This chapter summarises the strategic planning and financial commitments to address long COVID at a national level in the health system, including national plans, dedicated health and research budgets, and involving patients in research. Two national initiatives from Germany and the Netherlands illustrate the efforts made to address long COVID by providing coordination and funding at national level and across different sectors to support research on and organisation of care for long COVID.
Addressing the Costs and Care for Long COVID
The Long Shadow of the Pandemic
Abstract
Given the prevalence of long COVID as a long-term condition with health, social and economic consequences for patients and the population as a whole (see Chapter 2), an overarching strategy is important for organisation of health and social welfare services and to identify research priorities.
In 2025, only four countries (Australia, Austria, Canada and the Netherlands) reported having a national plan or strategy to address the long-term consequences of long COVID (Figure 5.1). Norway and Poland both had national plans for rehabilitation of patients affected by SARS‑CoV‑2, but these were discontinued. As of 2025, development of a national plan or strategy is under consideration in Czechia, France, Slovenia and Switzerland. In Australia, the government is awaiting results from a national OUTPOST study under way to guide development of a new long COVID plan. Switzerland is considering a national strategy to improve the health situation of people with ME/CFS and long COVID, with a motion passed in the Federal Council and the National Council. In Sweden, while no national long COVID strategy is in place, the National Board of Health and Welfare is implementing both completed and ongoing government commissions aimed at supporting people with long COVID. Germany has managed to advance a comprehensive national policy initiative for long COVID (Box 5.1) and organise substantial social and economic support without an official national long COVID plan in place. Japan reported no national strategy dedicated specifically to long COVID.
Note: Survey question: “Is there a national plan or strategy in place to address the long-term consequences of long COVID?”
Source: 2025 OECD Long COVID Mapping Policy Survey.
The German Federal Ministry of Health launched the BMG Long COVID Initiative in July 2023
The Ministry of Health launched two multi-year funding initiatives (2024-2028) for health services research on long COVID. Their scope includes clinical presentations of post-acute infection syndromes such as chronic fatigue syndrome (ME/CFS), as well as symptoms related to a COVID‑19 vaccination. The first initiative “Research and strengthening of patient care for post-acute sequelae of COVID-19” includes 30 projects which focus on three main areas: integrated care, innovations, and epidemiology. The second is composed of four pilot projects for care of children and adolescents with long COVID and conditions with a similar cause or symptoms. The largest includes 43 institutions and 37 associated partners to build a nationwide healthcare network for post-acute infection syndromes, including biobanks.
The innovation fund of the Federal Joint Committee (G-BA) dedicated 16 projects to adequate care for patients with post-viral syndromes, e.g. long COVID or chronic fatigue syndrome (ME/CFS)
The Federal Joint Committee (G-BA) issued a long COVID directive in 2024 describing “clinical pathways” for the treatment of long COVID. Furthermore, in 2025 fee items to the outpatient sector fee schedule (EBM) were added.
The German Respiratory Society, together with a number of other medical societies, published an S1 Clinical guideline. The clinical recommendations describe current long/Post-COVID symptoms, diagnostic approaches, and therapies based on current knowledge. A guideline for children and adolescents is currently being developed.
Five long COVID Round Tables have connected experts from research, science, healthcare, health policy, patient advocacy groups and related fields to discuss current developments and recommendations on long COVID.
Under the BMG Long COVID Initiative, a new alliance for post-infection syndromes was launched to enhance co‑operation between the Federal Ministry of Health and the Federal Ministry of Research, Technology and Space. The ministry plans to fund further research projects and has announced a national decade against post-infection syndromes.
The Federal Institute for Drugs and Medical Devices (BfArM) convened an expert group on long COVID Off-Label-Use to draft a list of medicines that can be recommended for off-label prescription and reimbursement for long COVID patients based on current evidence. Recommendations of the expert group were submitted to the Federal Joint Committee in October 2025. In addition, a “therapy compass” (recommendations for the use of authorised drugs for the treatment of long COVID-associated symptoms) has already been published.
The Netherlands leads co‑ordinating efforts on long COVID policy between national and regional levels
A major ambition in the Netherlands has been to connect all stakeholders working on long COVID within a national network, to ensure sharing and implementation of guidelines and expertise.
The Netherlands Health Council (Gezondheidsraad) advises the Minister of Health, Welfare and Sport on the impact of post-COVID conditions. It is currently preparing a new report for 2026 that re‑examines scientific knowledge regarding the definition, prevalence, diagnosis and treatment methods of long COVID, in the context of other post-infectious syndromes.
Guideline development takes place through the Dutch Association of Medical Specialists and the Dutch College of General Practitioners. Within the former, an expert team advises on the interplay between post-COVID guidelines, post-COVID expertise centres and post-COVID‑19 research at local, regional and national levels.
Post-COVID Network Netherlands is a national collaborative network introduced in 2024, and funded independently by ZonMw (the Dutch Organisation for knowledge and innovation in health, healthcare and well-being), on behalf of the Ministry of Health. The Network’s goal is to ensure that patients, scientists, healthcare professionals and social partners collaborate to co‑ordinate research and patient care for long COVID, to promote use of all relevant knowledge.
In 2024, ZonMw developed a research agenda under which researchers could submit grant applications within the post-COVID programme. The Dutch Association of Medical Specialists contributed to developing clinical priorities for the agenda, while a patient consultation was conducted to identify the most urgent treatment challenges for patients.
Sources: BMG Long COVID Initiative, https://www.bmg-longcovid.de/en. Robert Koch Institute, https://www.rki.de/EN/Topics/Infectious-diseases/Acute-respiratory-infections/COVID-19/Long-COVID/content-total.html. S1 Guideline Long-Post-COVID https://register.awmf.org/assets/guidelines/020-027l_S1_Long-Post-Covid_2025-08-verlaengert.pdf. Ärzte‑ und Ärztinnenverband Long COVID, https://long-covid-verband.de/. BMG Long COVID Initiative, https://www.bmg-longcovid.de/en/discourse/long-covid-round-table. Charité Universitätsmedizen Berlin, https://cfc.charite.de/en/clinical_research/nksg. Bundesinstitut für Arzneimittel und Medizinprodukte, https://www.bfarm.de/DE/Arzneimittel/Zulassung/Zulassungsrelevante-Themen/Expertengruppe-Long-COVID-Off-Label-Use/_node.html#therapiekompass. Gezondheidsraad https://www.gezondheidsraad.nl/onderwerpen/z/zorg/alle-adviezen-over-zorg/post-covid.
Most countries see long COVID as an issue that is handled solely within the health ministry. However, given the broad range of needs of patients with long COVID – including educational adaptations for children, economic support for those unable to work, reintegration into the workforce and social support – and the broad implications of the condition on society, such an approach has major limitations. A cross-sectoral approach that looks beyond the health ministry, and that reaches outside government to include other sectors such as employers and insurance providers, can provide for more holistic, comprehensive solutions to the challenges posed by long COVID.
Having a national plan – as in Australia, Austria, Canada and the Netherlands – appears to facilitate interministerial management, although a national plan is not a requirement for such as an approach (as in the case of Germany and Switzerland) (Figure 5.2). In Austria the Ministries of Work, Education and Research were also involved in the creation of the Action Plan on PAIS (Bundesministerium für Soziales, Gesundheit, Pflege und Konsumentenschutz, 2024[1]). In the Netherlands, in addition to managing healthcare services, the Ministry of Health, Welfare and Sport funds the organisation C-support, which supports people with long COVID in various areas, including income and work-related issues. The Ministry of Social Affairs and Employment in the Netherlands is also working to improve recognition of and assessment of disability for long COVID as described in (Chapter 4, Section 4.8). It has raised awareness among occupational health professionals, employers and colleagues to support work reintegration of people with long COVID. The Ministry of Education, Culture and Science is working towards offering a fully developed digital distance learning system to ensure education for groups in need, such as children with long COVID.
Note: Survey question: “Are other government sectors outside of health addressing the long-term consequences of long COVID? (e.g. education, labour)”.
Source: 2025 OECD Long COVID Mapping Policy Survey.
In Germany, the Federal Ministry of Research, Technology and Space funds research initiatives related to long COVID and supports educational programmes for healthcare professionals and public awareness campaigns. In parallel, the Federal Ministry of Labour and Social Affairs develops policies and programmes to support reintegration of people affected by long COVID into the workforce, including flexible work arrangements and workplace accommodations, while the Federal Employment Agency provides vocational rehabilitation, retraining and job placement services tailored to the capacities of people with long COVID, and supports employers in adapting workplaces. In addition, the Federal Ministry for Education, Family Affairs, Senior Citizens, Women and Youth addresses the social and psychological impact of long COVID on families and vulnerable populations.
Nonetheless, in many cases, long COVID policies are still mainly siloed within the health system. Of the 16 countries responding to the survey, 10 reported not applying an interministerial approach in their response to long COVID issues. Among countries that do use this approach, such as Canada, involvement of other departments remains mainly limited to disability benefit programmes.
During the COVID‑19 pandemic, multiple national health authorities developed guidelines and recommendations to manage acute COVID‑19 illness. However, the emergence of long COVID as a chronic condition with long-term effects and additional health and social consequences also requires evidence‑based guidelines for management. In 2025, ten countries (Australia, Austria, Canada, France, Germany, Luxembourg, the Netherlands, Norway, Slovenia and Sweden) reported having a national scientific committee or institute to advise on long COVID evidence and policy (Figure 5.3). Six countries (Belgium, Czechia, Finland, Korea, Poland and Switzerland) reported not having such a committee, with countries such as Poland relying on existing bodies for advice as needed.
Note: Survey question: “Does a national scientific committee or institute or something comparable exist to advise on long COVID evidence and policy?”
Source: 2025 OECD Long COVID Mapping Policy Survey.
Scientific and national advisory committees come in many different forms. In Austria, the advisory group focusses on PAIS, and a national reference centre for post-viral syndromes has been established. In France, a working group composed of physicians, patient representatives and researchers has been established by the Haute Autorité de Santé to advise on best practice approaches to definition, diagnosis and management (Haute Autorité de Santé, 2021[2]). In Slovenia, a multidisciplinary body is preparing guidelines and clinical pathways, while in Sweden, the National Board of Health and Welfare has published guidelines to support healthcare workers. In Australia, the APPRISE Network leads research programmes to inform the country’s response on long COVID, while the COVID‑19 Research Advisory Committee has provided guidance in diagnosis and treatment of long COVID. Canada established a Chief Science Advisor’s Task Force on Post-COVID‑19 Condition, which has identified data gaps as well as recommendations on addressing the health and socio‑economic impacts of long COVID (Office of the Chief Science Advisor of Canada, 2024[3]). The Task Force set out a list of priority direct actions and health system-oriented actions, summarised the evidence base and provided updated epidemiological and economic estimates of long COVID, outlining best practices and listing available clinical trials in Canada. Nationally-led efforts on scientific co‑ordination and health policymaking for long COVID have progressed in Germany and the Netherlands to date (Box 5.1).
Sustainable budgeting for long COVID care supports planning and allocation of healthcare resources for the management of patients living with long COVID as a chronic condition. Only five of the OECD countries surveyed (Austria, Germany, Luxembourg, the Netherlands and Switzerland) have a dedicated health budget allocated to long COVID management, while this is under consideration in four others (Australia, Czechia, France and Slovenia) (Figure 5.4). Poland used to have a dedicated budget for rehabilitation for long COVID, but this has been discontinued.
Note: Survey question: “Is there a specific health budget allocated toward long COVID management? (e.g. regarding acute care measures, pilots, rehabilitation…)”. In Canada funding is provided at provincial and territorial level and thus no response is included for the national level.
Source: 2025 OECD Long COVID Mapping Policy Survey.
Countries have invested millions of euros in long COVID research. Nine countries (Australia, Austria, Canada, Germany, Korea, Luxembourg, the Netherlands, Poland and Sweden) reported having dedicated funding for long COVID research (Figure 5.5). The Netherlands has invested about EUR 41 million for 2023-2028, including on initiatives outlined in Box 5.1 above. Australia has invested AUD 50 million in long COVID, including on designing and evaluating clinical pathways and models of care, and generating new diagnostic and therapeutic approaches to improve outcomes. Similarly, Korea invested about USD 16 million during 2022-2025, while Canada invested CAD 20 million for 2023-2027. While Sweden reported funding of about EUR 4.5 million during 2021-2025, funding will be highly limited from 2026 onwards, with no further dedicated research grants for long COVID. In 2025, two countries (France and Slovenia) reported integrating long COVID research funding into their general health research budget. Between 2019 and 2024, the United Kingdom invested over GBP 57 million through the NIHR and UKRI into long COVID research, including clinical trials and rehabilitation studies. Japan reported two research cohort studies on long COVID with budget provided from the national research funding scheme.
Note: Survey question: “Is there dedicated funding for research on long COVID at a national level?”
Source: 2025 OECD Long COVID Mapping Policy Survey.
Substantial patient engagement is necessary for any initiatives on long COVID to ensure that research and policymaking are aligned with the actual needs of patients living with the condition, to support improvements in their quality of life. Overall management of the condition has been hindered – first by a lack of recognition of its existence by the medical community, and subsequently by underestimation of its prevalence and impact across all sectors of society. Several patient associations have been established for long COVID, which actively provide support to members and can advise and provide relevant lived experience of the condition to inform health policymakers. Eleven OECD countries reported that their long COVID national initiatives benefited from formal participation of patients (Figure 5.6).
Note: Survey question: “Have any of the long COVID initiatives benefited from consultation or participation of patients or patient associations?”
Source: 2025 OECD Long COVID Mapping Policy Survey.
Poland considered the voices of patients and patient organisations (such as the Patient Rights Ombudsman) during the creation of its rehabilitation programme; however there is no permanent, formalised representation of long COVID patient associations in national decision making processes. Germany encourages patient participation in all funded research projects of its Federal Ministry of Health, and patient representatives also attend the Federal Ministry of Health’s Round Table meetings (Box 5.1). In the Netherlands, several patient associations have joined forces in the PAIS Alliance, which encompasses other post-acute infection syndromes including long COVID (Alliantie, 2023[4]).
The perspectives of the public and people with lived experience were also critical in the development and dissemination of the Canadian Guidelines for Post-COVID‑19 Condition. Patient representatives were included in each working group, and feedback on the steps from a public panel and comment periods was also incorporated (CAN-PCC, 2025[5]). Patients were also co-designers of resources developed to communicate and increase accessibility, dissemination and implementation of the recommendations.
Patients can be included in many ways in national initiatives, including via input on research priorities; participation in research studies, guideline development and communication; and development of care pathways, among others. For long COVID, where many patients have felt unheard or unrecognised and many questions remain, including patient voices is crucial for aligning research priorities, resources and services with patient need.
References
[4] Alliantie, P. (2023), PAIS, https://paisalliantie.nl/.
[1] Bundesministerium für Soziales, Gesundheit, Pflege und Konsumentenschutz (2024), Aktionsplan zu postakuten Infektionssyndromen, https://broschuerenservice.sozialministerium.gv.at/Home/Download?publicationId=842&attachmentName=Aktionsplan_zu_postakuten_Infektionssyndromen.pdf.
[5] CAN-PCC (2025), Our Approach, Canadian Guidelines for Post-COVID-19 Condition (CAN-PCC), https://canpcc.ca/our-approach/.
[2] Haute Autorité de Santé (2021), Symptômes prolongés suite à une Covid-19 de l’adulte - Diagnostic et prise en charge, https://www.has-sante.fr/jcms/p_3237041/fr/symptomes-prolonges-suite-a-une-covid-19-de-l-adulte-diagnostic-et-prise-en-charge (accessed on 22 October 2025).
[3] Office of the Chief Science Advisor of Canada (2024), Dealing with the fallout: Post-COVID Condition and its continued impact on individuals and society, https://science.ised-isde.canada.ca/site/science/en/office-chief-science-advisor/initiatives-covid-19/dealing-fallout-post-covid-condition-and-its-continued-impact-individuals-and-society.