“It feels quite liberating, as though it invites illegal activity – national authority seems very far away,” says Klasien Horstman about growing up close to the German border, in the Northern part of the Netherlands. This notion of borders and transgression has stayed with her. She’s become a philosopher working across disciplines and studying public health, a field which in itself has to grapple with the blurred borders between medical expertise, clinical realities, socio-economic processes, cultural repertoires, and so much more.

Five years ago, Maastricht University's Care and Public Health Research Institute (CAPHRI) established a collaboration between researchers from the humanities, social sciences, law, medical microbiology and infectious diseases prevention with a shared commitment to the public character of health, rather than just the purely clinical aspect. In this transdisciplinary environment, Horstman focuses on the sociocultural dimension of disease control.

Crossing the t’s and borders

Transdisciplinary research is a ubiquitous buzzword, but it takes hard work and a great deal of openness and curiosity to make it work properly. “It took us three years to understand each other,” laughs Horstman. “We’re trying to investigate the role of individual behaviour, involvement of the state, the democratic legitimation of top-down prevention strategies, etc. – and we generate recommendations how to get citizens involved in the process.”

Given her background and the degree of mobility between Belgium, the Netherlands and Germany around Maastricht, Horstman quickly became interested in the spread of infectious disease in border regions. “Bacteria and viruses don’t care about borders – but in a way they do! My colleagues showed that an outbreak of the zoonotic Q Fever with thousands of cases in the Netherlands led to mass cull of livestock – but there was no outbreak in Germany, even though it happened very close to the border.”

Covid-19 is the wheezing elephant in the room, especially in a city as international and defined by borders as Maastricht. “States respond differently – and the impact is most clearly observable in border regions. In Germany, you have to wear a facemask in shops, in the Netherlands you don’t. That means that Germany might be safer, but it definitely means that Germans come to Maastricht to shop without the inconvenience of having to wear a facemask…”

So, can different national approaches explain different mortality rates? “Of course, closing borders and containment measures make a difference. At the same time, Germany has massively tested people and therefore got many positives back from young people who didn’t develop symptoms; the Netherlands didn’t include nursing home deaths in the statistics, while Belgium has. So there might well not be that much of a difference after all.”