Background
Rapid advances in artificial intelligence, genomics, nanotechnology, regenerative medicine, and brain–computer interfaces are expected to fundamentally transform healthcare. However, realising this potential by 2050 will require effective integration between science and policy, particularly in the context of climate change, geopolitical instability, and persistent healthcare inequities.

Objectives
This study aimed to assess expert consensus on the feasibility, risks, and policy implications of transformative healthcare innovations by 2050, and to identify priority interventions at the science–policy interface that could enable equitable and sustainable health futures.

Methods
Phase One of a large-scale Delphi study, initiated in November 2025 and targeting a minimum of 250 experts, was conducted among 83 experts from 35 countries. Participants represented academia and research (28%), hospitals and clinics (19%), regulatory and government agencies (9%), biotech and pharmaceutical industries (10%), venture capital (4%), and other sectors. Most respondents held advanced degrees, including PhD (36%), MD/PhD (13%), Master’s (23%), or other doctoral-level qualifications (13%). Areas of expertise included cancer (15%), diagnostic medicine, pathology and genetics (13%), AI and precision medicine (13%), infectious diseases and immunology (9%), cardiology (5%), regenerative medicine (4%), and others. Predefined 2050 scenarios were rated on a 5-point Likert scale (1 = strongly disagree; 5 = strongly agree), alongside open-ended qualitative responses.

Results
The median level of agreement across extrapolated scenarios was 4.0, with interquartile ranges predominantly between 4 and 5 and mean scores ranging from 3.97 to 4.2, indicating high but measured optimism. The strongest consensus was observed for AI- and quantum-computing–enabled drug discovery and cell and gene therapies with near-zero early-phase failure rates; bioengineered or xenotransplantation-based organ replacement eliminating transplant waiting lists in developed countries; and nanomedicine-based real-time ablation of cancer and atherosclerotic plaques. Lower, though still positive, agreement (median 3.4) was reported for reversal of biological ageing by at least 15 years and for achieving population-level life expectancy of 90 years or more globally. Open-ended responses highlighted underexplored innovations, including personalised microbiome therapies, molecular-scale screening and wearable technologies, emotionally intelligent AI-based mental health support, and health geoengineering approaches responsive to climate change. Key perceived threats included geopolitical conflict (13%), widening global inequalities (10%), loss of public trust and data privacy concerns (8%), restrictive or fragmented regulation (7%), and ethical and societal concerns around human enhancement (5%). Recommended high-impact interventions included globally interoperable data-sharing frameworks, large-scale investment in health literacy and prevention, policies to ensure equitable access to healthcare and gender equity in research participation, and greater emphasis on nutrition and non-communicable disease prevention.

Conclusions
Phase One findings demonstrate strong expert consensus on the technical feasibility of radical healthcare innovation by 2050, with uncertainty centred more on implementation risks than on scientific capability. The study underscores the value of foresight and Delphi methodologies in strengthening the science–policy interface, particularly for advancing planetary health, equity, and adaptive capacity in future healthcare systems.