What does RIVMNational Institute for Public Health and the Environment do when there is an outbreak of infectious disease?
In the event of a nation-wide outbreak of infectious disease, the Centre Infectious Disease Control (RIVM-CIb) plays a coordinating role in controlling that disease. The director of the CIb decides to convene a meeting of the Outbreak Management Team (OMT) if the situation calls for it. This is also the case for the coronavirus SARS-CoV-2. When that happens the focus is on identifying and advising on outbreaks and threats of infectious diseases and how to control them. During this time, RIVM is working closely with Municipal Public Health Services (GGDs), experts and representatives from various organisations. By doing so, we advise many different parties in the Netherlands on how to control this outbreak as effectively as possible.
RIVM gives advice on control measures, contributes to the development of new laboratory diagnostics, and maps epidemiological trends by means of surveillance and research. In addition, RIVM develops guidelines and scenarios for professionals working in infectious disease control, for example on the best way to respond to an epidemic. These are based on scientific insights. If there is a cross-regional outbreak of infectious disease, or if there is an international threat of infectious disease, RIVM can convene an Outbreak Management Team (OMT).
The Dutch response to COVID-19
The Netherlands has opted for an approach based on maximum control of the virus. That means working together to ensure that people follow the hygiene rules, that we maintain physical distance from each other, and that some venues are only open to a limited extent (and only when possible). People who have symptoms that could indicate COVID-19 are asked to get tested immediately and stay home until the results are known. In this way, we can ensure that people are less likely to infect each other. If someone is infected, the GGD carries out source and contact tracing. People who may have been infected by this patient are then informed that they must stay home, because they may also become ill (and contagious), and will also have to be tested if they develop symptoms. This makes it possible for us to contain the coronavirus SARS-CoV-2 as soon as it emerges.
What does the Outbreak Management Team do?
RIVMNational Institute for Public Health and the Environment can convene the Outbreak Management Team (OMT) in the event of a cross-regional outbreak of infectious disease, or an international threat of infectious disease. Specialists and experts with different backgrounds and knowledge about that specific disease are invited to join the OMT. They discuss how to control the outbreak based on the latest information, their own professional expertise and available scientific literature. They also discuss the risks and uncertainties of measures. The OMT provides an advisory report to the Ministry of Health, Welfare and Sport (VWS) via the Administrative Consultative Committee (BAO). The BAO assesses the substantive advice in terms of administrative feasibility and implementation, and ultimately determines the control policy.
The OMT combines medical expertise from various doctors. This specifically focuses on the current situation regarding efforts to control the virus. In addition to medical expertise, other aspects are obviously also important in determining policy. These aspects also receive attention. For example, the RIVM behavioural unit and the Municipal Public Health Services (GGDs) are jointly researching how people in the Netherlands are doing, in terms of physical, mental and social health and well-being. Supplementing the OMT advisory reports, this provides important input to such authorities as the Ministries and the Dutch government about the expected consequences of the measures, which have sometimes been severe. There are also organisations that advise the government on long-term effects, such as the Netherlands Bureau for Economic Policy Analysis (CPB), the Netherlands Institute for Social Research (SCP) and the Netherlands Environmental Assessment Agency (PBL).
Participation in the OMT
The director of the RIVM Centre for Infectious Disease Control chairs the OMT. The head of the RIVM National Coordination Centre for Communicable Disease Control (LCI) is secretary of the OMT. Other permanent members of the OMT are invited to take part in all OMTs by default, regardless of the subject matter. They are invited because they have a position within an organisation or association that plays an important role in infectious disease control in the Netherlands. This includes representatives from the Dutch College of General Practitioners (NHG), the Netherlands Center for Occupational Diseases (NCvB), the Dutch Society of Medical Microbiology (NVMM), the Infectious Diseases Society of the Netherlands (VIZ), and the National Consultation on Infectious Disease Control (LOI).
Other participants in the OMT are invited on the basis of their field of expertise, or their specific expertise with the disease in question, or their experience in controlling this disease. In the context of COVID-19, the OMT also includes members from the Dutch Association for Intensive Care (NVIC), the Netherlands Society for Clinical Geriatrics (NVKG), the Dutch Association of Elderly Care Physicians (Verenso) and the Dutch Paediatrics Society (NVK), as well as various specialists (internist-infectiologist, virologist, epidemiologist, medical microbiologists, a regional physician consultant, a geriatrician), representatives from the reference laboratories, and representatives from various RIVM centres. Other experts will sometimes join this permanent group, depending on the items on the agenda.
The guiding principle is that all those participating are in the OMT in a personal capacity. This is because it is important for them to be able to discuss freely with each other, without feeling inhibited by their backers. The task of the OMT is to arrive at the best possible advice at that moment.
OMT advisory reports
New threats are often caused by a new infectious disease. In such situations, a great deal is initially still unknown. Accordingly, the OMT bases itself on the data available at that time, current international literature, Dutch research, modelling, and general knowledge about infectious disease control.
The reports of the OMT consultations are confidential. After every meeting of the OMT, RIVM drafts an advisory report for the Ministry of Health, Welfare and Sport (VWS). After that, the OMT advisory report is discussed in an Administrative Coordination Consultation (BAO) and by the government ministers. The administrators in the BAO assess the OMT advisory report on administrative and political feasibility. The Cabinet ultimately decides what happens with the recommendations and whether measures are implemented. After that, the OMT advisory report is made public. The OMT COVID-19 advisory reports (in Dutch) are available here.
Declaration of interests
The OMT members give independent advice. In order to be transparent and avoid conflicts of interest, each member completes a declaration of interests before taking part in an OMT. This ‘Code of conduct to prevent undue influence as a result of conflicts of interest’ requests information on employment positions, ancillary positions, personal financial interests, and research funding. After review and signature, the declaration is made public on the RIVM website.
A civil servant in the national government is bound by rules of conduct in which, by taking an oath or making a promise, he or she swears or promises to comply with these rules; civil servants are also required to adhere to the standards of integrity. This does not apply to people who are not civil servants. Therefore, anyone who is a member of the OMT and is not officially sworn in as a civil servant is required to sign a declaration of interests in order to be part of the OMT.
Compensation for OMT members
Members of the OMT, with the exception of civil servants, receive attendance fees of a maximum of €200.00 per meeting, on the basis of a decree by the Dutch Government regarding attendance fees.
Advice regarding OMT-Z on minks and SARS-CoV-2
- 3 June 2020: Advice regarding OMT-Z on minks and SARS-CoV-2