The second sub report on the government’s approach to the COVID-19 crisis focuses on the period from September 2020 to July 2021. Part 2focusses on the vaccination programme and three measures that were introduced during this period: the facemask requirement, the closure of primary and secondary schools, and the curfew.

The Dutch Safety Board is publishing the results of its investigation into the approach to the COVID-19 crisis across several sub-reports.


Investigation publication

Effects of COVID measures not clear enough

The Cabinet did very little to monitor or evaluate the effects of the COVID measures. As a result, little is known about both the desired and undesired effects of the measures. More knowledge about the effects of the measures that were taken would allow the Cabinet to make better-informed decisions in the event of coronavirus resurgences or future pandemics. This is what the Dutch Safety Board writes in its investigation report Approach to the COVID-19 crisis, Part 2, which covers the period from September 2020 to July 2021. In this second sub-report, the Board focuses on three measures: the facemask requirement, the closure of primary and secondary schools, and the curfew. The handling of the vaccination programme was also examined.

Long-term crisis

The Dutch Safety Board’s second research report looks at the period after the relatively calm summer of 2020, during which the Netherlands faced a new surge in coronavirus infections and hospital admissions. This was when the general public started to realise that the coronavirus pandemic was not over yet, and that it would be a long-term crisis. In the autumn of 2020 and the winter of 2020-2021, the Cabinet introduced far-reaching measures to curb the spread of the virus. These included a facemask requirement, the closure of primary and secondary schools, and a curfew. Little was known at the time about the effects these measures would have, an uncertainty that persists to this day as a result of insufficient monitoring and evaluation. The Board recommends that more knowledge be collected about the effects of the measures, as this would allow the Cabinet to make better-informed decisions in the event of coronavirus resurgences or future pandemics.

Vaccination programme

European cooperation enabled effective vaccines to be developed and made available within an unprecedented timeframe. The Netherlands played an active role in this process. When the vaccination campaign started in early January 2021, expectations were high. However, vaccines remained in short supply for several months, whereupon it became necessary to prioritize. The Dutch Health Council advised the Cabinet to vaccinate the most vulnerable groups first: the elderly and people who were at risk due to medical reasons. The Cabinet chose to deviate from this advice to some extent. Healthcare workers in long-term care were vaccinated first, followed by people the government classified as vulnerable to the virus due to medical reasons. The latter group, however, did not include all at-risk groups. As a result, at-risk groups that were not eligible for early vaccination felt unfairly disadvantaged. In the end, they were vaccinated months later than originally planned. After a hesitant start, the vaccination campaign started to pick up steam, and by June 2021 a large proportion of the population was vaccinated.

Division of roles and scenarios

Looking at this second period of the COVID-19 crisis, the Board observes the same patterns it saw in the first part of its investigation. In its first sub-report, the Board concluded that the division of roles – the Cabinet as decision-maker and the experts as advisers – was not always clear. The Board notes that this was also the case during the decision-making process regarding the facemask requirement. Initially, the Cabinet followed the Outbreak Management Team’s (OMT) recommendation not to institute a facemask requirement. Only later, as a result of political pressure, did the Cabinet change its view on the matter. The OMT did not always adhere to its formal role at times, for instance when it allowed the scarcity of facemasks to become a factor in its negative recommendation regarding facemask requirement.

In addition, the Board again notes that the Cabinet did not sufficiently consider a variety of possible scenarios. For instance, in preparing the vaccination campaign, the Cabinet assumed that the vaccine would be administered by general practitioners. All preparations were geared towards that scenario. When it eventually became apparent that the first vaccine to become available was not suitable for distribution through general practitioners, a last-minute switch to large-scale vaccination by the Municipal Health Departments (GGDs) was required. This put significant pressure on the Municipal Health Departments (GGDs) to set up large vaccination sites in a short timespan.

Recommendations

In this second sub-report, the Dutch Safety Board examines the Netherlands’ response to the COVID-19 crisis, focusing on the period from 1 September 2020 to 1 July 2021. As before, the Board’s aim is to determine how and why the situation developed as it did, and what lessons can be drawn.

The recommendations made on the basis of this sub-report relate to a period which, at time of publication, is over one year in the past. Now that the COVID-19 crisis has been ongoing for some two-and-a-half years, several modifications to the crisis approach have already been made. For example contingency plans to increase preparedness for a future pandemic, a Societal Impact Team (Maatschappelijk Impact Team; MIT) and a National Functionality for Infectious Disease Control (Landelijke Functionaliteit Infectieziektebestrijding; LFI) which, under the direct authority of the Minister of Health, Welfare and Sport (VWS) will be responsible for preparing for future pandemics and for the operational coordination of the GGDs. Alongside these developments, the Board wishes to make a number of supplementary recommendations.

To the Cabinet:

1. Ensure that each of the measures implemented during the crisis is individually evaluated as soon as possible. All effects, both intended and unintended, should be examined. The knowledge gained will support decision-making about similar measures in future waves of infection or a subsequent pandemic. Where measures are implemented in the future, ensure effective monitoring and evaluation of the effects and implementational aspects.

2. In preparation for future public health crises, build on the knowledge and experience gained in European cooperation with regard to joint procurement, supply security and the timely availability of (scarce) pharmaceutical products and medical devices. Take the initiative in placing relevant aspects on the European agenda.

In its first sub-report, the Dutch Safety Board recommended that the Cabinet should ensure a clear delineation of roles, safeguarding the independent position of elected representatives as decision-makers and experts as advisors. Based on this second sub-report, the Board wishes to add two further recommendations to the Cabinet:

3. Clearly define the role, task and position of advisory bodies in future protracted crises with a national impact. In doing so, devote attention to the interaction between the advisory parties, and their interaction with decision-makers. Ensure that the role and responsibilities of the Health Council, the Outbreak Management Team (OMT) and new parties such as the Societal Impact Team (MIT) in any future pandemic situation are clearly established. To this end, evaluate the crisis response organization in place during the COVID-19 crisis.

4. Ensure that the consideration of values and interests in a crisis is undertaken by the politicians who are accountable within the democratic process. Use the (scientific) advice as input for decision-making. Communicate clearly with society about the weight given to the various values and interests, and about the manner in which the decision-making has taken account of uncertainties. Avoid creating unrealistic expectations.

To the Minister of VWS:

In its first sub-report, the Dutch Safety Board recommended the modification of the crisis structure for the healthcare sector in order to give the Minister of VWS authority to address problems which transcend sectoral, regional or institutional boundaries in any case including directly binding instructions. The Minister of VWS intends to adopt this recommendation through the establishment of the National Functionality for Infectious Disease Control (LFI). Based on this second sub-report, the Board wishes to add a further recommendation:

5. Clearly define the tasks and responsibilities of the LFI, and how those tasks and responsibilities relate to those of the Minister of VWS and other executive or advisory parties involved in the crisis response. Ensure that the lessons learned from the implementation of the COVID-19 vaccination programme are fully embedded within the LFI, whereby specific attention should be devoted to:

  1. central coordination of the GGDs, and coordination between GGDs;
  2. timely and recurrent preparation of various scenarios, including their operational implications;
  3. a national vaccination registration system, including the necessary linkages between the IT systems of the various operational parties.

To the Health Council of the Netherlands:

6. Adopt and embed methods and procedures which allow appropriate speed and flexibility of the advisory process. In doing so, draw on lessons learned from the COVID-19 crisis.

To RIVM:

7. Protect the position, authority and integrity of an OMT and its individual members by means of published ‘Rules of Procedure’. This document should state the composition of the OMT, its working procedures, its position in relation to the Ministry of VWS, and external communications.

 

Investigation in images

The report includes a reconstruction of key events in the period September 2020 – July 2021.

Investigation in images

Imagery

Updates

  • News

    Aanpak coronacrisis deel 2: september 2020 - juli 2021

  • Press

    Effects of COVID measures not clear enough

  • Update

    Safety Board to publish results COVID-19 investigation in sub-reports

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