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World of Genomics: The Netherlands

Original World of Genomics: Netherlands article written by Harry Yuen, July 2022. Updated by Aleisha Collins, October 2023.

Home to 90% of the world’s tulip fields and over 1,000 windmills, we travel to the Netherlands in our latest World of Genomics.  

Translated as “the low countries”, one-third of its land mass sits below sea level. The Netherlands thrives as Europe’s major shipping port and its soil fertility means it is the second-largest food exporter in the world. Not to be mistaken solely as an agriculturally driven country, the Netherlands’ advanced infrastructure has provided a long archive of genomic sequencing records and they are partnered with multiple organisations to further genomics-guided precision medicine. 

The population of The Netherlands 

The earliest known human life to inhabit the Netherlands was “Krijn,” a Neanderthal fossil found on the Dutch coast that dates back 60,000 years. 

From 800BC, the Netherlands was invaded by Celts, Romans and Germanic tribes and from 57BC, the Roman Empire prospered for approximately 500 years. In 1556, the Netherlands was under Spanish rule. 

After the Eighty Years’ War, the Netherlands gained independence from Spain in 1648. This marked the beginning of the Netherlands’ rapid growth and development, an era known as the “Golden Age.” Despite the territorial hardships from neighbouring countries and the German invasion in WWII, the Netherlands has sustained economic growth. International migration and rapid population growth have played key roles in shaping the modern Dutch population. 

The Netherlands is known for its very low-lying topography and the country possesses a flat terrain comprising coastal lowlands, farmland and grassy dunes. 

According to the World Population Review in 2020, the Netherlands ranked 8th in the world for most developed country. 

Geographic and demographic information 

Summary statistics 

  • Area:  
    • Total: 41,543 sq km 
    • Land: 33,893 sq km 
  • Gross domestic product (GDP): 
    • Total: 991.11 billion (current US dollars) (Dec 2022) 
    • Per capita: 55,985.4 billion (current US dollars) (Dec 2022

Population statistics 

  • Population size: The estimated population size in 2023 is 17,975,000. 
  • Birth rate: 10.98 births/1,000 population (2021 est.) 
  • Death rate: 9.22 deaths/1,000 population (2021 est.) 
  • Infant mortality rate:  
    • Total: 3.45 deaths/1,000 live births (2021 est.) 
    • Male: 3.82 deaths/1,000 live births (2021 est.) 
    • Female: 3.06 deaths/1,000 live births (2021 est.) 
  • Life expectancy:  
    • Male: 79.72 (2021
    • Female: 84.3 (2021
  • Ethnicity: Dutch 75.4%, EU (excluding Dutch) 6.4%, Turkish 2.4%, Moroccan 2.4%, Surinamese 2.1%, Indonesian 2%, other 9.3% (2021 est.) 

Healthcare system 

The Netherlands has a universal healthcare system where every Dutch citizen must have basic level health insurance. The system is managed by the Dutch government and supplemented by private insurance companies. All primary healthcare and long-term services are provided at a fixed price. 

The Health Consumer Powerhouse 2018 report on healthcare systems in Europe ranked the Netherlands as having the 2nd best healthcare system in Europe.  

The Netherlands has 3.7 physicians and 11.5 nurses per 1,000 people. In 2020, the Universal Health Coverage of the Netherlands was deemed to be 83, in comparison to the global score of 57. They have a projected score of 63 for 2030.  

The Dutch healthcare system has developed over a prolonged period, with the introduction of the first health insurance funds to aid low-income households dating back to the 18th century. At the beginning of WWII, the German mandatory health insurance system, “Krankenkasse,” was introduced in 1941. After the occupation, the Dutch government decided to keep the system of mandatory health insurance. However, as health insurance institutions become professionalised, the addition of supplemental services has caused a separation between private and public health service sectors.  

The Netherlands also encounters significant challenges in managing healthcare spending. In 2018, their healthcare expenditure accounted for 10% of their GDP and this figure has steadily increased each year, reaching 11.21% in 2021. Despite this escalation, the country’s ranking in healthcare expenditure among the 38 OECD nations has dropped from the 3rd highest to the 10th highest. 

While resources have remained stable thus far, the soaring costs have prompted the implementation of cost-control measures. Notably, in 2019, Government health spending amounted to USD 5340.61 per person and rose substantially to USD 6531.01 by 2021. A continuation along this trajectory could potentially jeopardize the long-term affordability of the healthcare system and impact its overall resilience, particularly considering the introduction of high-cost technologies, the ageing population and an expected increase in chronic diseases. As these factors converge, it becomes imperative for the Netherlands to address these spending challenges effectively to ensure the sustainability and accessibility of its healthcare system. 

Health priorities 

In 2019, 88% of fatalities resulted from non-communicable diseases in the Netherlands. Ischemic heart disease, lung cancer, stroke, COPD and Alzheimer’s disease stood out as the top five contributors to mortality that year and the prevalence of each of these ailments had seen a substantial increase compared to a decade earlier. 

More than one-third (35 %) of all deaths in the Netherlands can be attributed to behavioural risk factors – below the EU average of 39 %. In 2019, 20% of deaths could be attributed to tobacco consumption, which is 4% higher than the EU average. The second major risk factor is dietary risks, which were responsible for an estimated 11 % of deaths in 2019 – well below the EU average (17 %). 

In 2022, there were 170,112 deaths in the Netherlands, an almost identical amount to the year prior (170, 972). Among the leading causes of death for both years were diseases of the respiratory or circulatory system, mental and behavioural disorders and neoplasms.  According to estimates from the Joint Research Centre based on incidence trends from previous years, around 110,000 new cases of cancer were expected in the Netherlands in 2020. However, fewer people were newly diagnosed with cancer than in previous years, probably because of the pause in cancer screening programmes in spring 2020 during the pandemic. Despite this observed drop in diagnoses, the total number of deaths from neoplasms remained at a similar level in 2019 and 2018. 

Prostate cancer is the main cancer type diagnosed in men, while breast cancer is the leading cancer diagnosed in women. Colorectal and lung cancers are the second and third leading causes of cancer among both sexes. The Dutch national screening program for colorectal, cervical and breast cancer was introduced in January 2014. However, participation rates saw a slight decline in the following 5 years. In 2020, the Netherlands Cancer Institute introduced VMware technology. This allowed hospital staff to access medical data and applications quickly, safely and easily, which accelerates treatment decisions and improves patient care. 

The Netherlands plays a key role in promoting health and well-being around the world. They have developed a longstanding partnership with the World Health Organisation (WHO) by funding crucial activities in the areas of mental health, response to disease outbreaks and humanitarian crises, water sanitation and hygiene, primary healthcare and antimicrobial resistance. The Netherlands ranks 4th among the WHO’s largest financial contributors and invested close to US $94 million between 2020 – 2021.  

One of the key goals for the Netherlands is attaining the highest level of sexual and reproductive health and rights for all girls and women. The Netherlands serves as a key financial contributor to the WHO’s Human Reproductive Programme (HRP) established in 1988 and has twice served as Chair for the programme. A study conducted by the HRP achieved with Dutch support was the introduction of Carbetocin, a drug used to prevent post-birth haemorrhage, saving the lives of thousands of women. 

The Netherlands also supports the WHO’s lifesaving work in response to health emergencies and humanitarian crises. They have contributed 12.5 million US dollars to the WHO’s contingency funds for emergencies which allow the WHO to immediately respond to disease outbreaks. 

The Netherlands is also a strong supporter of the WHO’s response to COVID-19, contributing a total of 11 million USD. As of June 2022, the Netherlands had 8.22 million confirmed COVID-19 cases and 22,401 confirmed COVID-19 deaths. 

Genomic medicine capabilities 

The Netherlands is committed to open collaboration, which directly contributes to its success in genetic research. Introduced in July 2015, the Government Information Reuse Act mandates that the archives of medical data are to be freely accessible to the public. This openness and transparency have created a sense of community among researchers, which has led to better cooperation and innovation. Genealogists have benefited as open, free access to genealogical records has enabled research that was previously too time-consuming and expensive. However, as archives once used the proceeds of the downloads to finance digitisation projects, without compensation for the loss of income, fewer sources might be available in the future. 

In 2018, the Netherlands signed a declaration enabling access to at least 1 million sequenced genomes in the EU by 2022. They became the 18th EU Member State to participate in the joint European effort to deliver cross-border access to genomic health data. The Netherlands values EU cooperation on health and having access to a larger cohort of genomic data will allow for more clinically impactful research. The Journal of Infectious Diseases reported the Netherlands as one of the 5 countries to show great performance for sequencing efforts in response to the pandemic, in addition to the UK, the USA, Iceland and Australia. 

At the Netherlands Cancer Institute (NKI), datasets of whole genome sequencing have allowed the Netherlands to discover new biomarkers and investigate cancer therapy resistance mechanisms. For example, the identification of the KRAS mutation in chemotherapy resistance and the role of antigen-presentation machinery in immune responses.  

In 2023, researchers at NKI mapped for the first time how a malignant tumour loses the encapsulation that prevents cancer cells from leaving the tumour.  They have also discovered how specialized immune cells can detect and remove cancers that are ‘invisible’ to the conventional defence mechanisms employed by the immune system. 

The year prior, in June 2022, the TIL trial conducted by NKI researchers concluded after an impressive 8-year journey. The trial demonstrated that a patient’s immune cells, when expanded into an army of billions in a specialised laboratory, can serve as a living drug against metastatic melanoma, a highly aggressive form of skin cancer. These groundbreaking results were presented at the 2022 annual congress of the European Society for Medical Oncology (ESMO) in Paris. The success of the trial paved the way for the Dutch National Health Care Institute to confirm the effectiveness of TIL therapy was comparable to standard treatments, leading to its coverage under basic health insurance. Inspired by this achievement, the NKI has listed plans that include expanding the use of TIL therapy to address other cancer types beyond melanoma and reducing the side effects of the therapy by modifying the utilization of the growth factor interleukin-2. 

Earlier this year, Dutch researchers at the Leiden University Medical Center published a remarkable development in precision medicine. They introduced a groundbreaking concept known as the “DNA medication pass,” enabling tailored treatments across various disease areas. By adjusting medication dosages based on individual patients’ DNA profiles, they managed to achieve a significant reduction of 30% in serious side effects. This discovery has the potential to revolutionize treatment approaches and significantly improve patient outcomes. 

Notable projects 

  • Genome of the Netherlands (GoNL): GoNL is a project within the Biobanking and Biomolecular Research Infrastructure. It is a whole genome sequencing project consisting of 250 trio-families across all provinces in the Netherlands to characterise DNA sequence variation in the Dutch population. 
  • Netherlands Genomics Initiative (NGI): NGI creates societal and economic value from genomics through a network of large-scale genomics centres. 
  • Mobile DNA-Lab: An educational outreach project launched in 2006, the ‘Language of a Tumour’ programme educates high school children on cancer genomics. 
  • Genetics, Arthrosis and Progression (GARP) Study: A database of over 200 sibling pairs both affected with osteoarthritis and non-affected partners in The Netherlands, which has been used for many osteoarthritis studies. The patients and their partners have undergone periodic testing over decades, providing a mass of longitudinal data for statistical analysis. A large number of participants have also provided blood and urine samples for testing of DNA, RNA and proteins. 

Notable organisations and institutions 

  • The Biobanking and Biomolecular Research Infrastructure- Netherlands (BBMRI-NL): BBMRI-NL is a national node of the European BBMRI, a research infrastructure for biobanking that aims to bring together leaders in the biobanking field to boost biomedical research. 
  • Dutch Society for Human Genetics (NVHG): The NVHG is a scientific association for those active in researching human genetics. The organisation unites medical specialists and facilitates meetings, conferences and collaboration. 
  • Erasmus MC- Institute for Genetics and Medical Research (EMC): The EMC aim to understand the function of the genome and to identify causes of metabolic diseases, cancer, neurodevelopmental disorders, cardiovascular disorders and congenital malformations. 
  • Netherlands Cancer Institute: Established in 1913, the Netherlands Cancer Institute includes an internationally acclaimed research institute and a dedicated cancer clinic, aimed to deliver rapid translation of basic research into clinical applications. 
  • Integraal Kankercentrum Nederland (IKN): Founded in 1980, the Integrated Cancer Centre of the Netherlands is an independent knowledge institute for oncological and palliative care. IKNL’s mission is to reduce the impact of cancer. 
  • Cancer Genomics ( Established in 2013, is a consortium of research groups that combines expertise to understand cancer genomics and integrate benefits into the clinic. 

Notable individuals 

  • Anton Berns: Berns is a molecular geneticist known for his pioneering work on generating and utilising genetically modified mice as a tool to search for new cancer genes. 
  • Piet Borst: Borst is a molecular biologist and former Director of the Netherlands Cancer Institute. His work focused on chemotherapy resistance in cancer cells and the biosynthesis and function of DNA Base J. 
  • Titia de Lange: Lange is an award-winning biochemist known for her work on telomeres. She identified the Telomeric-repeat binding factor protein 1 and discovered the t-loop structure of telomeres. 
  • Helga De Vries: Vries is a neuroimmunologist and leader in the field of the blood-brain barrier. She led the discovery of the importance of microRNAs in the blood-brain barrier and finding targets for multiple sclerosis. 
  • Jan Hoeijmakers: Hoeijmakers is an award-winning molecular geneticist known for his work on the mechanisms of DNA repair and the effects of defects on genetic stability in ageing, cancer and hereditary diseases. 
  • Karst Hoogsteen: Hoogsteen was a biochemist famous for noting a new base paring form in DNA, now called Hoogsteen base pairs. 
  • Roel Nusse: Nusse is a biologist who is famous for the discovery of Wnt signalling and research on stem cell development and tissue repair. 
  • Eline Slagboom: Slagboom is a geneticist specialising in ageing and osteoarthritis. She is the founder of the Leiden Longevity Study and the GARP study. 
  • Cisca Wijmenga: Wijmenga is the former leader of the GoNL project. She is a Dutch professor of Human Genetics at the University of Groningen and the University Medical Center Groningen. She has been Rector Magnificus of the University since September 2019. 

The future genomics landscape

The Netherlands is taking significant strides in advancing its medical and scientific capabilities, particularly in the field of precision medicine and genomics research. With the recent deployment of the Concentriq® Dx diagnostic platform by the NKI, the country is expanding its digital pathology practice and laying the groundwork for pathologists to deliver personalized diagnoses. This secure digital platform not only allows the NKI to generate additional pathology data for potential clinical breakthroughs but also fosters interoperability with third-party image analysis applications to identify clinically impactful patterns. By scaling its digital pathology practice, the NKI is making strides towards unlocking greater value from its data and incorporating it into research initiatives.  

The nation’s ambition to be a part of global efforts to enhance access to precision medicine is evident, with experts envisioning the implementation of whole genome sequencing as a standard tool in research and molecular diagnostics in the coming decade:  

“In the next ten years, whole genome sequencing will become a standard tool in research and molecular diagnostics. We hope to kick start the nationwide implementation of such tools and build up the expertise needed to enable our scientists and the public to benefit from these future developments.” 

~ Dr. Cisca Wijmenga, Professor of Human Genetics at the University of Groningen and the University Medical Centre Groningen 

Organizations like BBMRI-NL are actively working to build genomic capabilities in the Netherlands, prioritizing findable, accessible, interoperable and reusable projects. However, there are concerns about the potential brain drain of scientists from other disciplines due to private company formations following research financed by the Dutch government and universities. 

With the emergence of cell and gene therapies as relatively new areas of research, the Netherlands stands poised to explore numerous opportunities for expanding their applications and optimizing production processes. As the nation continues to invest in cutting-edge research and technology, it remains dedicated to becoming a key player in shaping the future of precision medicine and genomics research on a global scale. 


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