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Dr. Mark Dybul has some good news and bad news regarding the COVID-19 pandemic. The good news is that advances in therapeutics, vaccines, and the biotech sector will likely help the world avoid a repeat of the catastrophes that 2020 and 2021 brought. The bad news is that we’re likely to see a vaccine-resistant strain of the coronavirus sometime in spring 2022.

Dybul, who is currently the CEO of Enochian BioSciences and a professor at Georgetown University Medical Center’s Department of Medicine, didn’t make this prediction lightly when speaking at the Fortune CEO Initiative conference in Washington, D.C., on Tuesday. He noted that since the beginning of the pandemic, the U.S. has lagged about a month behind Northern Europe and Israel, areas that are highly vaccinated but still experiencing rising rates of infection, hospitalizations, and deaths. On the bright side, the U.S. is offering booster shots whereas those regions are not—so we might catch up, but the forecast for the holiday season doesn’t look great.

“The faster we get boosted, the better off we’ll be for the next couple of months,” he said. “Sadly, every prediction I’ve made has pretty much come true. I hope I’m wrong this time, but I think by March, April, May, we will have a fully vaccine-resistant variant. There’s simply no way you can have such low rates of vaccination around the world with the virus ping-ponging between vaccinated and unvaccinated people. I’m an immunologist. The probability of us seeing a vaccine-resistant strain is very high.”

What will help are the therapeutic medications developed by Pfizer and Merck that reduce hospitalizations, as well as products in development by several companies, Enochian included, like nasal sprays that provide prophylaxis and prevent transmission. “I think we’ll have products like that in the next year and a half or so,” the Fauci-trained physician said. “So the longer term will be okay, but the next year and a half could be pretty rough.”

When asked about workers returning to offices, Dybul said that vaccine mandates, cyclical testing, and improving airflow to limit the virus’s spread are key. It’s also imperative that leadership is vocal about enforcing these changes, rather than relying on the government to call the shots.

“CEOs can drive social change in a way that I don’t think governments can,” he said. “And I think just talking to your workforce—it’s one thing to put a mask mandate in, it’s another to talk with them. That’s one thing to say, ‘You’re going to come back to work’ or ‘You’re not going to come back to work,’ it’s another to talk with people about it and explain why and how and listen to them and hear what their concerns are. If you do that, you can actually move through processes with them.” Dybul noted that while HR can handle the responsibility of reaching out to employees, CEOs should take the initiative of leading communication and make it clear that they care about their workforce.

A positive aspect to the pandemic, he said, is that technological advances are reducing the cost and difficulty of producing mRNA vaccines: “There’s a lot of investment now in the making of the product that could really disrupt everything so that you could have production all over the world relatively easily in the next couple of years. That could have a significant disruption in the whole biotech pharmaceutical industry. Because if you don’t need big global pharmaceutical companies anymore to solve these problems, we could see a really exciting disruption that could radically change where we’re going. That’s one silver lining in all of this potential.”

To sum up his thoughts on the future of the pandemic, Dybul offered three scenarios. The first is that it “peters out” like the Spanish flu of 1918–19. That’s a long shot because, unlike then, the world is so mobilized and transmission is exponentially easier for the virus. The second is that advancements in therapies and prophylaxes will help the wealthier areas of the world, while the virus remains in poorer nations. “Rich countries are going to do just fine because we’ll have all these products available, and then we’ll have endemicity in lower-income countries, and that’s what’s really going to drive constant variants,” he said. “It’ll become like influenza. We’ll have every year or twice a year therapies, vaccinations, prophylactic treatments, and we’ll be fine. We’ll have some people dying and getting sick and breaking through, but we’ll be fine.”

Dybul saved the most dire hypothetical outcome for last. “The third possibility is that it’s a mess for the foreseeable future everywhere because the virus will mutate so much that it will even get around therapies,” he said. “That’s really unlikely. I think we’re probably headed towards the middle scenario, but it’s gonna take two to three years to get there. In between could be pretty rough.”