How different COVID-19 recovery paths affect human health, environmental sustainability, and food affordability: a modelling study

Background The COVID-19 pandemic arrived at a time of faltering global poverty reduction and increasing levels of
diet-related diseases, both of which have a strong link to poor outcomes for those with COVID-19. Governments
responded to the pandemic by placing unprecedented restrictions on internal and external movements, which have
resulted in an economic contraction. In response to the economic shock, G20 governments have committed to
providing US$14 trillion stimuli to support economic recovery. We aimed to assess the impact of different COVID-19
recovery paths on human health, environmental sustainability, and food sustainability.

Methods We used LandSyMM, a global gridded land use change model, to analyse the impact of recovery paths from
COVID-19. The paths were illustrated by four scenarios that represent different pandemic severities (including a
single or recurrent pandemic) and alternate modes of recovery, including a transition of food demand towards
healthier diets that result in changes to the food system: (1) solidarity and celery, (2) nothing new, (3) fries and
fragmentation, and (4) best laid plans. For each scenario, we modelled the economic shocks of the pandemic and the
impact of policy measures to promote healthier diets in the years after the COVID-19 pandemic, including the supply
of and demand for food, environmental outcomes, and human health outcomes. The four scenarios use established
future population growth and economic development projections derived from the Shared Socioeconomic Pathways 2.
We quantified the outcomes from more societally cooperative pandemic responses that result in reduced trade
barriers and improved technological development against less cooperative responses.

Findings Repeated pandemic shocks (the fries and fragmentation and best laid plans scenarios) reduce the ability of
the lowest income countries to ensure food security. A post-pandemic recovery that includes dietary transition towards
the consumption of less meat and more fruits and vegetables (the solidarity and celery scenario) could prevent
2583 premature deaths per million in 2060, whereas recovery paths that are focused on economic recovery (the fries
and fragmentation scenario) could trigger an additional 778 deaths per million in 2060. The transition of dietary
preferences towards healthier diets (the solidarity and celery scenario) also reduces nitrogen fertiliser use by 40 million
tonnes and irrigation water by 400 km³ compared with no dietary change in 2060 (the nothing new scenario). Finally,
the scenario with dietary transition increases the affordability of the average diet.

Interpretation The economic impact of the COVID-19 pandemic is most visible in low-income countries, where a
reduction in growth projections makes a greater difference to the affordability of a basic diet. A change in dietary
preferences is most impactful in reducing mortality and the burden of disease when income levels are high. At lower
income, a transition towards lower meat consumption reduces undernourishment and diet-related mortality.