There is a realistic chance that the Netherlands will once again face large-scale infectious disease outbreaks in the upcoming years. The COVID-19 pandemic has shown that we need to be better prepared for this and that rapid upscaling and central coordination of medical-operational* processes, such as testing, vaccination and source and contact tracing, are essential during such an outbreak.
To achieve these aims, a new crisis response organisation has been set up under the umbrella of RIVM: the National Functionality for Upscaling Infectious Disease Control (LFI). Officially launched on 1 September 2023.
*The LFI will focus exclusively on the medical-operational processes, i.e. it will have no authority as regards the medical substance. In other words, the LFI will not determine which medical-operational processes (vaccination, testing, source and contact tracing) are required. This will remain the responsibility of the Centre for Infectious Disease Control. The LFI will solely be responsible for the safe, efficient, effective and uniform implementation of these processes.
Two tasks
The LFI will have two tasks:
1. Upscaling and coordination
In the event of a class A infectious disease outbreak that requires a national control response, the LFI will coordinate the rapid upscaling of the medical-operational processes and manage the scaled-up operation. The LFI will work closely with the GGDs to implement these processes. They include large-scale testing, vaccination and source and contact tracing, ensuring sufficient suitable locations, and making contact with the population.
2. Management of preparations
To ensure that the control response can start immediately in the event of a large-scale outbreak, the LFI will also be responsible for the central management of control preparations. These preparations will include contracts for immediate action in case of an alert for the hiring of personnel, the provision of logistical services and the supply of materials and resources, joint education, training and exercises, and building and maintaining an extensive network of professionals and administrators in the field of infectious disease control. This will ensure that all parties know what their roles and responsibilities are and are able to work together quickly, effectively and efficiently when required.
Design
The LFI was designed in close cooperation by the Dutch Municipal Public Health Services (GGDs), the national umbrella organisation of the twenty-five Municipal Health Services and Regional Medical Assistance Organisations (GGD GHOR Nederland). various RIVM departments and the Ministry of Health, Welfare and Sport (VWS). Experts with varying backgrounds and levels of experience in such areas as infectious disease control, management consultancy and communications contributed to the design of the LFI’s tasks. Where necessary, infectious disease control experts from outside these organisations were involved as well.
Cooperation
The LFI will work intensively with the GGDs, various RIVM departments and the Ministry of VWS – even in periods when a pandemic might seem a long way off. This is the only way to ensure rapid and effective upscaling in the event of a large-scale infectious disease outbreak. Making preparations together ahead of time will increase the certainty that each party knows its role inside out and plays it well during a crisis. Moreover, joint preparations by the LFI and its partners will ensure uniformity, which is one of the key conditions for rapid, effective upscaling.
The LFI as part of RIVM
The LFI is part of a new RIVM domain that is currently being set up. This domain will also house the Department for Vaccine Supply and Prevention Programmes (DVP), the Centre for Population Screening (CvB) and the COVID-19 vaccination programme. The new domain will coordinate the implementation of the vaccination and population screening programmes, as well as the national upscaling of testing, vaccination and source and contact tracing in the event of a large-scale infectious disease outbreak. In the coming years, LFI will work with its partners to become a decisive crisis response organisation that is capable of supplementing the existing infectious disease control chain.
Public Health Act
The principles of infectious disease control are legally enshrined in the Public Health Act (Wpg). An amendment to the Wpg will be introduced to make it possible for the Minister of VWS to coordinate the medical-operational processes of the GGDs directly through the LFI during a pandemic. The Ministry of VWS is currently in the process of preparing this amendment. It is expected to enter into force in the middle of 2024. At that point, the responsibilities and competences of the LFI will have been formalised officially and the LFI will become fully operational. In the event of an earlier infectious disease outbreak that requires a national control response, the LFI will address this in cooperation with the GGDs.
What does ‘LFI’ mean?
In Dutch, LFI is the abbreviation for Landelijke Functie Opschaling Infectieziektebestrijding, which stands for The National Functionality for Upscaling Infectious Disease Control. The LFI is a new national crisis response organisation. In the event of a class A infectious disease outbreak that requires control at a national level, the LFI will work with the Municipal Public Health Services (GGDs) to control it. In addition, the LFI will be responsible for the central management of preparations for such large-scale outbreaks.
What will the LFI be doing?
The National Functionality for Upscaling Infectious Disease Control (LFI) will have two tasks:
- Upscaling and coordination
In the event of a large-scale class A infectious disease outbreak that requires a national control response, the LFI and the GGDs will scale up rapidly. Together, they will coordinate the medical-operational processes that are needed to control the outbreak. These include large-scale testing, vaccination and source and contact tracing, but also contact with the population. - Management of preparations
The LFI will be responsible for the central management of preparations for large-scale infectious disease outbreaks, so that these can be controlled immediately and as soon as required. These preparations will include contracts for immediate action in case of an alert, allowing for customer contact centres to be set up quickly, and joint education, training and exercises. We do not just want to control new outbreaks better – we also want to be better prepared.
Why has the LFI been set up?
The COVID-19 pandemic has shown how significant the impact of a large-scale global infectious disease outbreak can be. It is therefore incumbent upon us to be better prepared in the event of a future pandemic. We need more personnel, take swifter action and be more flexible. It is vital that we are able to scale up (escalate) rapidly, that infectious disease control is managed centrally and that all parties involved work well together at all times. To achieve these aims, a new crisis response organisation has been set up: the National Functionality for Upscaling Infectious Disease Control (LFI).
When will the LFI be operational?
The design of the LFI was completed in August 2023 and it was launched on September 1st under the umbrella of RIVM. In the coming period, the various parts of the organisation will become operational one by one. Recruitment of personnel is in progress. At the same time, the capacity of the GGDs is being improved. This is because the GGDs in the regions are essential for the LFI in order to perform as intended. The overall objective is to ensure that joint action can be taken immediately when required.
The principles of infectious disease control are legally enshrined in the Public Health Act (Wpg). The LFI will be responsible for preparations for future class A infectious disease with national impact. In the event of such an epidemic, it will coordinate the medical-operational processes of the GGDs on behalf of the Minister of Health, Welfare and Sport (VWS). The division of the roles of the various parties will be clarified in an amendment to the Wpg that the Ministry of VWS is currently preparing.
This amendment to the Wpg is expected to enter info force in the middle of 2024. At that point, the responsibilities and competences of the LFI will have been formalised officially and the LFI will become fully operational. In the event of an earlier infectious disease outbreak that requires a national control response, the LFI will address this in cooperation with the GGDs.
How did the LFI come into being?
The cabinet took the decision to set up the LFI in July 2022. Since that time, the GGDs, the Netherlands Municipal Public Health Services and Medical Assistance in Accidents and Disasters, various RIVM departments and the Ministry of Health, Welfare and Sport have worked closely together to determine how the new crisis response organisation will boost pandemic preparedness. The design of the LFI was completed in August 2023. Experts with varying backgrounds and levels of experience in the area of infectious disease control have helped with the design.
What will the LFI be doing when there is no pandemic?
We do not just want to control new large-scale infectious disease outbreaks better – we also want to be better prepared. To that end, one of the tasks of the LFI will be to manage preparations for large-scale outbreaks. Among other things, the LFI will enter into contracts for immediate action in case of an alert, so that organisations – such as suppliers of building materials and resources for vaccination locations – can take swift action in the event of a pandemic. It will also consider all eventualities in case of an outbreak well ahead of time, conduct exercises, and educate and train the necessary personnel. It will do this together with other organisations involved in infectious disease control.
How will the LFI prepare for a pandemic with an entirely different course from the COVID-19 pandemic?
By large-scale testing, vaccination and source and contact tracing. It is essential that the LFI prepares for any future pandemics. To do this, the LFI is preparing ‘implementation scenarios’. These take into account such factors as potential outbreaks of new infectious diseases and the shortage in the labour market. With the aid of these scenarios, it will continue to assess critically whether preparations are still up to date and sufficient. If this turns out not to be the case, the LFI will adapt its approach. That is why the LFI must be agile, able to improvise and innovate continuously. Through education, training and exercises, the LFI will evaluate whether its programme organisation and guidelines can be implemented in practice and make ongoing improvements to its working methods.