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COVID has been raging for two years. Multiple variants have emerged. Worldwide, hundreds of millions of people have been infected, millions have died, and untold numbers have developed long COVID. COVID has disproportionately affected communities of color, those living in poverty, and those in less developed countries. COVID has disrupted education and led to significant learning loss. And, there has been tremendous economic dislocation, millions of people thrust into poverty, and the loss of tens of trillions of dollars from the world economy. Importantly, effective vaccines and therapeutics have helped make progress in combatting the virus, but cases and deaths still remain high. As the pandemic enters its third year, two factors have become critical. One is fatigue. People are tired of restrictions used to fight COVID. Simultaneously, the virus continues to surprise experts and make it challenging to anticipate what lies ahead.

In all cases, the world must be better prepared. It is possible for a new variant of concern to emerge. But greater population immunity increases the probability of a lower disease burden, lower strain on the health system, and fewer deaths if waning immunity or immune evasion do not become significant factors.

The following 12 elements constitute the fundamental core of this Roadmap and are elaborated in this report.

1. Major Respiratory: Viral Illnesses Shift the focus from Covid to major respiratory viral illnesses like fu and RSV infection, with the interim goal of reducing annual deaths below the worst infuenza season in the last decade.

2. Dashboard: Create, maintain, and disseminate a transparent infectious diseases dashboard to guide both the public and policymakers at the national, state, and local levels on the introduction, modifcation, and lifting of public health measures.

3. Testing, Surveillance, and Data Infrastructure: Increase surge production capacity for at-home rapid tests to 1 billion per month. Establish a test-to-treat infrastructure that links all testing with high sensitivity and specifcity to immediate medical consults and appropriate treatment, clinical trial enrollment, and public health guidance.

4. Indoor Air Quality: Direct the Environmental Protection Agency (EPA) and Occupational Safety and Health Administration (OSHA) to develop standards to improve indoor air quality and protect workers from inhalation exposure.

5. Vaccines and Therapeutic: Support the development of new, more effective therapeutics, especially multi-drug oral antivirals, and next generation vaccines, especially mucosal and pancoronavirus designs.   

6. Global Investment: Shift the goal of U.S. contributions to the global vaccination effort from stopping infections through population vaccination coverage alone to improving the distribution and administration infrastructure necessary to fully vaccinate the most vulnerable people in low- and middle-income countries.

7. Long COVID: Rapidly coordinate and expand research on long Covid, to produce data and biospecimens available through open science, with specific emphases on the INSPIRE and RECOVER studies. Aim to generate definitive answers to fundamental questions on frequency, risk factors, prognosis, and the benefits of vaccines and therapies for long Covid, within the next year.

8. Equity: Better address health disparities by creating a permanent cadre of community health workers to support vulnerable populations highly susceptible to adverse outcomes from viral respiratory illnesses and leveraging trusted community groups such as faith-based organizations.

9. Workforce: Expand and support the public health and health care workforces through improved wages, health benefts (including mental health), tuition assistance, loan forgiveness, and safe working conditions. Incentivize the accelerated adoption of automation for routine chores and paperwork.

10. Biosecurity and Pandemic Leadership: Create the post of Deputy Assistant to the President for Biosecurity (within the National Security Council), responsible for preparing for, monitoring, addressing, and coordinating responses to and communications about any biosecurity and pandemic threats.

11. Communication: Implement a comprehensive, scientifically-tested communication and behavioral intervention infrastructure to increase vaccination, testing, and treatment, especially among vulnerable groups.

12. Schools and Childcare: Governments should not close schools and childcare facilities unless all other community mitigation measures fail. Implement policies and programs, such as improved air fltration and expanded school nurse programs, that enable schools and childcare facilities to remain open and safe for in-person instruction and care without the need for special public health mitigation measures.