Approach to COVID-19 crisis – Part 3

Government maintained short-term strategy during COVID-19 crisis

The government maintained its chosen short-term strategy for too long during the COVID-19 crisis. The objectives set at the start of the crisis, forming the basis for decision-making, were kept throughout the crisis period, even when the crisis developed from an acute health crisis to a longer-term crisis with significant societal impact. The strategy during the crisis continued to be focused on ensuring that the ICU remained available to all patients. This approach meant that new risks and associated damage were insufficiently considered in the crisis strategy. This is what the Dutch Safety Board writes in its investigation report Approach to the COVID-19 Crisis, Part 3. 

The investigation report Approach to the COVID-19 Crisis, Part 3 is the final report in a series of investigations on the COVID-19 crisis strategy. In the reports, the Dutch Safety Board reflects on the government’s COVID-19 strategy during the entire period from January 2020 through September 2022. Chris van Dam, chairman of the Safety Board, says: “With the results of three and a half years of investigations now available, it is time to draw lessons; this third investigation also provides recommendations to better prepare the Netherlands for longer-term crises in the future.”

“The Dutch Safety Board believes that the government – taking the recommendations from the three reports into consideration – must take measures to be better prepared for long crises in the future. In its cover letter to the government, the Dutch Safety Board defined overarching lessons. These may also be of significance for the House of Representatives in considering whether or not to launch a parliamentary inquiry. For this reason, we are also sending this letter to the chair of the House of Representatives”, Van Dam explains.

Frequently assess the course taken against how the crisis is unfolding

The investigation report shows that the government addressed the COVID-19 crisis as a health crisis throughout the crisis period. The government’s main objective was to ensure the availability of acute care, with ICU occupancy being its focal point. Time and again, this was the deciding factor for intervening or for easing (restrictive) measures. However, as the crisis continued, other problems arose, such as post-COVID syndrome, health problems due to delayed care and broader social problems. These were not part of the original objectives and thus did not affect the crisis strategy – the government did not adapt their approach.

Over the course of the crisis, the pressure on healthcare workers increased. The government did not sufficiently pick up on signals from these healthcare workers and continued to rely on their resilience. This is particularly risky for a longer-term crisis. Van Dam continues: “The Dutch Safety Board recommends that during a longer-term crisis, frequent assessments of the course taken are conducted to determine whether the course is still appropriate for how the crisis is unfolding. Always assess whether objectives need to be adjusted.”

Shed more light on how the government makes its choices

The Dutch Safety Board observed that the government did not discuss  values underlying their decisions with society did not happen adequately. Hence, a social dialogue was not stimulated, despite the fact that the cooperation of society was essential in dealing with the crisis. The government also omitted to clearly explain which risks they did or did not find acceptable. The Dutch Safety Board recommends to explicitly specify the dilemmas and choices underlying decisions and to provide the public with information on how the government identifies risks, values and interests and how they make decisions. This will enable citizens to adapt their considerations and actions accordingly and take responsibility for themselves and others.  

Improve collaboration on data infrastructure

Fighting a pandemic calls for clear insight into the spread and consequences of the virus and into the impact of the measures taken. Particularly at the start of the crisis, this knowledge was insufficient because the testing infrastructure, laboratory capacity and the data infrastructure in the Netherlands were not prepared for a pandemic of this magnitude. Gradually, more data became available, but the parties involved were not forthright in sharing it due to different interpretations of privacy-related legislation and regulations. Reaching agreement on data sharing took a long time, while crisis management required quick decisions. To be better prepared for a future crisis, the recommendation of the Dutch Safety Board is to fully put the data infrastructure in place now, in collaboration with implementing parties, and to resolve bottlenecks in the sharing of data.

Expand crisis strategy to government-wide responsibility 

Ownership of the strategy during the crisis lay with the Minister of Health, Welfare and Sport. This was in line with the government’s approach to a health crisis. It meant that the focus of the restrictive measures was on epidemiological and direct health effects, even when the crisis developed into a comprehensive social crisis. Input of other parties was not always weighed equally, resulting in the broad-ranging and long-term effects of the crisis being insufficiently highlighted. The Dutch Safety Board therefore advises that in a longer-term crisis, the responsibility for the crisis strategy should be shared government-wide, so that the all-encompassing nature of the crisis strategy is unquestionable.

Professionalize scenario thinking for long crises with nationwide impact

The Dutch Safety Board calls for the professionalization of scenario thinking for a large-scale and long crisis, so as to enable a more adequate response under changing circumstances. The models of the National Institute for Public Health and the Environment played a key role in decision-making during the crisis. These models were mainly focused on the epidemiological developments of the virus and the short-term impact on health. The government generally chose the most likely scenario and aligned policy accordingly. The Dutch Safety Board is of the opinion that not enough provisions were made during the crisis for the various scenarios and uncertainties in the longer term and on a wider scale, including less likely scenarios with a potentially significant impact.

Recommendations

The following are recommendations based on the present report. This sub-investigation looked back at the entire crisis period up to September 2022. Partly because of this, some of the recommendations are in line with those in the sub-reports Aanpak coronacrisis 1 and 2. Sub-investigation 3 shows that improvements are still needed on those themes, or parts of them, in preparation for a possible new protracted crisis with national impact. As Sub-investigation 3 focused on how the government managed the risks to public health and safety during the corona crisis, the Dutch Safety Board focuses all its recommendations on the government.

1. Review and adjustment of strategy and objectives

The government maintained the objectives it set at the beginning of the crisis, while thecontext changed as the crisis unfolded. Risks that manifested themselves at a later stagewere not part of the original objectives and thus did not become part of the crisisresponse.

During a protracted crisis, reflect regularly and explicitly on the chosen objectives and assess whether they are still appropriate for the course of the crisis. In doing so, identify and assess risks not only within the applicable targets, but also outside them, and determine whether it is desirable to adjust targets. In doing so, organise a dialogue aimed at recognising and challenging assumptions and underlying values.

2. Ensuring broad ownership and integral considerations

Despite a widening of the crisis and an increase in the number of parties involved, theMinister of VWS retained ownership of the crisis. The Safety Board notes that thegovernment’s decision-making continued to approach the crisis mainly as an acute healthcrisis.

a. When scaling up to a national crisis structure, ensure that ownership of andresponsibility for the crisis approach are effectively shared government-wide, so thatthe integral nature of crisis policy is unmistakable.

b. Ensure that responsibility is taken at the ministerial level for input and decision-making on inter-ministerial themes, such as the long-term perspective, societal impactand post-crisis phase.

3. Thinking through scenarios

The RIVM’s epidemiological models played a central role in the decision-making. Partlyas a result of this, image and decision-making focused mainly on the most likely short-term scenario of epidemiological trends. Scenarios for less likely developments withpotentially high impact – including in broader areas and in the longer term – remainedunderexposed throughout the crisis.

Anticipate changing circumstances by professionalising scenario thinking within crisis counselling and decision-making during protracted crises with national impact. During a crisis, develop and think through less likely scenarios for the course, risks and impacts on a regular basis as well, to be better prepared to respond to bottlenecks and decision points.

4. Explaining considerations, risks and consequences for society

Measures had a major societal impact. At times of high ICU occupancy, the governmentaccepted those consequences. The downside of scaling down measures was higher viruscirculation. In doing so, the government accepted more infections, putting more peopleat risk of post-COVID or other long-term consequences, such as resulting from delayedcare. Choices and considerations were not clearly explained to society.

During a protracted crisis, explicate the dilemmas, the weighing of risks and interests, and the choices involved in decision-making. Make clear to society the downside of the strategy, a decision or measure, what risks are accepted, for whom and why. This enables citizens to act accordingly and take responsibility for their own safety and that of others.

5. Improving information provision

Adequate pandemic control required optimal insight into the spread of the virus, itspublic health impact and the impact of measures. The quality of insight increased duringthe crisis. To prepare for future infectious disease outbreaks and other types of crises,improvements are still needed.

a. In cooperation with implementing parties, establish and guarantee a crisis-proof datainfrastructure for the purpose of recording, sharing and modelling data.

b. Create the preconditions for the quick resolution of bottlenecks in interpreting andapplying privacy laws and regulations around data sharing between involved partiesin the next crisis.

c. In cooperation with implementing parties, secure the developed testing infrastructureso that it is equipped for a new acute crisis of large scale. In doing so, pay attentionto availability of materials and scalability of take-up capacity, laboratory capacity andlogistics.

d. Encourage structural partnerships to reflect more broadly on form, assumptions andoutcomes of leading models during a crisis, including using different types of modelsand insights from multiple modellers (or modeller groups) in the Netherlands.

6. Leveraging social-science knowledge

Pandemic control was not only an epidemiological issue but also a societal andbehavioural one. The success of pandemic response depends heavily on citizens’compliance with advice and measures. To strengthen the position of behavioural andsocial-science knowledge in crisis counselling and decision-making, important steps havebeen taken, for example by setting up the Behavioural Unit and establishing the MIT. Theposition of social and behavioural science knowledge can be strengthened further.

a. From the beginning of a protracted crisis, exploit social and behavioural scienceknowledge in modelling, advising the government, crisis consultations and policy-making, including the design of measures and recovery policies.

b. In collaboration with knowledge institutes, promote applicable social and behaviouralscience research that enables rapid translation of knowledge into action perspectivesduring a protracted crisis with national impact.