Lockdowns, vaccines and how the Dutch forgot how to organize anything
About three years ago, a new railway bridge was built not far from where I live, across the Amsterdam-Rhine canal outside Utrecht. The new structure wasn’t much to look at: a massive metal curve like a toppled archer’s bow, coloured the same dull grey as a Dutch winter sky. What made it remarkable, though, was the speed with which it was installed. Rather than being pieced together over several weeks or months, the whole structure was driven in by road in one massive piece, measuring nearly twice as long as a football pitch and weighing more than three thousand tons. Sliding along the top of a dike, it passed a row of apartment blocks which looked like tiny toys in comparison, navigated a tricky corner hanging out over thin air, and then slid out over the water. When I passed by on Friday morning there’d been no bridge to be seen, but by Sunday night the job was finished, and trains were already running on the surrounding tracks on Monday. Another week, another Dutch infrastructure marvel.
I’ve found myself thinking of that bridge a few times this week, in the context of the rollout of coronavirus vaccines. In many ways a vaccine is quite different from a railway bridge, of course: small vials of delicate, temperature-sensitive wizardry can’t be plonked in place by a crane at midnight. Yet delivering a vaccine seems (like bridge-building) something the Dutch state should be superb at: a complex technological undertaking, dependent on good planning and bureaucratic efficiency. However, unlike that railway bridge, the Dutch authorities have bungled the vaccine rollout horribly. In the UK, the Pfizer/BioNTech vaccine was approved by regulators on 2nd December, and the first member of the public received the jab on 8th December. Within three weeks, roughly a million Brits had received the first dose of the vaccine. Across the Channel, things moved a little slower, and regulatory approval didn’t arrive in the EU until 21st December, but things moved quickly after that: within six days, vaccines had been delivered to all 27 member states and several countries had begun administering jabs immediately. As of early January, about 265,000 Germans had received the vaccine, as well as thousands of Spaniards and Finns, Poles and Slovakians, Danes and Portuguese. The arrival of vaccines was, European Commission President Ursula von der Leyen said, a “moment of unity”, in which Europe would “start turning the page on a difficult year”. Unfortunately, however, the Dutch didn’t seem to receive the memo. At the time of writing (January 4th) not a single Netherlands resident has received a coronavirus vaccine outside of a clinical trial. Vaccination was planned to start only on a small scale on 8th January, in a small handful of locations, and on a significant scale perhaps ten days after that. With public anger rising, the government is now moving to accelerate things by a few days, and some medical staff may get vaccines in the next day or two. But still, by the time the first Dutch jabs are given, a month will have passed since Brits began getting their vaccines, and about two weeks since the first Germans did. The Dutch government now says healthypeople under the age of sixty probably won’t be able to get their vaccinations until the summer. They didn’t specify which year.
What, then, has gone wrong here? How has a country considered a world leader in managing massive projects somehow become terrible at delivering massive projects just when it matters most? Although some of the details are complex, the roots of the problem are quite simple: the government based their plans partly on the current scheme for delivering flu vaccines, and assumed the AstraZeneca vaccine would be rolled out first and were taken by surprise when the Pfizer one (which needs better cooling systems) was approved earlier. They were late in starting preparations for nationwide vaccine delivery, and appear to have moved quite slowly thereafter. To their credit, the authorities did recognize the transformative potential of a Covid vaccine early on – on 6th May, when no-one expected a vaccine to be available for another year or more, Dutch health minister Hugo de Jonge was already promising that “we will do everything we can to get vaccinated as soon as possible”. Yet inexplicably, when it came to following up on that commitment, the government seem to have taken preparations for vaccine delivery far less seriously than the average teenager takes planning for a Friday night out. It was only in November (when the pandemic had been raging for nine months, and several vaccines were close to being ready for public use) that the Dutch authorities began making serious efforts to organize vaccination, and decided to use dedicated vaccination centres rather than ordinary doctors’ surgeries to deliver the jabs, meaning there was an impossibly short timeframe for actually setting those centres up. “If we’d gone for large-scale vaccinations from the beginning, we could have started two weeks earlier”, one health official told the Volkskrant. Having started late, officials also became bogged down in things like the scripts which call centre staff would use. Fretting over the details, the government let big issues go ignored,like a bride who is so busy fussing about table decorations that she fails to notice her fiancé has set fire to the chapel and run away with one of the bridesmaids. In Germany, the government was already giving journalists tours of new mass vaccination centres in Berlin on 3rd December. In the Netherlands, meanwhile, nearly two weeks after that, on 16th December, the national broadcaster NOS was still reporting authorities had merely “started with investigations for where the vaccination locations will be”. Criticized on 2nd January for being slow to respond to criticism of the Dutch schedule, Hugo de Jonge uttered in his defence the immortal words: “I’ve been thinking about this since December 24”.
Predictably, there are some here who argue that the dispute over timing is overblown. Mass vaccination is a marathon rather than a sprint, they say, and it doesn’t much matter who starts vaccinating when, as long as we get it right in the end. Remarkably, the government has even gone as far as implying that other countries have been reckless in their haste to deliver. “It’s not responsible to do it earlier”, de Jonge said last week. “Then you’re just choosing a symbolic start and that’s not sensible”. “It’s not a competition to see who started first in Europe”, one of the national vaccination programme managers agreed. In some ways this pushback seems fair: vaccination campaigns will probably go on for years, and starting early doesn’t necessarily mean you’re doing things right. France, for example, launched its vaccination campaign with fanfare yet has since been heavily criticized as the number of people actually getting shots has remained very low. In Britain, numbers are much higher, but some have expressed concerns about corners being cut, with vaccine regimens being mixed and hospitals not keeping good computerized records of who’s received them. Several other countries, such as Italy, have also apparently been forced to keep many vaccine doses in storage, without the capacity to use them immediately. However, it’s also clear that the delays seen in the Netherlands do constitute a real problem. Saying “France has delays too!” or “it’s not a competition!” does nothing to change the basic fact that people here are not receiving lifesaving vaccines simply because the government isn’t capable of delivering them yet. It’s also worth noting that the numbers involved here are not small: the US has now vaccinated over two million people and the UK over a million. If those programs are merely ‘symbolic’ then the symbols are pretty big ones. More importantly, the new variant of the virus now circulating looks like a game-changer. Dutch hospitals are already badly strained, with elective surgeries cancelled and ICU occupancy at its highest level since April, and rising. In the six months between March and September 2020 around 13,000 people were admitted to Dutch hospitals with coronavirus; in the three months since then it’s already almost 19,000. If a new variant which is significantly more infectious begins to spread here as quickly as it appears to be in Britain, the only route forward will be mass vaccination as quickly as possible. And most importantly of all, for the thousands of people living at heightened risk of infection and death, those “few extra weeks” make an enormous difference. If you’re inclined to give the government a get-out-of-jail-free card here, perhaps just pause for a moment and imagine you’re a nurse working on an ICU in the Hague, unable to obtain a vaccine while your sister who works as a nurse in Berlin or Boston or Manchester received one days ago. Or worse still, imagine living in a place like Arnhem, in the eastern Netherlands, and watching your husband, wife, mother or brother dying via Zoom, and knowing that if they lived twenty kilometers to the southeast, in Germany, they would have received a vaccine to save them weeks ago. As a former director of microbiology for the national health agency RIVM said last week, the fact that the Netherlands will be one of the last countries in Europe to protect its people is “astounding [and] embarrassing… Of course this will cost lives. Every week counts.”
The vaccine delays also matter because the Netherlands is not starting from a position of having the pandemic under control. On the positive side, several weeks into a stricter lockdown the number of new infections finally appears to be falling: the number of daily infections is now more than a fifth lower than it was before Christmas. The graph of Dutch infections over time now looks essentially camel-shaped: a big spike in October, a nice dip in November, and then another big spike in December, with the beginnings of another decent decline now. However, we’re still seeing an average of about eight thousand people testing positive every day, compared with ‘only’ about five thousand at the start of December. (Yesterday’s figure was below seven thousand for the first time in a month, although daily data should be taken with a pinch of salt.) As several experts have pointed out, this means there’s little room for error. On a per capita basis, the Netherlands still has roughly twice as many daily infections as France and Germany; and in absolute terms more than twice as many infections as Belgium, Denmark, Norway and Finland combined. (All data is somewhat unreliable and comparisons are tricky, but they do indicate the scale of the problem.) Many Dutch people have long made a sport of poking fun at their neighbours in Belgium, with their silly accents and dysfunctional politics and badly potholed roads, but this week Dutch infections were (relative to the population, and according to Our World In Data) running at about four times the level of their southern neighbours. It’s another terrible irony: a country famed for its ability to keep floodwaters out has proved itself incapable of preventing a second wave.
Unfortunately, it’s also hard to believe the government’s pledges that swift efficiency is just around the corner. In the early days of the pandemic, the Netherlands’ response looked for a while admirably level-headed, but in retrospect it seems some serious strategic errors were baked in early on. A right-leaning government, proud of its pro-business credentials and nervous about losing votes to populist parties in the upcoming elections, quickly decided that the pandemic would be impossible to stop, and opted for a laissez-faire approach which sought to limit damage to the economy, abide by libertarian principles, and protect the vulnerable while quietly accepting that significant deaths were inevitable. The government’s reflex appears to have always been: do less rather than more, offer people advice rather than setting rules, and trust the public to make their own choices about how to behave. This all sounded quite nice in March, but proved woefully inadequate once people started behaving worse in the summer, and looked quite mad once infections started spiraling in the autumn. While there’s a legitimate ethical debate about some policies, the government sadly wasted weeks on laughable measures – claiming, for example, that rapidly rising infections could be curbed simply by closing bars an hour earlier. Bizarrely, a country which frets constantly about once-in-a-millennium flood risks has abandoned the precautionary principle. The refusal to encourage mask use was a totemic example: for months, anyone wearing a mask in a crowded place was liable to be treated as if they were wearing a red clown’s nose. Even in hospitals, it was for much of last year more common to see people without masks than with them. Astonishingly, in January 2021, not far off a year after the pandemic began, the main website of the RIVM public health agency still makes a point of emphasizing that “Non-medical masks are likely to be of limited help in preventing contamination of others… [and] it is not possible to say with certainty whether or not non-medical masks have added value [in preventing infection]”. At my local hospital, there’s still no separate entrance for coronavirus patients, and ordinary patients or visitors might easily find themselves sharing an elevator with an infectious person on a trolley. On the other side of town, my local shopping mall has installed one-way walking routes, removed some displays to create extra space and stationed staff at the entrances to clean trolleys and check shops don’t get overcrowded. This all looks sensible, but the mind boggles as to why it took until late December 2020 for these measures to be introduced, when any fool with a Twitter account or a newspaper subscription could see such things were necessary months ago. According to the latest government surveys, only 45% of Dutch people say they’d get tested if they had corona symptoms, 44% would stay at home if they were ill, and only 33% say they regularly wash their hands. In my own circle of acquaintances, foreign trips remain quite common, and distancing rules are often breezily ignored. These failures are largely the individuals’ own fault, of course, but they do also demonstrate a failure of government. If more than a third of people openly admit to ignoring distancing rules, it seems likely that those rules have been poorly explained and enforced. Public messaging has generally beenwoeful: around where I live, there are endless signs reminding drivers to upgrade their winter tires and switch their headlines on when it’s dark, yet I almost never see any public safety information advising me to stay home or wear a mask. Throughout the pandemic, the government has also made a series of unforced errors and set terrible examples: Mark Rutte failing to wear a mask when most other EU leaders made a point of doing so; Ferd Grapperhaus holding a wedding in breach of distancing rules and then cutting the penalties people pay for doing such things; the Royal family jetting off to Greece when everyone else was locked down; Jaap van Dissel claiming the pandemic was spread largely due to the poor education level of care home workers while apparently forgetting that he’d literally been appearing on national television telling people not to bother wearing masks. Individually these incidents are highly irritating, but collectively they’ve helped build a toxic sense of complacency; and a perception that the rules aren’t really important, and its fine to bend them as long as you generally stand a bit further apart from your friends. “Where’s your mask?” I overhead a security guard at a supermarket asking a young male customer at the door last week. “I had one of those blue ones but I lost it somewhere”, the customer said. To which the security guard replied: “Ok, well you can go in as long as you remember to bring one next time”. When I visited one hospital this morning, the catering and reception staff weren’t wearing masks. The beloved Dutch trait of “nuchterheid” (sobriety, or a refusal to panic) looks increasingly like a fatal condition.
When thinking about all this, it’s often easy to exaggerate the effects of political leadership and national culture while underestimating the power of other factors which no-one can do much about, such as population density or physical geography. However, it’s also clear that the pandemic has highlighted some serious weaknesses in the Dutch political system. The Netherlands is famously run with an unusual emphasis on consensus-building, expert consultation and respectful negotiation. Governments are always coalitions, and major policies carefully hammered out by parties, unions, businesses and experts discussing them at great length. On the face of it, this is a wonderful thing – after all, many of us have spent recent years wishing other parts of the world also had leaders who were a little less confrontational and little more guided by scientific evidence. Yet in recent months it’s become clear that a system which is excellent at delivering heavyweight systemic change over the longer term (healthcare reform, flood defences) really struggles when there’s an urgent need to do unpopular things, such as mandating lockdowns or compelling mask use. Giving everyone a say takes time, and for all its apparent efficiency, the Dutch state often changes direction about as quickly as an oil tanker turning through stodgy erwtensoep (pea soup).
In recent months, policy changes have followed a familiar cycle: after months of political debate and chat-show discussion, “bold” new policies are briefed out to the press on Sunday evening or Monday morning, announced by the government on Monday evening, and then hastily clarified, amended or reversed on Wednesday or Thursday once it becomes clear that the legal or societal implications haven’t been properly thought through. Delays with vaccine rollout are not the exception but the rule: the coronavirus tracing app, for example, was announced in April but not delivered until October, and doesn’t appear to have had much effect since then. The current lockdown is comprehensive and was badly needed, but unfortunately was launched when infections were already very high and weeks of further growth were already baked in. Reading the news lately, I often find myself inadvertently chuckling when I see what’s been announced: children with symptoms of infection can be tested as of 31st December; negative tests are required for incoming air travelers as of 29th December; sun-seeking package holidays are discouraged as of 17th December; shops are encouraged to reduce crowding indoors on 10thDecember; masks are made compulsory in enclosed public spaces from 1st December – all decent, sensible policies to which the natural reaction is “What? You mean we weren’t doing that already?” The Dutch state these days seems like that uncle who always sends you a happy birthday message several few weeks too late: well-intentioned, but so late that you wonder why they bothered at all. “If you need a big dam built over the next few decades then the Dutch will do that perfectly”, one friend said to me recently, “but if you need something fixing right now then bad luck – we’ll need to appoint a commission to discuss it for a couple of years first”.
Watching it all unfold, it also often strikes me that despite Dutch people’s reputation for directness and straight-talking, the political culture is surprisingly forgiving of failure here. Criticism of the government has been growing recently, but the overall sense is often of a climate where bad mistakes are greeted with a shrug, and everyone argues in parliament but then meets for a coffee afterwards. Some journalists do an excellent job, yet the media too often uses prime ministerial press conferences to ask about holiday options rather than to hold the powerful to account. The coalition system means many of Mark Rutte’s fiercest rivals are not outside government but inside his own cabinet, and lines of accountability are frayed. If vaccine delivery gets botched, which of the four parties in government should be blamed? This week leading members of both the CDA and VVD parties were seen criticizing the government’s vaccine mistakes, apparently forgetting that their parties currently hold the health ministry and prime ministership respectively. In a power-sharing system, there’s always someone else to take the blame. Oddly, failure often gets dressed up as success: if (for example) a British Prime Minister announced a new lockdown policy and then scrapped it a few days later after being criticized by his rivals, that would be mocked as a hapless “U-turn”, but here it’s merely “listening to parliament”. And Dutch exceptionalism remains a powerful drug: if bad things only happen in countries (like Spain and Greece and Italy) which are badly run, then when bad things happen here it means they must have been unavoidable. If we succeed it’s because of our unusually savvy approach, and if we fail it’s because God wanted it that way.
When writing pieces like this one, I try always to remember that the Netherlands isn’t unique in struggling to control the pandemic, that running a country is hard, and that many decent people in government are doing their best while grappling with impossible choices. Looking at the number of Dutch infections, the situation does (for now) look better than a few weeks ago. If one judges performance purely by the metric of “protecting the economy while preventing hospitals from collapsing” then the Dutch government has arguably been fairly successful so far. However, “our hospitals didn’t completely collapse yet” feels like a pretty low bar. This is, after all, one of the richest countries in the world, with a GDP per capita higher than Germany’s, and a healthcare system which is regularly judged to be the best in Europe. More importantly, this is a nation which prides itself on its ability to get things done, and on its ability to avert natural disasters, and work together in the best interests of the nation. Yet somehow, when it comes to the ultimate test – delivering a lifesaving vaccine – we’re relaxed about being the worst in Europe. I’m a citizen of two countries – the Netherlands and Britain – and if you’d asked me two months ago which one of those places would vaccinate a million people against Covid in 2020, I would have guessed wrong. In the month since the UK began vaccinating, roughly two thousand people have died of Covid-19 in the Netherlands, while vaccines which could have saved them are literally sitting in a fridge somewhere. If that isn’t a terrible failure of government, then I don’t know what is. If Suriname (for example) was in our position – following a boldly iconoclastic policy which went against the mainstream scientific advice for months, then experiencing some of the highest infections in the world, and vaccinating weeks or months later than everyone else – Dutch ministers would be pointing aghast, scoffing about failed states and wondering how they’d got in such a mess. And for someone like me, more used to blogging happily about the eccentricities and curiosities of European history, it’s increasingly hard not to feel let down. I am (believe it or not) an optimist at heart, and think that if lockdowns are managed properly and vaccines delivered well, some form of normalcy could return in the spring. But if the WHO announced tomorrow that wearing a blue baseball cap could reduce corona deaths by 95%, I don’t have much faith that the Dutch government would swiftly mandate their use and distribute caps nationwide. In fact, I wouldn’t be surprised if they spent a couple of months telling people not to wear blue hats at all, before ordering millions of red ones by mistake.
A few weeks ago, before the current lockdown, I spent a day out in the southern provinces of Zeeland and Zuid Holland, visiting a few bits of the famous Delta Works: the network of massive dams, flood gates and sea defences which was built to protect the country after a terrible flood (the watersnoodramp) killed several thousand people in 1953. I’d seen the concrete causeways which I cycled over many times before, yet I still alwaysfind them impressive; not just for their scale but because of their symbolic power, and the way they’d once infuseda nation battered by war with a renewed sense of national courage and purpose, and a determination to pay any price in order to protect its citizens. Yet as I watched the sun set over the Haringvliet, I couldn’t shake a singledepressing thought: that the coronavirus pandemic has now killed more than seven times as many Dutch people as the 1953 flood, and that no-one’s capable of building a Delta Works against it. The pandemic is our generation’s watersnoodramp, and we’re failing to do enough to stop it.