Long COVID in Pakistan: Health system capacity analysis and policy framework

Background While acute COVID-19 has subsided globally, Long COVID represents an emerging public health challenge in low- and middle-income countries. This policy analysis examines Long COVID burden in Pakistan and proposes a health system response framework. Methods We synthesized recent meta-analyses on global Long COVID prevalence (2024-2025) with Pakistan-specific observational studies and healthcare capacity assessments. Sources were identified through PubMed, Google Scholar, and institutional repositories. We applied the WHO health system building blocks framework to systematically identify gaps and inform recommendations. Results Global evidence suggests approximately 36% Long COVID prevalence among confirmed cases, with symptom persistence beyond one year in nearly half of affected individuals. Extrapolating these estimates to Pakistan’s confirmed and estimated infection burden suggests a substantial national burden potentially affecting several hundred thousand to over one million individuals, though these figures carry considerable uncertainty. Pakistan-specific research documents neurocognitive deficits, psychological impacts with notable gender disparities, and functional impairments among survivors. Analysis reveals critical gaps across all WHO health system building blocks: absent surveillance systems, no clinical guidelines, limited rehabilitation infrastructure, inadequate multidisciplinary care capacity, and no coordinated policy response. Being unvaccinated approximately doubles Long COVID risk, yet vaccination coverage remains suboptimal. Conclusions Pakistan requires coordinated response including surveillance leveraging existing community health programs, adapted clinical guidelines, rehabilitation expansion, and strengthened vaccination. The framework proposed offers a template for other low- and middle-income countries facing similar challenges.