This game was indirectly announced in September 2022, when Hideo Kojima shared a teaser poster showing only the silhouette of a woman, with a text in the middle saying "WHO AM I?". Many have instantly identified Elle Fanning as the woman. Another poster that was published the following month, this time revealing her face, confirmed that she was involved in Kojima's next project. Many similar posters were published over the next weeks, and despite the vague information, fans speculated that a Death Stranding (2019) sequel was in development. It wasn't until December, during The Game Awards 2022, that this game was officially revealed.
A few months after the release of Death Stranding (2019), fans have pointed out similarities between that game and the COVID-19 pandemic, as both included a deadly illness, a divided society, self-isolations, and people relying on delivery services in order to not leave their homes. This prompted Hideo Kojima to rewrite the story for this sequel, because he wanted to avoid predicting the future again.
Luca Marinelli was a candidate Kojima suggested for playing Solid Snake in Metal Gear Solid. Here, he plays a character with a similar costume to Snake as if a way of giving him the role in his own way.