHEW ZAHN, Medical Director, Division of Epidemiology and Assessment, Orange County Health Care Agency (California) vii PREPUBLICATION COPY—Uncorrected Proofs

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Reviewers This Proceedings of a Workshop was reviewed in draft form by indi- viduals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical com- ments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evi- dence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We thank the following individuals for their review of this proceedings: Ann Harada, University of Southern California Lloyd Michener, Duke University John Simpson, Public Health England Although the reviewers listed above provided many constructive com- ments and suggestions, they were not asked to endorse the contents of this proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by Carlos E. Rodriguez-Diaz, The George Washington University, Milken Institute School of Public Health. He was responsible for making certain that an independent examination of this pro- ceedings was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Respon- sibility for the final content rests entirely with the rapporteurs and the National Academies. ix PREPUBLICATION COPY—Uncorrected Proofs

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Acknowledgments The workshop summarized in this proceedings is the product of many valuable contributions. Special thanks go to the presenters and discussants who gave generously of their time and expertise to make the event possible. xi PREPUBLICATION COPY—Uncorrected Proofs

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Contents BOXES AND FIGURES xiii ACRONYMS AND ABBREVIATIONS xvii 1 INTRODUCTION 1 Background, 1 Lessons for the Future, 2 2 POTENTIAL LONG-TERM EFFECTS OF COVID-19 ON HEALTH EQUITY 11 Pandemic Inequalities in the United States, 11 Measuring Mental Health and Social Determinants, 14 Disease Mechanisms of Long COVID-19, 16 Discussion, 19 3 ADDRESSING UNCERTAINTIES IN PANDEMIC COMMUNICATION 21 Trust and Engagement, 21 Understanding Misinformation, 30 4 SYSTEMATIZING RECOVERY EFFORTS TO MITIGATE THE NEXT PANDEMIC 37 Community Engagement, 37 Available Tools for Recovery and Future Capacity Building, 50 xiii PREPUBLICATION COPY—Uncorrected Proofs

xiv CONTENTS 5 STRATEGIES FOR A POST-COVID WORLD 55 Visions for the Future, 55 Strategic Planning, 61 Closing Remarks, 68 REFERENCES 71 APPENDIXES A Workshop Statement of Task 75 B Workshop Agenda 77 C Speaker Biographies 85 D Table of Strategic Actions from Group One 105 E Table of Strategic Actions from Group Two 109 PREPUBLICATION COPY—Uncorrected Proofs

Boxes and Figures BOXES 1-1 Lessons Learned in Qatar as Presented by H. E. Hanan Al Kuwari, 7 5-1 Scenario Narrative, 62 FIGURES 2-1 Rates of uninsurance by poverty and Medicaid expansion status, 13 2-2 Change in symptom scores before and after vaccination, 17 4-1 COVID-19 cases per million inhabitants in Paraguay (2020–2021), 47 5-1 Change in life expectancy at birth, by Hispanic origin and race and sex, United States, 2019 and 2020, 59 5-2 Key characteristics of the future, as generated by Group Two, 65 xv PREPUBLICATION COPY—Uncorrected Proofs

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Acronyms and Abbreviations ACA Affordable Care Act CBPR community-based participatory research CCHN Center for Community Health Navigation CDC Centers for Disease Control and Prevention CEAL Community Engagement Alliance CHW community health worker COVID-19 coronavirus disease 2019 EMR electronic medical record FEMA Federal Emergency Management Agency HMC Hamad Medical Corporation ICS incident command structure IHR International Health Regulations IP independent panel LMIC low- and middle-income country NCD noncommunicable disease NCIRD National Center for Immunization and Respiratory Diseases NIH National Institutes of Health NIMHD National Institute on Minority Health and Health Disparities xvii PREPUBLICATION COPY—Uncorrected Proofs

xviii ACRONYMS AND ABBREVIATIONS OECD Organization for Economic Co-operation and Development OR odds ratio SDG Sustainable Development Goal SDOH social determinants of health SNAP Supplemental Nutrition Assistance Program UHC universal health coverage WHO World Health Organization PREPUBLICATION COPY—Uncorrected Proofs

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To take stock of lessons learned from COVID-19 around the world and in the United States, the Forum on Microbial Threats held two virtual workshops during 2021. The first workshop focused on what it means to frame the response to COVID-19 through a "syndemic" approach, and what the implications would be for global recovery. The second workshop focused more broadly on key lessons and emerging data from ongoing pandemic response efforts that can be incorporated into current health systems to improve resilience and preparedness for future outbreaks.

This workshop explored the long-term effects of COVID-19 on health equity, including considerations for mental health and social determinants of health. It also addressed uncertainties during a pandemic, such as trust, communication, and engagement and explored approaches to systematize recovery efforts to improve the ongoing responses and prepare for the next pandemic. Experts discussed possibilities for a post-pandemic world and a response strategy for stakeholders that ensures sustained community partnerships and prioritization of health equity. This Proceedings of a Workshop summarizes the presentations and discussions from the second workshop.

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