Pandemic preparedness and the Netherlands – where do we stand?

On 20 May 2025, at the 78th World Health Assembly, WHO Member States adopted the Pandemic Agreement (PA), designed to strengthen global preparedness and response to pandemics and only the second legally binding UN health accord in history (see text box 1). Eleven countries abstained from the vote, including the Netherlands, but this was under the -Schoof-led government, and with its demise in July 2025 and a new coalition in the making, our stance may shift – or not. So it’s time to explore how important the PA can be for the Netherlands, how prepared we are for the next pandemic, and how we may be unravelling a once-solid international reputation. 

To start with, if the Netherlands decides to opt-out of the PA – a real possibility – it won’t be bound by any of its provisions, such as data-sharing and information exchange on pathogens with a pandemic potential. However, Marion Koopmans, professor of virology at Erasmus Medical Centre as well as founding and scientific director of the Pandemic and Disaster Preparedness Centre (PDPC), remarks that information exchange has never been controversial for the Netherlands, and she trusts our institutions to continue to operate in that vein. But she is less confident about the possibility of strengthening our required capacities to detect such pathogens. “Funding seems to have quietly slipped from the table.”

The plans

After COVID-19, the Rutte-IV government, with Health Minister Ernst Kuipers, agreed to a 2022 ‘Policy Agenda for Pandemic Preparedness’ [1], focused on ‘decisiveness and agility’. It aimed to improve monitoring, surveillance, contact tracing, and crisis management coordination, and to strengthen Public Health Services, invest in research and One Health studies, upgrade essential data infrastructures, and create a new crisis response organisation. [2] The Policy Agenda also earmarked funding up to an annual 300 million euros, but this was slashed during the -Schoof government. Some funding has been restored recently, but only temporarily and not for the complete Agenda.[3] On its website, GGD GHOR Nederland [4] warns of ‘the severely weakened state of infectious disease control’.

The reality

Anja Schreijer, medical director of the PDPC is worried. During COVID-19, she reminds us, incompatible data systems across Municipal Health Services (MHS), hospitals, GP practices and long-term care facilities created major bottlenecks, with staff literally copying data between systems.  Another crucial functionality in outbreak management is the rapid scaling up of contact tracing capacity in order to collect data on virus spread, location of outbreaks and populations at risk – crucial information for public health and social measures, meant to buy time at the beginning of an outbreak until vaccination or treatment can begin. 

Schreijer adds: “While we had a well-functioning Outbreak Management Team that focused on the biomedical management of the outbreak, it took us some time to also establish a Societal Impact Team to look at the societal impact of measures, at willingness and intention to test and vaccinate, and at the consequences of disinformation and misinformation. And even then, the two teams worked in parallel, advising the government along separate channels, without any integration. Other countries were better organised.” 

Research and evidence

The PDPC conducts research to improve decision-making in times of disasters, including pandemics. Schreijer explains that its UNITY Project is developing an integrated assessment framework for pandemic preparedness and response that brings together biomedical, economical and societal perspectives, thus ensuring better decision-making. “The goal is to give policy-makers actionable, evidence-based guidance so that they can carefully weigh the different options, with all their pros and cons.”

Beyond integrated advice, the PDPC research agenda tackles key knowledge gaps observed during the pandemic through collaborative multidisciplinary research projects – for example how exactly climate change affects which vector-borne disease outbreaks. “These research topics align closely with the Pandemic Agreement, so they remain highly relevant, regardless of the Netherlands’ position,” says Schreijer. “And the programme – which is firmly embedded in a multi-year transdisciplinary cooperation between Erasmus University, Erasmus Medical Centre, and Technical University Delft [5] – has not been affected by recent cuts in university budgets, meaning we can continue our work until 2027 and hopefully beyond.” 

What next?

At the time of writing this article, D66 and CDA are negotiating the outlines of a new government coalition agreement. CDA’s election programme [6] is rather vague on pandemic preparedness, mentioning only measures to reduce the impact of disruptions—including pandemics—under the banner of ‘co-reliance’ [“samenredzaamheid”; CH]. The D66 implementation programme 2025-2030 [7] is more explicit, calling for structural investments in pandemic preparedness, more infectious disease physicians, scalable IT infrastructure, and sustainable funding. At the same time, most political parties plan to finance higher defence spending by cutting the health budget [8]. If that happens, then public health, traditionally under resourced and underfunded, will likely be even worse off.  

Moreover, the traditional frontrunner’s role of the Netherlands on antimicrobial resistance (AMR) and the Global Health Security Agenda [9] is fading rapidly. Koopmans worries that we have become too inward-looking. OneHealth approaches were very unpopular under the- Schoof government, despite broad agreement that our intensive animal husbandry practices and our warming delta environment increase the risk of animal-human disease transmission. “These conditions are quite unique in the world, so we could contribute significantly with more research—if we decided to do so.”

Schreijer shares Koopmans’ concerns: “We are very proud of our Delta Works, which are the result of sustained, multi-billion-guilder investments following the North Sea floods in 1953, killing some 2,000 people – the most devastating natural disaster in the Netherlands in the twentieth century. So how can more than 50,000 Dutch fatalities due to COVID-19 not spur greater investment in pandemic research?” Still, she emphasizes that the Netherlands has many internationally renowned experts, working in various national and international research consortia, some with positions in important international and global health decision making bodies. “We have strong expertise and a solid international reputation, and we’re still finding ways to continue our work.”

Eroding ambitions

Nevertheless, Schreijer and Koopmans are both worried. “We used to have ambitions to achieve more health equity in the world, but the Dutch cuts in international cooperation are disheartening,” Koopmans says, adding that countries like Germany and France are investing heavily in global health and pandemic preparedness—Germany has recently pledged €100 million to the international vaccine initiative CEPI and hosts the WHO Pandemic Hub. “They have vision and ambition. It’s a completely different ball game.”

Schreijer adds: “What the Netherlands lacks is a long-term vision for public and global health. We need a Chief Medical Officer or special envoy, who protects our long-term health interests and provides policy continuity and coherence, in national as well as international policies. Like in other countries, such a special envoy should be positioned above the separate ministries, directly under the Ministry of General Affairs, and become the one responsible for Health In All Policies.”

The United States’ decision to leave the WHO is also alarming. Schreijer notes the US contributed one-fifth of the WHO budget, a third of which went to outbreak management. “It’s a huge financial and practical loss,” she says. Without the US sharing outbreak data and pathogen samples or pathogen genetic sequence data—e.g., during the current avian flu—we risk taking inadequate response measures. Leaving the WHO also frees the US from adhering to the International Health Regulations (IHR). Their Centres for Disease Control are losing staff rapidly [10]. USAID is shutting down. Some ties to the Global Health Security Agenda remain, but the official US position remains unclear.

Vulnerabilities and uncertainties

“An apparently solid system with the WHO and the IHR turns out to be very vulnerable when reliant on one major player. That’s scary,” she adds. “Who will step into that void? Europe is quite well organised, with its Health Security Committee and the European Commission’s Advisory Committee for Public Health Emergencies [of which Schreijer is co-chair and Koopmans a member; Corinne Hinlopen]. During COVID-19, Europe purchased the necessary vaccines and other medical products, but on such a great scale that it resulted in enormous global disparities. Realisation has sunk in that this really needs to be done differently in the future.”

Koopmans hopes the Pandemic Agreement will spark a snowball effect, with major players encouraging other member states to join. “The EU, with Germany and France as big players, is influential and could become that champion, but it must deal with diverging agendas and anti-globalist sentiments, too. And as a bloc, the EU pushed back on certain aspects of the Pandemic Agreement, like the Pathogen Access and Benefit Sharing system (see text box 2), which is still under negotiation. And this is already being undermined by the US, who are forging bilateral deals to deliver global health aid in return for sharing data on pathogens [11]. So, there’s no telling where all this will end.”

Uncertainty is certainly the key word for global pandemic preparedness. The US are unpredictable in every aspect of their geopolitical manoeuvres, including health security and disease outbreaks. The EU has the expertise and the influence globally to steer things in the right direction, but is struggling with internal disagreements. As for the Netherlands, given the intense political and societal debates on topics like migration and asylum, agriculture and the nitrogen crisis, climate, housing and defence, pandemic preparedness and infectious disease control may be dangling at the bottom of our politicians’ priority lists.

References 

1. Rijksoverheid. Kabinet start plan pandemische paraatheid. 2022. 
2. The National Functionality for Scaling up Infectious Disease Control (Landelijke Functie Opschaling Infectieziektebestrijding, LFI)
3. GGD GHOR. GGD’en blijven werken aan pandemische paraatheid. September 9, 2025.
4. The Association of Community Health Services (GGD’s) and Regional Medical Emergency Preparedness and Planning (GHOR) offices in the Netherlands
5. See Convergence
6. See CDA | Oplossingen voor Nederland. 2025.
7. See D66 – Verkiezingsprogramma: Het kan wél
8. NOS. Politieke partijen willen hogere defensiekosten betalen door te korten op zorg. October 10, 2025.
9. The Global Health Security Agenda (GHSA) is a group of more than 70 countries, international organizations and non-government organizations, and private sector companies that have come together to achieve the vision of a world safe and secure from global health threats posed by infectious diseases. See https://globalhealthsecurityagenda.org/
10. The Wire. A Quarter of the CDC is gone. October 14, 2025.
11. Health Policy Watch.  US Ties Global Health Aid to Data Sharing on Pathogens – Undermining WHO Talks. November 7, 2025. 

The Pandemic Agreement emphasises prevention, preparedness, equity in access to countermeasures (vaccines, diagnostics, therapeutics), One-Health approaches, pathogen access and benefit-sharing (PABS) and global financing coordination mechanisms. It has a structural, systemic, long-term equity agenda, and complements the already existing International Health Regulations (IHR), which are more about acute-event response (notification, surveillance, travel and trade measures, outbreak containment). So, while the IHR remain crucial for the acute pandemic response and are more technical in nature, the PA is in essence a political instrument. This, of course, has complicated its negotiations, resulting in a stalemate on the Pathogen Access and Benefit Sharing (PABS) system, meant to be a cornerstone of the PA. The PA was adopted nonetheless, with provisions to negotiate the PABS system by an Intergovernmental Working Group, due to finalise its work and report its findings by the next World Health Assembly in May 2026.

The PABS system aims to establish mechanisms for the “rapid, systematic and timely” sharing of “pathogens with pandemic potential and the genomic sequence of such pathogens” for R&D purposes, and for fair and equitable sharing of the “benefits arising from [such] access”, such as vaccines, therapeutics and diagnostics. A first draft for the PABS was discussed with WHO member states during the first week of November 2025, with some countries raising concerns– inter alia – about local production, transfer of knowledge and technology, non-exclusive licensing, and a lack of enforceability of the PABS in its draft form. The role of the pharmaceutical industry (as private sector parties not legally bound by an agreement between WHO member states) in this complex interplay is of course subject to intense debate.