Poor working conditions and lack of social protections are likely to aggravate the impact on the world’s 2 billion informal workers.13 Source: IMF. 2019 and 2020. World Economic Outlooks and quarterly updates. REUTERS/MOON The Global Risks Report 2021 18 Health fallout At the time of writing, nearly 100 million people worldwide had contracted COVID-19 and more than 2 million had died,14 making SARS-CoV-2 one of the deadliest viruses in history.15 Global infections were rising, with upwards of 600,000 new cases and more than 10,000 deaths every day.16 Long-term health impacts remain unknown: in South Korea, a survey found that 90% of recovered COVID-19 patients were still suffering from physical and psychological side effects such as ageusia (loss of taste), anosmia (loss of smell), attention disorder and fatigue.17 Collateral health impacts—physical and mental—will continue to have devastating consequences worldwide: in the United States, for example, delayed treatment of emergencies, chronic diseases and psychological distress have already caused a death rate of 6% over what would normally be expected.18 The pandemic has strained healthcare systems, exposing their lack of capacity. Hospitals worldwide were quickly overwhelmed, and at the time of writing many were again at risk—from several countries in Europe19 to India,20 Mexico,21 South Africa22 and the United States.23 Some countries have reported new shortages of medical supplies.24 Healthcare professionals have struggled with anxiety, depression, fear, isolation and even social stigma.25 In countries such as Australia,26 Colombia,27 Ecuador,28 India,29 the United Kingdom,30 and the United States,31 financial, physical and mental stress have caused many to plan to stop working or leave the professionDecember 2020. Note: Change in Business Confidence between December 2019 and May 2020, when the indicator registered its lowest data point for OECD countries in aggregate. The Global Risks Report 2021 19 Underlying disparities The damage from COVID-19 has been worsened by long-standing gender, race, age and income inequalities. Disadvantaged groups went into the crisis with lower resilience as a result of disparities in well-being; financial stability and security; and access to healthcare, education and technology. Previous editions of the Global Risks Report have highlighted that income inequality, despite declining on a global scale, had reached historical highs in many countries (see, for example, The Fraying Fundamentals chapter in the 2020 edition of the report).32 million people into extreme poverty every year.34 This has amplified the pandemic’s impact on the physical well-being of people in low-income households,35 women,36 and the elderly. Sixty percent of adults lacked basic digital knowledge and skills when workplaces and schools across the world suddenly closed to curb the spread of COVID-19, forcing a rapid leap to online operations.37 Many students lacked access to a computer for schoolwork: percentages of students affected ranged from 25% in China to 45% in Mexico and 65% in Indonesia.38 Digital divides were already worrisome before the pandemic: in 2018, reporting that half the world’s population were connected to the internet, the International Telecommunication Union called to “redouble our collective efforts to leave no one offline”.39 Little left to lose The development of multiple vaccines may herald the beginning of recovery from the COVID-19 crisis—but the structural fissures that the crisis exacerbated, from individual well-being to societal resilience and global stability, threaten to make that recovery deeply uneven. “Livelihood crises”, “digital Health systems globally were already under strain from gathering pressures and emerging public health threats—a worrying trend analysed in depth in the False Positive chapter of last year’s Global Risks Report.33 Half of the world’s population lacks access to essential health services, and shortfalls in public health push 100 working women who believe their careers 70 will be slowed % REUTERS/THAPLIYAL The Global Risks Report 2021 20 inequality”, “youth disillusionment” and “social cohesion erosion” all show up in the GRPS as critical global threats for the next two years. Narrowing pathways Across developed and developing economies alike, the number of people without access to quality and affordable healthcare, education or digital tools is at risk of increasing. Billions of people face narrowing pathways to future well-being. In the short term, equitable and effective vaccine distribution is at risk from protectionist tendencies and geopolitical tensions—just as these tendencies and tensions put essential medical supplies at risk when the pandemic started (see Hindsight). In the longer term, inequitable access to quality healthcare will persist as a result of continued stress on healthcare systems globally. Health capacity in some European countries has already suffered from prolonged austerity measures.40 In Sub-Saharan Africa, 20% of people over 60—the highest-risk age group—are at least three hours away from the nearest health facility.41 Such obstacles have complicated the response to the pandemic. Looking ahead, failing to close public health gaps will exacerbate existing vulnerabilities and risk further humanitarian and economic damage. Barriers to