Pandemics occur rarely but disrupt every facet of society when they strike. Scientific studies put the risk of another COVID‑19 scale pandemic within 25 years at roughly one in two.
Left unchecked, an outbreak could overwhelm health systems within months and threaten economies. In OECD, critical care capacity could be exhausted in one to two months while expanding capacity to COVID‑19 levels could buy only days. Gross domestic product (GDP) could fall by 2.7% in a coronavirus-like outbreak and 16.2% in a measles-like outbreak over nine months. Transportation and storage, manufacturing and administrative, professional and technical services would be the hardest-hit sectors in all scenarios.
Early and effective implementation of non-pharmaceutical interventions (NPIs) can reduce the need for more disruptive measures later. A layered approach combining community-based infection prevention and control measures (e.g. hand hygiene) and voluntary quarantines could prevent at least 40% of deaths. Adding teleworking, domestic travel restrictions and mandatory quarantines could avert nearly all deaths, limit economic losses and avoid school closures, international travel restrictions and lockdowns. Lockdowns may be needed if compliance is low.
Stockpiling personal protective equipment (PPE) and hygiene supplies, alongside stronger disease surveillance, is critical for early and effective pandemic response. Combining clinical surveillance with wastewater monitoring enables earlier, more targeted NPIs, reducing deaths and shortening lockdowns. National and regional stockpiles enable rapid deployment of essential supplies, help absorb surges in healthcare demand and minimise the impacts of supply chain disruptions.
Investing in pandemic preparedness and response (PPR) is affordable. In OECD, investing about USD 7.1 billion per year on average, adjusted for purchasing power parity (PPP), or USD PPP 5.9 per person would be necessary to put core PPR systems in place. Stockpiling accounts for the largest share (USD PPP 3.2 per person) whereas strengthening disease surveillance capacity would cost less than USD PPP 1 per capita annually.
Planning ahead for the next pandemic
COVID‑19 claimed close to 7 million reported lives between 2020 and May 2023, stretched health systems far beyond capacity and disrupted routine care. Global GDP per capita contracted by around 4% in 2020 relative to 2019, compared to the levels seen during the 2008 global financial crisis (World Bank Group, 2025[1]; WHO, 2026[2]). Yet COVID‑19 was only the most recent pandemic to disrupt both health and economies. The 1918 influenza pandemic killed an estimated 40 to 50 million people worldwide (Beach, Clay and Saavedra, 2022[3]). The 2002‑2003 severe acute respiratory syndrome outbreak spread across 26 countries on five continents and cost the global economy around USD 50 billion (Wilder-Smith, 2021[4]).
Rapid urbanisation, deforestation, intensive farming, poorly regulated wildlife trade, changing weather patterns and growing demand for air travel exacerbate the risk that a local outbreak becomes a public health emergency of international concern. Previous evidence suggests that there is a one‑in-two chance of another COVID‑19‑scale pandemic occurring within 25 years (Madhav et al., 2023[5]). The risk of a future pandemic is not hypothetical. The ongoing Ebola outbreak in the Democratic Republic of the Congo and the reports of human infections with highly pathogenic avian influenza continue to raise concerns.
The OECD Strategic Public Health Planning Model (SPHeP) for PPR was used to simulate how five outbreaks would unfold across 51 OECD, EU/EEA and G20 countries. Scenarios are broadly based on the characteristics of five pathogens with recognised pandemic potential, including Ebola-like, avian influenza-like, influenza A-like, coronavirus-like and measles-like outbreaks. Analyses cover the first nine months of an outbreak when treatments and vaccines are unlikely to be available at scale.
In unmitigated pandemic scenarios, designed as a stress test to identify the breaking points of the health systems and the economies, between 1% of the population in a coronavirus-like outbreak and more than 5% in an influenza A-like outbreak could lose their lives. In OECD countries, intensive care services would reach full capacity within one to two months on average, similar to EU/EEA and G20 countries (Figure 1). Even an extraordinary effort to expand intensive care beds to 130%, corresponding to the levels seen during COVID‑19, would provide only temporary relief. Once critical care capacity is saturated, mortality would rise for every patient who needs critical care services, including those with heart attacks, strokes or cancer.
Average number of days it takes to reach intensive care unit (ICU) capacity, unmitigated pandemics
Note: The figure shows the average number of days required to reach full and 130% ICU capacity under stress-test scenarios involving unmitigated outbreaks (e.g. a value of 43.3 in the Ebola-like outbreak scenario means it would take on average 43.3 days to reach 100% ICU capacity in the OECD).
Source: OECD analysis based on the OECD SPHeP-PPR model.
An unmitigated outbreak would cut GDP by 2.7%, on average, in a coronavirus-like scenario and by 16.2% in a measles-like one over nine months. The damage would be uneven. Sectors that depend on physical contact or discretionary spending would suffer most. Output in transport and storage would drop, on average, by 13% to 19% depending on the scenario, in manufacturing by 6% to 16% and in administrative, professional and technical services by 4% to 16%. In contrast, sectors delivering essential services, such as education, human health and social work activities, would remain operational in most scenarios. Education and health would contract, on average, by 0.5% to 4.5%, public administration and information services by 1.5% to 4.4%, depending on the scenario. No sector of the economy would be immune in higher-severity scenarios. In a measles-like outbreak, even in the sectors that provide essential services, the average output would fall by around 16%, reflecting the widespread disruption caused by the outbreak.
NPIs slow transmission either by reducing contacts between people or by making those contacts safer. In the early phase of an outbreak, they are usually the only tools available. The OECD modelled eight NPIs, grouped into four levels reflecting progressively greater disruption to daily life and mobility.
“Safer contact” package (Level 1) covers community-based infection prevention and control (e.g. hand hygiene, mask wearing, indoor ventilation) together with voluntary quarantine for people with symptoms.
“Reduced contact” package (Level 2) includes all Level 1 interventions and adds teleworking, limits on domestic travel and mandatory quarantine.
“Targeted closures and restrictions” package (Level 3) entails all previous levels and adds school closures and international travel restrictions and
“Lockdown alone” (Level 4) package explores what happens when lockdowns are imposed on their own as a last-resort measure and without the implementation of other less restrictive NPIs.
The timing of scaling up NPIs is critical. Early action slows transmission, reduces pressure on health systems and lowers the likelihood that interventions that severely disrupt daily life and mobility will be needed later. When implemented early and effectively, the “Safer contact” package alone could prevent at least 40% of deaths in otherwise unmitigated outbreaks while limiting average GDP losses to around 2.5% in avian influenza-like, influenza A-like and coronavirus-like outbreaks and to 8.6% in a measles-like outbreak.
A layered approach, introducing NPIs with increasing stringency as needed, can protect population health while limiting economic disruption. In most scenarios and countries, layering the “Reduced contact” package measures on top of the “Safer contact” package offers the most practical strategy to balance health and economic gains, averting the vast majority of deaths while limiting economic losses to around 2.5% of GDP (Figure 2). This corresponds to a small fraction of the losses from inaction and, depending on the scenario, 5 to 12 times lower than those associated with delayed action requiring lockdowns. It would also avoid the need for school closures and international travel restrictions in most cases.
Note: “Reduced contact” package includes community-based infection prevention and control measures (i.e. mask wearing, hand hygiene and indoor ventilation), mandatory quarantines of infected people, promotion of teleworking and domestic travel restrictions. “Lockdown alone” package explores what happens when lockdowns are imposed on their own as a last-resort measure.
Source: OECD analysis based on the OECD SPHeP-PPR model.
Relying on lockdowns only as a last-resort without implementing other NPIs is the least effective strategy for saving lives and the most damaging to the economy. On average, GDP could decline by 11.7% in an avian influenza-like outbreak and up to 28.9% in a measles-like outbreak (Figure 2). In most scenarios, timely implementation of less restrictive NPIs can avoid the need for lockdowns.
The effectiveness of every NPI package depends on how far the public follows the recommended actions. Where compliance is low, more restrictive interventions, including lockdowns, could become difficult to avoid. Bolstering public trust in institutions, clear crisis communication and encouraging community engagement, therefore, are integral to ensuring higher levels of compliance in the general public.
Decision makers can act early if they can see an outbreak is looming. Many pathogens are shed in bodily fluids before patients ever reach a clinic, as happened during the COVID‑19 pandemic. In many OECD countries, wastewater surveillance became a valuable complement to clinical reporting during the pandemic. OECD analysis shows that combining information gathered from clinical and wastewater surveillance systems could allow NPIs to be triggered earlier and lifted sooner than clinical surveillance alone. In a coronavirus-like outbreak, guiding the “Safer contact” package with the combined surveillance approach would avert 41% more deaths and, where lockdowns still prove necessary, their duration could fall by up to 90%. In some cases, this means nearly three additional weeks without a lockdown, which would not only mean further limiting the economic damage but also operating workplaces, schools and travel without major disruptions.
Seeing the outbreak earlier is not enough if the supplies are not in place. National and regional stockpiling of personal protective equipment (PPE) and hygiene supplies are the first line of defence when demand for healthcare services surges and supply chains falter. They can also play a critical role during natural disasters, chemical, biological, radiological and nuclear incidents and against other threats such as antimicrobial resistance. Effective stockpiling policies require strategic planning and risk management, effective inventory management and logistics, clear governance and oversight structures and sustainable funding.
Managing outbreaks also depends on broader governance systems for guiding strategic decisions during health crises, building public trust, effective crisis communication, as well as close collaboration across sectors and mechanisms for facilitating international co‑operation.
Strengthening PPR capacity across OECD countries would cost, on average, USD PPP 7.1 billion per year or USD PPP 5.9 per person (Figure 3). Across the EU/EEA, this figure is around USD PPP 2.6 billion (USD PPP 6.3 per person). Almost all this investment is concentrated in two areas. In OECD, around 53% would be used to build and maintain national stockpiles of PPE and hygiene supplies (USD PPP 3.2 per capita per year in the OECD and in EU/EEA). A further 43% would be used for planning and putting in place the systems to support the implementation of physical contact-reducing NPIs such as physical distancing and teleworking (USD PPP 2.5 and 2.8 per capita per year in the OECD and EU/EEA respectively). Enhancing wastewater surveillance capacity would come at a much lower cost, with cost per person averaging less than USD PPP 1 a year. These estimates represent an upper bound, as they assume countries start with limited PPR capacity. Countries with more advanced systems already in place would require lower levels of investment.
Annual average cost of PPR, USD PPP per capita, by components
Notes: Physical contact-reducing NPIs include 1) promoting higher compliance with physical distancing measures, 2) ensuring innovative workplace solutions, 3) ensuring educational continuity and 4) encouraging safe international and domestic travel. PPE = Personal protective equipment; PPP = Purchasing power parity.
Source: OECD analysis based on the OECD SPHeP Costing Tool.
Invest before the next pandemic. About USD PPP 7.1 billion (USD PPP 5.9 per person) a year would be needed to put core PPR systems in place across OECD countries (USD PPP 2.6 billion per year in EU/EEA). This investment would concentrate on three priority areas: 1) planning and putting in place the systems for early and effective implementation of non-pharmaceutical interventions, 2) stockpiling personal protective equipment (PPE) and hygiene supplies and 3) strengthening disease surveillance systems including wastewater surveillance.
Plan a layered pandemic response now. A well-designed mitigation strategy starting with community-based infection prevention and control (IPC) such as hand hygiene, mask wearing, indoor ventilation and respiratory etiquette, quarantines of infected persons which would be escalating to teleworking and domestic travel restrictions could help avoid school closures and international travel restrictions and highly restrictive lockdowns in most scenarios.
Build and maintain stockpiles of essential supplies. PPE and hygiene supplies are the first line of defence during outbreaks when supply chains falter. Availability of clear governance and oversight structures, strategic planning and risk management and effective inventory management and logistics and sustainable financing are essential for effective stockpiling.
Strengthen disease surveillance capacity. Combining data gathered from clinical and wastewater surveillance allows less restrictive measures such as community-based IPC to be introduced earlier, potentially preventing 41% more deaths in a coronavirus-like outbreak compared to clinical surveillance alone. If lockdowns become unavoidable, this combined approach can help cut time in lockdown by up to 90%.
Maximise the benefits and the synergies of PPR investments. PPR infrastructure, disease surveillance systems and co‑ordination mechanisms are dual-use assets that strengthen routine care, accelerate detection of other health threats including chemical, biological, radiological and nuclear threats and reinforce public trust in institutions in normal times.
OECD (2026), The Economic Case for Pandemic Preparedness and Response: Beyond Lockdowns, OECD Health Policy Studies, OECD Publishing, Paris, https://doi.org/10.1787/b7b3852e-en.
References
[3] Beach, B., K. Clay and M. Saavedra (2022), “The 1918 Influenza Pandemic and Its Lessons for COVID-19”, Journal of Economic Literature, Vol. 60/1, pp. 41-84, https://doi.org/10.1257/jel.20201641.
[5] Madhav, N. et al. (2023), Estimated Future Mortality from Pathogens of Epidemic and Pandemic Potential, https://www.cgdev.org/sites/default/files/estimated-future-mortality-pathogens-epidemic-and-pandemic-potential.pdf (accessed on 18 October 2025).
[2] WHO (2026), WHO COVID-19 Dashboard, WHO COVID-19 Dashboard, https://data.who.int/dashboards/covid19/deaths (accessed on 7 May 2026).
[4] Wilder-Smith, A. (2021), “COVID-19 in comparison with other emerging viral diseases: risk of geographic spread via travel”, Tropical Diseases, Travel Medicine and Vaccines, Vol. 7/1, https://doi.org/10.1186/s40794-020-00129-9.
[1] World Bank Group (2025), World Development Indicators: GDP per capita (constant 2015 US$), https://databank.worldbank.org/source/world-development-indicators# (accessed on 18 October 2025).
Contact
OECD Directorate for Employment, Labour and Social Affairs, Health Division (health.contact@oecd.org)
