While virologists are closely monitoring global developments around mpox and bird flu outbreaks, Health Minister Agema (PVV) has decided to make deep cuts to the budget for infectious disease control in the Netherlands. The structural cuts of up to €300 million are likely to mean the end of the National Infectious Disease Control Functionality (LIV), a crisis organisation that was set up specifically to ensure a rapid response to a future virus outbreak. Scientific research is also taking a hit.
What is your view of the cuts that have been announced?
“Everyone working in infectious disease control is deeply concerned. If the cuts wipe out the investments in pandemic preparedness that had been put in place, we’ll be back where we were in 2020: underprepared. As well as the 300 million, there are also massive cuts to education and science.”
300 million euros is obviously a lot of money. It could be used to do a lot of useful things in other policy areas.
“It’s extreme short-term thinking. It’s about choosing a point on the horizon. We had one mega-flood with 1,500 deaths, the 1953 flood disaster. Since then we’ve been a dyke-monitoring country, and we invest a billion euros in it every year. A whole research sector emerged; new knowledge is still being generated from it today. That’s what is needed to prevent infectious disease outbreaks, too. With the money you save from preventing a single pandemic, you can invest a huge amount for a very long time.”
Did you expect us to learn more from Covid-19?
“I may have been a bit naive. Shortly after 2020, I hoped we could have a conversation about the anthropocene (the current era, in which humans are dominant – ed.). The likelihood of virus outbreaks is increasing due to our impact on everything around us: deforestation, travel, international trade, climate change, livestock farms, and so on. I thought: after the pandemic, everyone has realised how badly things can go wrong. And we were relatively lucky, because it could have been a more serious infection, like Ebola. But unfortunately, we’re still on an unsustainable path, and that creates risks.”
“Of course, good things have happened, too. For example, there’s now more focus on pandemic preparedness. Like the WHO pandemic convention, for example (which is supposed to orchestrate a coordinated global response to outbreaks – ed.). At the same time, this is very much about the response: when an infection sweeps across the world, how do we detect it quickly? But the initial period, when people are falling ill and how that can be prevented, receives very little attention.”
What do you think of the response to the current outbreaks of mpox and bird flu?
“You can see it in the Democratic Republic of the Congo. Now that a new virus variant has emerged, things are really speeding up; it’s even being transmitted through lorry drivers and bars. It’s a little bit like the early days of HIV. HIV, of course, spread completely underground, because at the time no one knew of its existence. Thankfully, things are different now. There’s an action plan, including a WHO call for millions of vaccines to be donated. But then some countries like the Netherlands say: we’re not going to do that. Then I think: yes, of course that’s an option, but did you really learn anything from the Covid-19 pandemic?”
“With the current bird flu outbreak among cows in the US, I’m astonished that we’re not doing everything we can to stop that circulation. It’s truly bizarre. If this virus leads to an epidemic in humans, we can’t say we didn’t see it coming.”
China’s wildlife trade could also become the cause of another pandemic. What is currently happening there to prevent zoonoses, infections that jump from animals to humans?
“Who can say? I wouldn’t know; China is closed off. The country does report mpox and bird flu outbreaks to the WHO, but what has changed in terms of prevention, I have no idea. Before Covid-19, I had an excellent working relationship with Chinese scientists, but they don’t dare say anything about possible zoonoses now, it’s really become a taboo. I find that political clash alarming, because we should be able to inform each other globally.”
Are there any positive developments?
“Fortunately, yes, if you look at the wider picture. For example, Africa has set up its own CDC, Centres for Disease Control, kind of an African equivalent of our RIVM. As a result, there’s now much greater control over mpox. The Africa CDC is now telling people exactly what’s needed. Think ways to nurse people, testing capacity, training people who are good at source and contact tracing. So that’s good. The tragedy, though, is that in many parts of Africa all of these things are still severely lacking, due to political situations such as civil wars.”
You lead the Pandemic & Disaster Preparedness Centre (PDPC), set up by Erasmus and TU Delft. What is the purpose of a research centre like this?
“To give an example, we created the test that demonstrated the new variant of mpox. So as soon as a virus starts to spread, we can monitor it. Anyone can use that test. In addition, at the PDPC we’re working on a major project to predict when we can expect mosquito-borne diseases in the Netherlands. Look at the West Nile virus. It’s already circulating in birds here, but we’re yet to see outbreaks in humans, unlike in the US, for example. So then the question is: what’s the crucial trigger for an outbreak? Could it be the weather? If that’s the case, we could develop a kind of weather warning, for example. That would be a big step towards prevention.”
Are any other preventative measures needed?
“More and more wetlands and water buffers are emerging in our country. These are important for climate change resilience, but at the same time they attract mosquitoes. That ‘mosquito awareness’ is still a blind spot. We’re currently looking at what can be done about it. It involves sitting down with people from very different professional fields. For example, I once spoke to someone from a water authority; they had never thought about mosquito risks. But then he said: oh, just tell us how long the land can be under water for. Then we’ll just drain it sooner.”
“You can also take mosquito prevention into account in urban environments, for example by building in ways that lower the risk of standing water. So you can have a lot of impact, particularly since urbanisation is dramatically increasing worldwide. It’s a way of taking a big step towards prevention.”
The National Zoonosis Action Plan was published this summer. How important is this plan for pandemic preparedness?
“Following the emergence of mpox and bird flu, which are both zoonotic diseases, the government asked a group of experts to make a list of things we can do to be more prepared. I wasn’t one of those experts, by the way. Some of the recommendations from their report were incorporated into the Action Plan, in particular the ways of keeping a finger on the pulse: knowing what is circulating, for example among pigs. Strengthening mutual collaboration was also in the report. But the report also talked about how to fundamentally reduce the probability of outbreaks by looking at things like the scale of livestock farming. Unfortunately, that discussion hasn’t yet been acted upon.”
Why is that important?
“Our environmental footprint is huge, and that’s partly due to intensive livestock farming. You could say: let’s become a model country for the agricultural transition. How cool would that be?”
