Minister for shiny shoes

The slow start to vaccination is the new 'agile'.

FINALLY, it’s happening. The first coronavirus vaccine in the Netherlands was injected, far later than was promised but two days ahead of the new schedule, on Wednesday January 6th - de eerste prikken komende woensdag – en niet pas vrijdaganticipated NRC.

Sanna Elkadiri, 39, from Eindhoven was injected - ingespoten - with the Pfizer vaccine at a GGD-priklocatie in Veghel. Hers was the first of 30,000 doses distributed to 10 hospital pharmacies, all with facilities to store them in deep freezers at -70 degrees. 

Health workers are at the head of the queue for vaccination after the government bowed to a televised appeal by two top health service managers on Nieuwsuur, NPO’s primetime news programme. Doctors are on the list too, after the ministry of health did a last-minute deal with the Landelijke Huisartsen Vereniging, the National General Practitioners Association which represents almost 11,000 GPs. 

Ella Kalsbeek, chairman of the LHV, told the Volkskrant that everyone who plays a role in emergency GP care is part of the acute care chain and will be vaccinated as soon as possible - iedereen die een rol speelt in de spoedeisende huisartsenzorg maakt deel uit van de acute zorgketen en wordt zo snel mogelijk gevaccineerd

That’s a start, and overdue. But doctors are a small part of the “acute care chain”. The hospital system alone counts 300,000 employees. To date, the Netherlands has acquired half a million doses of the Pfizer vaccine: enough to vaccinate 250,000 people, with two doses each, the second dose administered after a three-week interval.

Not all health workers are on the front line, nor exposed to corona patients. But while everyone working in hospitals has a claim to priority, more vaccines for those inside the health system means fewer still available to others such as the staff in nursing homes and long-term care facilities for the elderly.

This - ironically - is just the kind of difficult, awkward, morally vexing trade-off that advocates of the Dutch political system have tended to believe the diffused power structure of the Netherlands can manage well. Not yet.

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‘The Shoes’

A day before the first jab in Veghel, MPs returned early from their Christmas recess for a parliamentary debate in the Hague on January 5. They came to interrogate Hugo de Jonge, minister of health, and prime minister Mark Rutte over coronavirus policy, and in particular their attempts to organise an orderly queue for the vaccine - problems that many people expected a coalition government of competent Dutch technocrats should take in its stride.

De Jonge - a former Rotterdam councillor known as De Schoenen, The Shoes, for his shiny shoes - was widely reported to be fighting for survival in the cabinet. Wiser heads suggested his departure was never likely: the peak of a crisis is the wrong time to axe an incumbent minister. John Bijl, who offers training to politicians at the Pericles Institute, recommended an apology to make amends. A public enquiry will come later, he predicted.

Pre-empting the anger and frustration among MPs, De Jonge got his apologies in first - albeit after weeks of stalling. In a briefing for MPs on the evening before the debate, De Jonge said he had expected another vaccine - the Oxford/AstraZeneca variant - to come to market before the Pfizer/Biontech formulation. The AstraZeneca vaccine can be stored in refrigerators, making it suitable for distribution via smaller clinics and medical centres rather than hospital pharmacies.

Rob Jetten, leader of the liberal D66, said the minister had bet on the wrong horse - dat hij op het verkeerde paard heeft gewed, an explanation which amounted to “a kind of sorry”. For the PvdA, opposition leader Lodewijk Asscher told parliament that vaccines have been kept in the freezer for weeks. The cabinet has failed, he said - het kabinet heeft gefaald. 

The Netherlands has lagged behind its European peers, but is far from the only country to encounter problems in dispensing the vaccine. In Poland, a scandal emerged after celebrities jumped to the front of the queue. France has administered just 7,000 doses. De Jonge is blamed not merely in the slow delivery, but also for wrongly predicting a concrete date for vaccinations to begin in December - a political gamble.

A slow-moving target

True to the national self-image, De Jonge had insisted that the Netherlands acted slowly because its approach was “more careful” than in other countries. That defence tested credulity as governments across Europe began to scale up their programmes, prompting De Jonge to comment that starting dates were “symbolic”.

In the UK, the first country to begin vaccinations, the tally of vaccinations stands at 1.1 million doses reaching 23% of over-80s, the most vulnerable age cohort. In Germany, where 244,000 people have received the vaccine, ministers are facing public pressure to move faster by opting out of the EU’s centralised quota system for the Pfizer-Biontech vaccine and purchasing directly from drugmakers. 

De Jonge survived his mauling in parliament. Geert Wilders, the nationalist PVV leader (and no stranger to shiny shoes himself) called for the minister’s resignation. De Jonge was the wrong man in the wrong place, Wilders told him: “U bent niet de juiste man op de juiste plek”. GroenLinks, the Dutch Greens, took a more practical line by calling for a new, separate minister for vaccination. 

In the aftermath, De Jonge faces an uphill struggle to recover authority. As vaccinations begin with hospital staff at the front of the queue, and more infectious new strains of the coronavirus gather momentum, perhaps the health minister has bought time to make up lost ground. The next parliamentary elections are three months away, in March, when Jonge will seem a less important target for rivals than the prime minister. 

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A mop, a wheelbarrow and frogs

The new political season of 2021 has begun in much the same way that it ended in 2020: with a debate about vaccination - Zo begint het politieke jaar 2021 zoals het in 2020 was geëindigd: met een debat over vaccineren, wrote Lamyae Aharouay and Pim van den Dool in NRC. When, finally, the coronavirus crisis is brought under control, what might a formal enquiry into the government’s handling of the pandemic conclude?

De Jonge’s agility - wendbaarheid - in conjuring explanations for the delays in administering the vaccine is seen as a ‘mop policy’, mopping up mess: De wendbaarheid van De Jonge wordt gezien als zwabberbeleid, read the headline to the NRC article.

In a culture which disdains entitlement, and charcterised by innate respect for practical decisions made in the face of tough reality, De Jonge has sacrificed the self-image of Dutch national pride. He stands apart from the tradition of pedantic engineers who built their homeland behind high dam walls to fend off the approaching tide.

John Bijl of the Pericles Institute, where he trains politicians, attributes De Jonge’s predicament to two “big problems”. The first is underfunding, the legacy of spending cuts in the public service, not only in healthcare. This is a problem not of his making - niet aan hem te wijten. The second obstacle is the nature of the pandemic: a fast-changing situation, especially for vaccines when delivery times were not known. 

The bureaucracy has been slow to catch up with this reality. Ministers need an organisation that can adapt - die zich kan aanpassen, but that is not the case - maar daar is geen sprake van. A minister in a public health crisis is required to motivate and explain the evolving approach, Bijl told RTV-Rijnmond: it all comes down to how you can defend the policy - dan komt het aan op hoe je het beleid kunt verdedigen.

Policy shifts are inevitable, in every country. The rules change with successive lockdowns. New measures are required to scale vaccinations. De Jonge failed to inspire confidence because so many experts have appeared in the media to explain why their positions differ from policy that the minister had failed to justify.

In this ferment of divergent opinion and expertise, absent agreed basic facts, an English idiom springs to mind about the difficulty of ‘herding cats’. In his advice to De Jonge, also dispensed via a television interview, Bijl offered a Dutch equivalent: Als je de kikkers niet in de kruiwagen kunt houden dan moet je helemaal niet op vertrouwen rekenen. The literal translation is about counting on trust; meaning: if you can't keep the frogs in the wheelbarrow then you really shouldn't expect to be trusted.

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Also from 2nd Opinion, on how the Dutch have managed the pandemic:

Second wave, second lockdown: not-so-intelligent

Seeing Red, not Blue