Integrative learning through student-led transdisciplinary investigation of Belgium’s COVID-19 pandemic preparedness

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A systemic preparedness for the complexity of a pandemic is required that integrates knowledge from researchers and practitioners alike. However, countries such as Belgium were not prepared to handle the crisis in a systemic way. Here we show how an interdisciplinary group of students in the context of their honours degree designed, organised, and facilitated a transdisciplinary co-creation workshop to evaluate Belgium’s pandemic preparedness with stakeholders after the first year of the pandemic. We find that a lack of transdisciplinarity, pandemic illiteracy, insufficient involvement of human sciences in decision making processes, and fragmented authority are some of the most important gaps in pandemic preparedness according to the Belgian stakeholders. They identified important underlying causes which we have clustered in five emergent themes: principal agent problems (politicians taking decisions in their own interest instead of in the interest of the people they represent), distrust in authority, government incompetence, apathy, and lack of transdisciplinarity. Additional student reflections on the experience of guiding the workshop show that the students developed their understanding of the concept of transdisciplinarity, experienced difficulties in facilitating transdisciplinary knowledge integration, and developed critical career skills. More general, our results demonstrate how students in the context of transdisciplinary education designed an innovative method for co-creation which led to improved systems knowledge of Belgium’s pandemic preparedness and the development of important skills. Humanities/Complex networks Humanities/Health humanities Humanities/Medical humanities Social science/Complex networks Social science/Education Social science/Social policy COVID-19 pandemic preparedness transdisciplinarity co-creation Belgium Figures Figure 1 Introduction The COVID-19 pandemic caught the world off guard despite humanity’s past experiences with deadly disease outbreaks. Prior to COVID-19, pandemic preparedness plans included installing pathogen surveillance and infection control measures aimed to minimise the number of infected people to reduce morbidity, mortality, and social disruption (World Health Organisation, 2018; Public Health England, 2014; Government of Canada, 2018). Yet, the pandemic and the strong restrictive measures introduced by authorities also had a significant effect on the global economy (International Labour Organisation, 2020). Recently, Stockman and colleagues argued for a transition from epidemiology-centred strategies for pandemic preparedness, to an approach that encompasses the societal and cultural interests in addition to healthcare concerns for a multifaceted pandemic preparedness plan (Stockman et al., 2024). Pandemic preparedness plans lacked comprehensive assessments of the impacts beyond the health sector such as economic and social impacts, and considerations of the various costs and benefits of such strategies to different sectors of the economy and socioeconomic classes (Keogh-Brown et al., 2010; Pasquini-Descomps et al., 2017). Other than public health and economic issues, there was a global rise in psychological distress caused by fear of infection, sudden disruption of daily activities, and loss of family and friends amongst others (Oyebode et al., 2021; Armbruster & Klotzbücher, 2020). Through the unfolding of the effects of the pandemic, researchers have drawn comparisons between the climate crisis and the COVID-19 pandemic, conceptualising both as wicked problems (e.g. Schiefloe, 2020; Auld et al. 2021; Klasche, 2021; Sultana, 2021). Wicked is understood as a problem resisting definition and solving due to its complexity. The term was coined in 1973 by planning scientists Rittel and Webber (1973) and has been further elaborated more recently (Alford & Head, 2017). A wicked problem continuously evolves and requires an adaptive approach. For example, the COVID-19 crisis started as a health-crisis, but quickly became a plethora of different crises such as mental health and economic crisis. Attempts to solve a wicked problem inevitably make it turn into a different problem. This evolving nature calls for a different approach to problem-framing, problem-analysis, and (re)solving that relies on a deep understanding of the components and dynamics that make up the problem, which we understand as systems knowledge. Through systems knowledge it becomes possible to identify important factors to be addressed for change. This type of knowledge requires researchers to have a wide understanding of the problem, which can be achieved through participatory research such as transdisciplinary research approaches where lived experience and scientific knowledge are integrated (Pohl et al., 2021). This study presents a student-led transdisciplinary learning project performed in an honours degree context at [Redacted Institution]. The authors explored the gaps in Belgium’s pandemic preparedness and response during the period of the first year of the pandemic. They designed, organised and facilitated an online co-creation workshop. The results of this student project provide an elaboration on how Belgium’s pandemic preparedness plans can be enhanced to take into account and prepare the wide array of dimensions affected. We also illustrate our reflections on participating in a transdisciplinary honours program. Transdisciplinary honours education focusses on fostering an appreciation of systemic relationships and interpersonal dynamics, prioritising competences such as innovation-, critical thinking-, and collaboration competences (Eronen et al., 2019; OECD, 2020; Remington‐Doucette et al., 2013; Pohl et al., 2018). In this light transdisciplinary education has gained recognition as one promising approach to prepare students for their future careers (Roy et al., 2020; World Economic Forum (WEF), 2025) as employers seek employees who possess the competences to navigate the complex changes in society (Bushell, 2024; McGunagle & Zizka, 2020; WEF, 2025). Honours pedagogy makes the learning experience deeper, more meaningful, and transformative (Wolfensberger, 2012) by offering bounded freedom (Kingma et al., 2018), engendering academic competences (Canrinus et al., 2020), and creating a committed community (Heijne-Penninga & Wolfensberger, 2018; Canrinus et al., 2021). Background of the research In February 2020, [a redacted research institution] set up a transdisciplinary research project with a transdisciplinary learning team to learn lessons from the COVID-19 pandemic while it unfolded, in order to be better prepared for a next pandemic. We will refer to this team as the COVID-19 Pandemic Preparedness (CPP) learning team. The goal was not to make an impact on the COVID-19 pandemic, but to learn from this pandemic and push society towards a gradual transformation to become more resilient and ready for future pandemics. During the first wave of infections (March-September 2020), the CPP learning team compiled their systems knowledge into a list of twenty gaps in Belgium’s pandemic preparedness (table 1). In October 2020, a group of students from [redacted name of programme] was invited to join the project (October 2020 – May 2021), we call this team CPP student team. [Table 1] This paper describes the transdisciplinary project of the CPP student team, who are also the authors of this paper. Through following [redacted name of programme] workshops and interacting with the CPP learning team they decided upon their objective to obtain stakeholder-validated systems knowledge of what went wrong during the COVID-19 pandemic through a co-creation workshop. The CPP student team sought to explore the following research questions: RQ 1: What are the gaps in pandemic preparedness perceived by the Belgian population? RQ 2: What are the underlying causes to Belgium’s pandemic preparedness gaps? Methodology The CPP students were enrolled in the [redacted name of programme] between October 2020 and May 2021. [redacted name of programme] provides students with the opportunity to learn about transdisciplinary research by offering a challenge-based approach, asking student teams to address a specific wicked challenge, in this case pandemic preparedness. Throughout the academic year the students meet with their coaches on a weekly basis and participate in several workshops on problem framing, systems thinking, and futures thinking during which they do exercises for co-creating knowledge around their challenge. They also learn how to involve stakeholders at multiple levels. These workshops are linked to the research approach used by [redacted name of research institute] named [redacted research approach name]. This approach consists of an iterative cycle for transdisciplinary research to generate three types of knowledge: systems (what is?), target (what should be?), and transformation (how to get there?) (Pohl & Wuelser, 2019). DF3 is an adaptation of the 10 reflective steps approach for transdisciplinary research described by Pohl and colleagues (2017). By taking their challenge through this framework and designing and executing an “action” (in this case the co-creation workshop with stakeholders) related to their challenge, the students are ‘learning by doing’. The CPP student group consisted of one bachelor’s, one doctoral, and six master’s students from the [redacted name of university] (7 students) and the [redacted name of university] (one student). The team was supported by three coaches: 2 master’s students and one postdoctoral researcher, who was also a member of the CPP learning team. The group covered diverse disciplinary fields of knowledge with philosophy, business administration, medicine and health sciences, intellectual property and ICT law, business engineering, data science and biostatistics, biomedical sciences, social sciences and clinical and epidemiological virology all being represented by different members. The CPP learning team went through a total of three iterations of the DF3 and collaborated with the students during the second iteration to enhance and validate the systems knowledge of gaps in pandemic preparedness through stakeholder interaction. The results of the CPP learning team are available online at [Redacted link]. The CPP student team supported the CPP learning team’s research by validating the systems knowledge through stakeholder interaction. The CPP student team designed, prepared and facilitated an online knowledge co-creation workshop through Zoom. The aim was to discuss, refine and validate the list of gaps in pandemic preparedness (Figure 1) with diverse stakeholder groups. Before the workshop, stakeholders were provided information about the gaps list through an introductory video and stakeholder guide. The video can be viewed here: [Redacted link] the stakeholder guide can be found online in supplementary doc. S1. Relevant categories of stakeholders were identified through an actor constellation exercise inspired by the methodology described by (Pohl, 2020), a copy of the resulting actor constellation can be found in Supplementary fig. S2 online. Individuals in these categories were identified through internet search, and from a list of stakeholders known to the CPP learning team. 158 stakeholders were then invited through e-mail, using addresses publicly available online. For missing categories, we asked stakeholders if they knew someone in those categories who we might contact. The stakeholder’s invitation email can be found in Supplementary Document S3 online. Thirty-two stakeholders accepted the invitation, which is a response rate of 20%, and 30 took part in the workshop. The participating stakeholders’ backgrounds covered the domains of Medical research (5 stakeholders, or SH), Healthcare (5 SH, which included a patient), Medicine (2 SH); mental health (2 SH), business and economics (5 SH), social sciences (5 SH), law and politics (2 SH), and others (4 SH). The entire overview of participants including their demographics can be found Supplementary Table S4. Participants were predominantly from Flanders (27 SH), with a few participants from Brussels (1 SH) and Wallonia (2 SH). The predominance of Flemish stakeholders is most likely due to the location of the university in Flanders and possible language barriers as invitations were sent in Dutch and English, while French is the most prevalent language in Wallonia and Brussels . The stakeholders were divided into 5 groups of 6 individuals which were each guided by two facilitators from the CPP student team. Special attention was given that each group had a maximum diversity of stakeholders to encourage discussions among people with different mindsets. The team constitutions are displayed in table 2. [Table 2] Workshop design Due to the COVID-19 pandemic restrictions, an in-person meeting with all stakeholders was not possible, so we organised it online through Zoom. The CPP student team designed three 45-minute exercises to guide a focus group discussion around the gap list and further knowledge co-creation using Miro, an online whiteboard software for collaboration ( www.Miro.com ). The workshop was facilitated by members of the CPP student team. In the first exercise the gaps list (Figure 1) was provided and discussed, in the second exercise one of the gaps was discussed more deeply and in the third exercise all the gaps including eventual newly identified gaps were used once more. These exercises were tested in a pilot run with students of [redacted name programme] and several friends two weeks before the workshop took place. This provided the opportunity to spot any remaining issues that may have been overlooked and get a first experience of the dynamics and how to facilitate the exercises. Each exercise was followed by a 10–15-minute break, during which the results would be gathered from each group's board by the CPP student team to be shared in the plenary, allowing participants to learn about and react to the other group’s results. This gives insight into how the other groups are solving the exercises and how diverse answers can be. This process was repeated for each of the exercises. All groups performed the same exercises. Exercises The first exercise aimed to assess stakeholders’ reactions and opinions about the existing list of gaps that the CPP learning team had compiled. First, participants were asked to share their feedback about the list of gaps, which had been shared in advance and was also visible on the Miro board. At this stage participants could add missing gaps to the list. Next, the group voted for a top three most important gaps. These would then be used as the starting point in the next exercise. To prepare the group a scaffolding task for ranking the societal importance of gaps was done before voting. In the second exercise participants had to identify the deeper cause(s) of the top three gaps. The image of a waterfall was used as a metaphor: ‘We are searching for the source’. Starting from one of the team’s most important gaps, participants moved up towards the source by writing down and explaining the deeper causes behind the gap on sticky notes. The participants would first write down causes individually, before discussing the answers collectively, bringing together the causes that were similar. When the discussion reached a point of saturation, the team moves on to the next level to identify possible causes for the causes. In this way, deeper, and underlying issues were identified by the team every level they went up. Once the team reached a point of saturation (when no deeper causes could be found anymore) they had found one or possibly a few of the deepest causes of the gap. In the third exercise, all the gaps from the list were grouped by their deeper causes. Participants could use the deeper causes they had uncovered in the previous exercise, come up with new ones or use some of deeper causes proposed by the CPP student-facilitators based on feedback from the CPP learning team. This exercise relied on group discussion, and in most groups the facilitator would take charge of editing the Miro board. An example image of a complete Miro board is available in Supplementary fig. S5. Data analysis We employed thematic analysis (Braun et al., 2019) to examine the groups’ responses to the exercises. The analysis was based on an inductive process, meaning that no predefined themes were established prior to the analysis. Instead, themes emerged organically from the data itself. This approach allows for a richer understanding of the gaps that aligns closely with the participants’ responses, which was suitable for our goal to openly explore and elaborate on the gaps in Belgium’s pandemic preparedness with diverse stakeholders, and to uncover deeper causes to the gaps. The analysis was performed in two steps: first two students of the student team compiled the responses and started coding responses looking for emergent themes. These coding and themes were then presented for verification and further refinement to the other team members in a second iteration. Student reflections As part of the [redacted name programme] students present their project and reflect on their transdisciplinary learning experience during the [redacted name] symposium [redacted link] at the end of the academic year. This presentation has been captured on video and transcribed. Results This chapter is divided into two parts, presenting the results of exercise one first, and exercise two and three next. Each part seeks to answer one research question. All responses to the exercises by each group have been added in this article or are available as supplementary tables online (Supplementary Table 6 and 7). The analysis of the exercise results is structured according to how they address the research questions. The first exercise relates to the gaps in the Belgian pandemic preparedness, as perceived by our group of stakeholders, addressing the first research question. Exercises two and three were designed around research question 2 aiming to uncover deeper causes behind the gaps. Exercise 1: Analysis of the gaps list and most important gaps The first exercise resulted in the confirmation of the 20 proposed gaps, and the discovery of three new gaps. The results of the exercise of each group can be found in supplementary materials (cfr. Supplementary Table S6). The first new gap was “the insufficient involvement of, communication with, and funding for primary care workers working with infected patients”. Second, “the lack of strategic logistical supply chains for medical equipment and household products”. Third, “the lack of preventing pandemic events by taking care of our ecological environment, because massive deforestation and large-scale animal industry bring humans into contact with animal virus populations more frequently”. Other reported missing gaps were similar to gaps already in the list, enhancing their understanding. We present here how these discussions led to reinterpreting the gaps and in some cases also reformulation. For the purpose of the article, we elaborate on four gaps which were reported as missing gaps, but which after lengthy discussions in all groups appeared to relate to existing gaps in the original list. This discussion was very informative to reinterpret and reformulate the original gap. These four gaps were the lack of transdisciplinarity (gap #1), pandemic illiteracy (Gap #5), lack of involvement of human sciences in decision making processes (Gap #12), and fragmented authority (Gap #9). Other gaps were also discussed in some groups. For example, gap #15 focussed on learning from countries that preceded us in the pandemic (cfr. table 1), while the gaps that were reported missing were ‘[We] don’t look to [the] far east for pandemic control, why?’ and ‘learn from pandemic history’ pointing towards insufficient learning from previous pandemic events, these were both close to gap #15. Participants discussed the lack of international cooperation emphasising that Belgium did not open itself up towards non-Western countries to learn about how to handle a pandemic, even though especially eastern countries had more recent experience. Not seeking to learn from others also constituted a barrier for cross-border and even cross-regional collaboration and data communication. We reformulated the gap as: ‘Insufficient learning from previous pandemic experience such as other countries or historical pandemics’. First, the lack of transdisciplinarity relates to gap #1 the absence of a transdisciplinary advisory board for the government’s handling of the crisis and gap #3 insufficient funding to explore, test, and implement transdisciplinary approaches, which stakeholders based on observed neglect of diverse information channels that held valuable input for decision making. Some missing gaps which we grouped under this theme were: ‘multidimensional communication strategy’, ‘more than just a procurement issue - create an integrated vision away from 'crisis mode' reactivity’, ‘places to discuss among different fields of science to support decision-making’, ‘lack of use of master educated nurses in advisory board’, and ‘neglecting student wellness’. Additionally, one team mentions the lack of transdisciplinarity in education as a missing gap due to which linear thinking remains prevalent in solution-oriented thinking. Through the input of participants, we reformulate gap #1 to: ‘lack of transdisciplinary collaboration in policy making’, including the lack of involving practitioners of affected fields to formulate strategies to handle the crisis and identify a way out. Second, some missing gaps related to the theme pandemic illiteracy, which was already listed as a gap (#5): ‘accessible and easy to understand information about how the virus spreads and how vaccines work’, ‘lack of systemic knowledge of biology’, and ‘reflecting on the implication of mass vaccinations vs. emergence of a super-virus’. We further specify the gap to ‘pandemic illiteracy in population and decision makers about infectious disease control’. In part caused by the lack of involvement of multiple disciplinary fields, and a primary focus on virological knowledge by government officials at the start of the pandemic. Third, different groups mentioned that insufficient attention was given to the legal and psychological aspects of measures such as lockdowns, stay home orders, closing hospitals for non-emergency patients, quarantining or social distancing. This relates to the theme of insufficient involvement of human sciences in designing pandemic measures. It is important for decision makers to take into consideration that measures may also inadvertently affect the population negatively, and to incorporate this into the planning through studies on risk acceptance and proper communication of decisions. These responses add to gap #12: not sufficiently involving human sciences into the design of pandemic measures, but do not require reformulation The fourth theme to emerge from the groups responses was fragmentation of responsibility, related to the legal gap (#9) in the assignment of and taking up of political responsibility and accountability for pandemic preparedness and response, and responsibility amongst the population. Originally described from a political perspective, referencing the complex political structures of Belgium, the responses add a lack of guidelines and juridical frameworks for crisis situations. The responses grouped under this theme are: ‘lack of financial and juridical framework or clinical nursing specialists’, ‘need for more guided interaction between hospitals and other care centres (homes for elderly, ...)’, ‘clear role/responsabilities/hierarchies ® clear communication’, ‘ideology (neoliberal) inhibited strongly the investment in psycho-social "support" and interventions towards the population’, ‘the advice was strongly given, repetitively, but not implemented massively’, and the ‘lack of commitment of nursing leadership’. We reformulate gap #9 as: fragmented authority and responsibility across societal levels. After compiling these results with the original gap list, we come to the following renewed list of gaps (table 3). We added the new gaps and elaborated the phrasing of the other gaps to better cover the different viewpoints towards these gaps. This list addresses our first research question, “what are the gaps in pandemic preparedness perceived by the Belgian population”. [Table 3] The groups also voted a top three of the most important gaps to be addressed for pandemic preparedness. These were chosen from the existing gaps list and new gaps. The results of these votes are aligned with the four emergent themes we have just described, the most discussed gaps were also seen as the most important gaps. The most important gap (number 1) was clear in each group, while in two groups the second or third most number of votes was shared by two or more gaps. Table 4 displays the results of the voting. These gaps were subsequently used in exercise 2. [Table 4] Exercise 2 and 3: Identifying deeper causes to gaps We addressed our second research question using the discussions during the second and third exercises. Each group first discussed the deeper causes behind their most important gap in exercise two. Groups who finished early also identified deeper causes behind the second most important gap. The identified deeper causes in exercise two are listed in table 5 below per group. In exercise 3 groups then discussed and identified whether there are deeper causes shared by many gaps. Starting with the deeper causes identified in the previous exercise. The groups also came up with additional shared deeper causes. The detailed results of exercise 3 can be found in Supplementary Table 7 online. A selected summary is described in the text below. [Table 5] The results from exercise 2 and 3 are addressing our second research question: what are the underlying causes to Belgium’s pandemic preparedness gaps according to our stakeholders? The second and third exercise, brought forth a wide array of deeper causes to the gaps in pandemic preparedness that can be grouped into five major groups: principal agent problem (relates to politicians taking decisions in their own interest instead of in the interest of the people they represent) (1), distrust in authority (2), government incompetence (3), apathy, or inconsiderateness for the needs of others, on individual and group level (4), and lack of transdisciplinarity (5). First, the groups understood the principal agent relationship of politicians to the public as an unwillingness to take unpopular, yet necessary, preventative actions. Politicians are not prepared, or are not given the opportunity, to learn from mistakes, because unpopular policy decisions required for long-term thinking in the context of a pandemic can be costly in the short term for the approval ratings of politicians. They appear reluctant to admit when they do not know, need help or are making mistakes in trying to address the crises caused by the pandemic. Conversely, unscientific measures with uncertain impact on the spread of COVID also undermined public trust. Second, the distrust in authority was perceived as a deeper cause of the unwillingness amongst the population to listen to and/or follow advice, instructions, and regulations mandated by political or intellectual authorities, such as medical experts and government officials. It was also discussed that disregard for experts and government officials who do not always say or make policy suggestions people feel comfortable with was a deeper cause behind the lack of involvement of human sciences. A comparison was made with the choice for quick and easy meals over healthy foods. Short-term solutions provide only temporary resolvement yet have unwanted consequences in the future. Third, government incompetence was identified amongst the focus groups as the cause of flawed reasoning, tunnel vision, and short-sighted perspectives from political and bureaucratic leadership. Similar to the principal agent problem this incompetence is perceived as a lack of taking necessary risks and long-term planning, but in this case for the government as an institution rather than the individual politicians who make up the government. Fourth, the apathy (understood as the opposite of sympathy) on individual and group level is perceived as not considering interests of other individuals, groups, or countries. In general, it refers to the tendency to make decisions based on one's own experiences and feelings and on personal interests and losses. As some of our stakeholders noted at individual scale refusing to wear a mask or not isolating while infected indicated a lack of empathy for others. On a group or national scale this was perceived in cases where countries refused to cooperate or share their knowledge and resources to combat the pandemic. Fifth, the lack of transdisciplinarity is understood as the absence of a transdisciplinary mindset, transdisciplinary advisory boards, and funding for transdisciplinary initiatives in pandemic prevention, preparedness and response. Interestingly, this theme was both a gap and now also identified as a cause of other gaps. It envelops a lack of shared understanding that there is no such thing as no-risk in a pandemic event and that shared leadership should be harnessed. Though these deeper causes are here presented separately, they were seen as interconnected by the groups. The groups often identified multiple causes to gaps; with 14 out of 20 gaps having more than one underlying deeper cause. In figure 1, we show how the gaps of the gaps list were linked to the six themes of deeper causes by the groups. It shows for example that the initial lack of transparency of decision-making processes was the result of the principal agent problem, government incompetence, apathy, and distrust in authority. Our learning experience allowed us to build an understanding of pandemic preparedness through a transdisciplinary research project, but through performing the research we also developed a deeper understanding of transdisciplinary research itself. As a group we reflected on whether the workshop could be called a succesful example of transdisciplinarity, the importance of good facilitation for knowledge integration, and whether there are limiting factors to consider. “We all went beyond our academic backgrounds and tried to find stakeholders, engage with them, also as moderators. I think we had some really interesting discussions, and I think, for me that's our transdisciplinary achievement. So, I think we succeeded” (author 4) A transdisciplinary approach entails the co-production of an understanding beyond the limits of our disciplines. We found that mapping stakeholders in an actor constellation (cfr. supplementary fig. S2) and facilitating a workshop with a diverse group of participants were useful to start thinking beyond the borders of our own disciplines. However, we also found it difficult to moderate and guide the focus group discussions. “we really need a good guide, a person that can really guide a transdisciplinary team,” because otherwise, “it’s very difficult to get a meaningful result and a meaningful discussion” (author 6). Not only is a meaningful discussion dependent on good facilitation, but “it's also the willingness of everyone else to collaborate and to move forwards and to stop walking in circles and to listen to the opinion of people that differ from our own and to appreciate them and to understand them and to try to agree or disagree with them but in a constructive manner. And I think that something that's even more valuable than the collection of very intelligent people is the collection of enthusiastic people [...]” (author 3). Up to now our results have shown what knowledge we have gained. But transdisciplinary education also aims to foster the development of future skills and competences in students. It was beyond the scope of this project to study this development in detail, but we do wish to share two exemplary testimonies taken after the course to give readers a feeling of the course’s transformative potential. By working in a transdisciplinary team, I encountered myself. I was confronted with Otherness on a different level than before, breaking through the worldview I had built up over the years about the world, society, and myself. It allowed me to become more open, more communicative, more in-the-world. It empowered me to go beyond what I took as my personal limits and I have not experienced that anywhere else in my higher education curriculum. (Author 1) Thanks to the corona pandemic preparedness challenge, I have learned and developed immensely in my communication, critical and systems thinking skills and my understanding of the Belgian society and people. Regarding communication skills, the corona measures have prevented my coaches, teammates and me to have face-to-face conversations, so I have to find ways to communicate efficiently via text messages on Slack and conversations in Zoom meetings. I have noted that it is extremely important to deliver concise and to-the-point messages so that others can pay attention more easily and understand more quickly. Furthermore, I have realized that when debating with my teammates, I need to try my best to see things from their point of view and when I state my opinion, I should concede their points first so that they are more likely to listen and accept my points. With regards to critical and systems thinking skills, I have experienced growth in the way I think about problems, especially complex problems and potential solutions. Before doing the programme, I am quite convinced that the way my country, Vietnam, has been handling the pandemic is an optimal answer to this crisis, but after many in-depth conversations with my team, I have acknowledged that all solutions implemented, while capable of solving the target problem, will give rise to other issues in other areas, and in my country's case, we have completely ignored mental health and human rights. Moreover, I have profoundly realized that crises are inevitable no matter how well we prepare ourselves, but we can move forward by living more sustainably in order to be more adaptable to our increasingly volatile world. Finally, thanks to this project, I have built meaningful friendships with my Belgian teammates which allow me to understand the reasons behind the diversity as well as the divisive nature of the Belgian society. They have helped me find similarities between their culture and mine and also supported me in my Dutch learning process. All in all, this project has been very enlightening and thoughtprovoking for me, and I genuinely felt that it has enriched my experience as an international student in Belgium. (Author 2) Discussion We here discuss the research results of a student team of [redacted programme information]. This CPP student team worked with a research team that had listed 20 gaps in Belgium’s pandemic preparedness (Table 1 ), focussing on their observations during the first wave of infections in Belgium [redacted webpage]. Through a co-creation workshop with 30 diverse stakeholders, the CPP student team expanded this understanding of gaps in pandemic preparedness at the start of the COVID-19 pandemic, and mapped their deeper causes. Dividing the stakeholders in 5 groups and taking each group through three identical exercises using online Miro boards, facilitators from the CPP student team guided online focus group discussions and subsequently analysed the results of those discussions. Learning from a poor start Our results paint a rather negative picture of Belgium’s response to the COVID-19 crisis through our study, while later studies appear to have more positive conclusions. For example, in response to the many critiques voiced in Belgian media and social media with regard to how the pandemic was dealt with over the first few years (2020–2022) the government ordered an independent evaluation of its response by the Organisation for Economic Co-operation and Development (OECD) (OECD; 2023 ). They collaboratively evaluated with the governments and drew “on a wide variety of qualitative and quantitative data, including survey data collected from the country’s ministries, municipalities, hospitals, general practitioners and schools” (p. 4). This wide collaboration for the OECD report after the first few years of the pandemic appears to be in contrast with our finding of a major lack of transdisciplinarity during the first wave. Additionally, the OECD found that “Belgium demonstrated economic and social resilience through a whole-of-government response to the crisis that was closely co-ordinated between the federal and federated public authorities. This co-operative approach, in areas including health, education, employment and the economy, enabled Belgium to address and adapt to the considerable challenges of the COVID-19 pandemic” (p. 3). So the country did demonstrate at least some exemplary responses such as maintaining and ensuring pedagogical continuity and a robust and adaptive health system that prevented overwhelming of hospitals. The timeframe of the evaluations may be a major factor in explaining the difference in tone in our study. The OECD report covers a 4-year period in which the government had time to improve on earlier mistakes, whereas our study only focusses on the first year of the pandemic, and took place when events were still unfolding. The OECD also indicates that Belgium fared rather poorly over the first year of the crisis due to several weaknesses in pandemic preparedness (Luyten & Schokkaert, 2021; OECD, 2023 , p.113). For example, over this period Belgians saw how their politicians were unable to form a majority government, experienced drastic, and unpopular measures being imposed to navigate the crisis by a minority government without widespread political support. Taken that these events took place over a period of only a few months amid a growing crisis and that we collected data just about a year after the first measures were introduced it becomes more understandable why our stakeholders identified government incompetence as a deeper cause of Belgium’s pandemic preparedness. Similar to our results, the OECD recommends Belgium to improve coordination of government crisis management and whole-of-government approach (2023), as well as: “structuring a robust and credible system to provide multidisciplinary science advice in times of crisis” (p. 35), and promoting trust, societal resilience, and citizen engagement in “the design and implementation of policies” (p. 36) which is very similar to the call for more transdisciplinarity, more involvement from human sciences from our stakeholders, and to several other gaps in our list. Another suggestion, to address inequality, was not flagged as a gap by our stakeholders. However, several other major concerns by our stakeholders were not addressed in the OECD report, especially the need to improve pandemic literacy across several layers of the society, including politicians and scientists. In summary, although Belgium displayed a good response compared to other countries, our work adds that there is still room for improvement in pandemic preparedness. Belgium may have acted well in response to its initial weaknesses, but we acknowledge that those weaknesses were an indication that the country was not sufficiently prepared. Looking back at the gaps list Our findings show what must be improved for a next pandemic according to our 30 stakeholders. Compared to the original list of 20 gaps set up by the CPP learning team, three new gaps were identified and other gaps in the gap list were further elaborated by participants, leading to a revised list of 23 gaps (Table 3 ). The most discussed gaps in Belgium’s pandemic preparedness relate to a lack of transdisciplinarity (gap #1), pandemic illiteracy (gap # 5), insufficient involvement of human sciences in decision making processes (gap #12), and fragmented authority (gap #9) which align with the problems arising during the unfolding of events throughout the first wave of infections. ‘The lack of involving, communicating and funding primary care workers’, ‘the need for strategic logistical supply chains’, and ‘the care for the natural environment’ were three gaps added to the list. In addition, the most important gaps, according to the stakeholders were the same as the most discussed gaps (Table 4 ). A study found that 70% of Belgian general care practices reported at least one safety incident (when a general practitioner is unable to provide treatment in time) due to for example performing consultations on the phone and patients no longer finding their way to the doctor during the first pandemic year (Van Poel et al., 2024 ). This is symptomatic of the first new gap: ‘insufficient involvement of, communication with, and funding for primary care workers’ which led to problems such as not always being able to follow all safety protocols while trying to maintain a good level of service and quality. The second new gap was also reported by Ivanov ( 2021 ): it is important to have strategic logistical supply chains in place before the pandemic starts that can keep the provision of medical, food and other necessary commodities running efficiently (Ivanov, 2021 ). These shortages resulted from export controls imposed by affected countries (Gereffi, 2020 ) and can be addressed through installing more redundancy and reducing the dependency of one or two production locations for more robust and resilient supply chains. The third new gap related to insufficient respect for the natural environment both with respect to pandemic preparedness and pandemic prevention. Indeed, research has already shown relations between the health of our ecological environment, the frequency of zoonotic spillovers and the spread and impact of diseases (Beyer et al., 2021 ). For example, early on during the pandemic positive correlations have also been found between air pollution and transmission rates (Ali & Islam, 2020 ), showing how ensuring a healthy environment is an important factor for reducing the impact of pandemic events on society (Guo et al., 2024 ). A symptomatic relationship between two wicked problems is also a typical characteristic of wicked problems (Rittel & Webber, 1973 , p.165). Pandemic preparedness requires systems thinking We argue that addressing pandemic preparedness would require systematically addressing these deeper causes. There is never an end to identifying gaps which are only symptoms of deeper problems that need to be addressed, a hallmark of wicked problems. We did not yet find published reports that search for deeper causes of the gaps in Belgium’s pandemic preparedness. Through analysis of the stakeholder group discussions, we found that the gaps of pandemic preparedness are symptomatic of important underlying causes which can be clustered in five emergent themes: principal agent problems, distrust in authority, government incompetence, apathy, and lack of transdisciplinarity (Fig. 1 ). All of these themes contribute to the wickedness of the COVID-19 pandemic problem. Participants rarely identified just one linear cause and effect relation between a gap and deeper cause, which might indicate that each gap is a wicked problem by itself. Our focus lay on mapping out the problem of pandemic preparedness. However, future research can look into each of the gaps separately to investigate how they might be symptoms of a wicked problem. Our data suggests that most of the gaps appear to be part of a complex system of interrelated deeper causes. Auld et al. ( 2021 ) point to four key features that make the COVID-19 pandemic a “super wicked problem” (Levin et al., 2012 , p. 124). First, there is an urgency to address the problem, as waiting to intervene results in exponential growth of infections and consequences running out of hand. Second, individual behavioural change is needed to curb the spread of the virus, while individuals are also the cause of the spread. Third, a pandemic does not respect country borders making it a global challenge. However, authoritative powers lie within the national and regional governments, indicating that fragmented authority is a major issue in the face of global crises. Global organisations such as WHO have no power to dictate what countries should do. Fourth, the political decisions irrationally discount the future by rapidly committing to decisions that cover the most direct impacts but discount the ones that are more abstract or indirect. This results in policy decisions inconsistent with scientific evidence on what is required in the long-term. For example, an initial overreliance on epidemiological knowledge indirectly impacted the economy. Measures were redrawn in the summer of 2020 to take this into account but then neglected the warnings of a second wave of infections by virologists and epidemiologists (Schiefloe, 2020; Auld et al., 2021 ; Luyten & Schokkaert, 2021). This shift reflects how the emergence of the pandemic as more than a health crisis did not translate into policies based on a transdisciplinary understanding of the crisis as a complex system, nor into the prioritisation of long-term thinking. Facilitating a knowledge integration processes Our reflections are in line with some ongoing research questions found in literature on transdisciplinary research about facilitating knowledge co-production and integration processes. The need for socially robust knowledge to navigate complex real-world problems through the integration of theory and practice has been a main driver of transdisciplinary research approaches (e.g. Van Kerckhoff, 2005; Klein, 2005 ; Pohl et al., 2017 ; Klein, 2020 ; Pohl et al., 2021 ; Scholz et al., 2024 ). Different methods of integration have been described such as ‘weaving’ or ‘consensus’ (cfr. Pohl et al. 2021 ), and these imply different ways of stakeholder interactions ranging from informing to empowering activities (Stauffacher et al. 2008). Working in a diverse group brings about a linguistic challenge that the facilitator must be attentive to. We experienced firsthand that the transdisciplinary context makes communication even more difficult if people do not in some way speak the same language, i.e. share an understanding of concepts. The facilitator must be able to navigate differences and nuances of understanding that each person brings in to facilitate a knowledge integration process. In literature this role has been described as the “integration expert” (Hoffmann et al., 2022 ). This is a person capable of building bridges, crossing boundaries, mediating conflicts, translating different perspectives, evaluating, facilitating and contributing to integrative processes (p.3). Limitations With only 3 non-Flemish stakeholders out of 30, our participants are not representative of the entire Belgian population. Our results must therefore be interpreted as Belgium’s pandemic preparedness evaluated through the eyes of the Flemish population. In this regard the CPP learning team was able to strike a better balance, consisting of members from all Belgian regions. Handing back our results to them therefore provides an opportunity for further review of the gaps with a regionally more diverse group. Additionally, the sample size of 30 is perhaps too small for reliable results. However, this number was close to the maximum number of participants we could accommodate taking into account that we had little previous experience with facilitating we felt that it would be better to facilitate groups in pairs. A smaller group size allows for active participation and more meaningful discussion, yet will require more facilitators for bigger samples. This leads to a fundamental question about inclusivity in transdisciplinary research. During our reflections we talked about as one of us summarised: “how to do [transdisciplinary research] in an optimal way” (Author 2): Yes, we did a workshop and we invited as many participants as we could. But the participants that we invited were mostly from an academic background, were representatives of very big companies. Does that make our project transdisciplinary? Because I thought the idea of transdisciplinarity is [that] you try and get the voices that aren't easily heard, to get them into the decision making processes. (Author 1, own addition) Perhaps a first condition is that “the voices that are not being heard need to want to be heard” (JL). We did not set out to exclude particular profiles, and invited many diverse backgrounds to our workshop, but not everyone who was invited was able to participate. We invested a lot of effort in identifying and contacting stakeholders outside of academia and beyond the already listed stakeholder group of the project. We assume that this representation bias is due to obvious barriers such as lack of time, language, resources. For example the absence of stakeholders who had a stake in economic resilience can be due to the fact that they had suffered a lot of economical losses from the restrictive measures of the first wave and could not afford to spend half a day taking part in a workshop. In hindsight we believe that an additional investment in invitiation methods, besides e-mail could potentially have improved the attendance. Also, a shorter workshop may have made attendence more attractive. However, we were able to organise an online workshop in line with the restrictions that brought together a diverse and manageable number of participants to run the co-creation workshop effectively. The future of pandemic preparedness Future research on pandemic preparedness could be inspired by our workshop, and apply our concepts to other countries. Due to the uniqueness of wicked problems the gaps and underlying causes may differ depending on country and participants. Additionally, further investigation of the gaps list remains possible with a regionally more diverse group of participants. This would provide a deeper understanding of the gaps in pandemic preparedness as experienced by the Belgian population. The methodology may be of value to identify emergent elements in varying gaps across countries that might be crucial to establishing worldwide pandemic preparedness plans. It would also be interesting to explore how this co-creation workshop methodology can be used to study other wicked problems. The results of this workshop have resulted in an enhanced gaps list for the CPP learning team that has been validated by insights and opinions of stakeholders that were not yet included in the original co-creation process of the main project. The CPP learning team has drawn inspiration from this list to formulate recommendations sent to the federal parliament’s special corona commission for future pandemic preparedness. The results have also been incorporated in a policy advice for establishing pandemic preparedness goals [redacted reference]. These reports are available online on the project website: [redacted link] Conclusion The COVID-19 pandemic caught the Belgian government off-guard. Lessons are to be drawn before the emergence of similar crises in the future to ensure that next time we are prepared. Our study applied a transdisciplinary approach to gain a more in-depth understanding of the complexity of Belgium’s pandemic preparedness. We conclude that the country was ill-prepared to tackle the complexity of a pandemic due to a lack of transdisciplinarity, lack of involvement of social sciences in decision making processes, pandemic illiteracy, and fragmented authority. The wide array of gaps and deeper causes that were discussed by the groups confirm that the COVID-19 pandemic is a wicked problem in need of a transdisciplinary collaborative approach. To address the wicked problem of pandemic preparedness in a systematic and sustainable way, we must consider these gaps and their causes as an interrelated whole characterised by complex relationships between diverse fields. Rather than addressing gaps of wicked problems as individual problems, addressing their deeper causes is needed (Abson et al., 2016). Such a systems approach requires both top-down and bottom-up support, for which close collaborations between individuals, scientists and policy makers in transdisciplinary and other types of participatory research are needed to share information and seek closer agreements on goals, strategies, and actions (Head, 2022 ). Towards the future the country will have to adopt a systemic approach and invest in adressing their deeper causes: principal agent problems, distrust in authority, government incompetence, apathy, lack of transdisciplinarity. Declarations Data availability The anonymised datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The author(s) declare no competing interests. Ethical statements All data was collected in accordance with the GDPR regulations, as confirmed through the clearance given by the [Name institute’s ethical committee] under the number [file number]. Approval was obtained prior to the workshop on [date]. Verbal informed consent for participation in the workshop, for further academic use of the results. Consent was collected from all participants on the day of the workshop (27/03/2021), before starting the activities. Participants were assured no personal identifiers would be published. Supplementary Information For supplementary materials we refer to the document ‘CPP supplementary information’ supplied with this manuscript. Author contributions All authors have read and agreed to the submission of the latest version of the manuscript. The authors have made various substantial contributions to the research as detailed below. Author 1, Author 2, author 3, author 4, author 5, author 6, author 7 and author 8 contributed equally to the research conception, research design, data acquisition, data analysis. Author 9, author 10, author 11, and author 12 have jointly supervised the research and supported the design of the research, data acquisition, and data analysis. A first draft of the manuscript was jointly written by author 1, author 2, author 3, and author 4 in the summer of 2021. Author 1 and 12 thoroughly revised and rewrote the manuscript together in 2024. They are corresponding authors. Acknowledgements The student team would like to express great appreciation for the opportunity, support and guidance by the [name research institute], the CPP learning team, and the Honours programme organisers. We send our gratitude to the students who participated to our test run of the workshop, amongst whom were many of our friends and colleagues. We thank the participants for their valuable contribution during the co-creation workshop. A special thank you goes out to [redacted name], who joined from the CPP learning team to fill in as a facilitator during the workshop. References Abson DJ, Fischer J, Leventon J, Newig J, Schomerus T, Vilsmaier U, von Wehrden H, Abernethy P, Ives CD, Jager NW, Lang DJ (2017) Leverage points for sustainability transformation. Ambio 46(1):30–39. https://doi.org/10.1007/s13280-016-0800-y Alford J, Head BW (2017) Wicked and less wicked problems: A typology and a contingency framework. Policy Soc 36(3):397–413. https://doi.org/10.1080/14494035.2017.1361634 Ali N, Islam F (2020) The effects of air pollution on COVID-19 infection and mortality: a review on recent evidence. Front Public Health 8:580057. https://doi.org/10.3389/fpubh.2020.580057 Armbruster S, Klotzbücher V (2020) Lost in lockdown? Covid-19, social distancing, and mental health in Germany. Albert-Ludwigs-Universität Freiburg, Wilfried-Guth-Stiftungsprofessur für Ordnungs- und Wettbewerbspolitik, Freiburg i. Br:34. https://doi.org/10.13140/RG.2.2.17900.39043 Auld G, Bernstein S, Cashore B, Levin K (2021) Managing pandemics as super wicked problems: Lessons from, and for, COVID-19 and the climate crisis. Policy Sci 54(4):707–728. https://doi.org/10.1007/s11077-021-09442-2 Beyer RM, Manica A, Mora C (2021) Shifts in global bat diversity suggest a possible role of climate change in the emergence of SARS-CoV-1 and SARS-CoV-2. Sci Total Environ 767:145413. https://doi.org/10.1016/j.scitotenv.2021.145413 Braun V, Clarke V, Hayfield N, Terry G (2019) Thematic analysis. In: Liamputtong P (ed) Handbook of research methods in health social sciences, 1st edn. Springer Singapore, Singapore, pp 843–860. https://doi.org/10.1007/978-981-10-5251-4_103 Bushell A (2024) Tackling talent shortages in Europe: Evolving strategies for 2024. TALiNT Partners Insights. Available via Manpowergroup https://insights.talintpartners.com/tackling-talent-shortages-in-europe-evolving-strategies-for-2024/ Accessed on 14 Jan 2025 Canrinus ET, Heijne-Penninga M, Wolfensberger M (2021) About creating community. CoTalent. Available via E-library. https://www.cotalent.eu/wp-content/uploads/2021/01/Creating-Community_English.pdf Accessed 16 Jan 2025 Eronen L, Kokko S, Sormunen K (2019) Escaping the subject-based class: A Finnish case study of developing transversal competencies in a transdisciplinary course. Curriculum J 30(3):264–278. https://doi.org/10.1080/09585176.2019.1568271 Gereffi G (2020) What does the COVID-19 pandemic teach us about global value chains? The case of medical supplies. J Int Bus Policy 3(3):287–301. https://doi.org/10.1057/s42214-020-00062-w Guo Y, Gu K, Garber PA, Zhang R, Zhao Z, Xu L (2024) A comparative analysis of influenza and COVID-19: Environmental-ecological impacts, socioeconomic implications, and future challenges. Biosaf Health 6(6):369–375. https://doi.org/10.1016/j.bsheal.2024.10.001 Head BW (2022) Political governance of wicked problems. Wicked problems in public policy, 1st edn. Palgrave Macmillan, Cham, pp 37–60. https://doi.org/10.1007/978-3-030-94580-0_3 Heijne-Penninga M, Wolfensberger M (2018) Creating community as a teaching strategy for honors students. J Eur Honors Counc 2(1):1–5. https://doi.org/10.31378/jehc.8 Hoffmann S, Deutsch L, Klein JT, O’Rourke M (2022) Integrate the integrators! A call for establishing academic careers for integration experts. Humanit Soc Sci Commun 9(1):1–10. https://doi.org/10.1057/s41599-022-01138-z International Labour Organization (2020) Almost 25 million jobs could be lost worldwide as a result of COVID-19, says ILO. International Labour Organization: https://www.ilo.org/resource/news/almost-25-million-jobs-could-be-lost-worldwide-result-covid-19-says-ilo-0 Ivanov D (2021) Supply chain viability and the COVID-19 pandemic: A conceptual and formal generalisation of four major adaptation strategies. Int J Prod Res 59(12):3535–3552. https://doi.org/10.1080/00207543.2021.1890852 Keogh-Brown MR, Wren-Lewis S, Edmunds WJ, Beutels P, Smith RD (2010) The possible macroeconomic impact on the UK of an influenza pandemic. Health Econ 19(11):1345–1360. https://doi.org/10.1002/hec.1554 Klasche B (2021) After COVID-19: What can we learn about wicked problem governance? Soc Sci Humanit Open 4(1):100173. https://doi.org/10.1016/j.ssaho.2021.100173 Klein JT (2005) Integrative learning and interdisciplinary studies. Peer Rev 7(4):8–10 Klein JT (2020) Sustainability and collaboration: Crossdisciplinary and cross-sector horizons. Sustainability 12(4). https://doi.org/10.3390/su12041515 . Article 4 [Redacted reference] Levin K, Cashore B, Bernstein S, Auld G (2012) Overcoming the tragedy of super wicked problems: Constraining our future selves to ameliorate global climate change. Policy Sci 45(2):123–152. https://doi.org/10.1007/sl 1077-012-9151-0 Luyten J, Schokkaert E (2022) Belgium’s response to the COVID-19 pandemic. Health Econ Policy Law 17(1):37–47. https://doi.org/10.1017/S1744133121000232 McGunagle D, Zizka L (2020) Employability skills for 21st-century STEM students: The employers’ perspective. High Educ Skills Work-Based Learn 10(3):591–606. https://doi.org/10.1108/HESWBL-10-2019-0148 Mormina M, Müller B, Caniglia G, Engebretsen E, Löffler-Stastka H, Marcum J, Mercuri M, Paul E, Pfaff H, Russo F, Sturmberg J, Tretter F, Weckwerth W (2024) Where to after COVID-19? Systems thinking for a human-centred approach to pandemics. Humanit Soc Sci Commun 11(1):1–7. https://doi.org/10.1057/s41599-024-03246-4 OECD (2020) Addressing societal challenges using transdisciplinary research/ OECD Science. Technol Ind Policy Papers 88:1–80. https://doi.org/10.1787/0ca0ca45-en OECD (2023) Evaluation of Belgium’s COVID-19 responses: Fostering trust for a more resilient society. https://doi.org/10.1787/990b14aa-en . OECD:1-291 Oyebode O, Ndulue C, Adib A, Mulchandani D, Suruliraj B, Orji FA, Chambers CT, Meier S, Orji R (2021) Health, psychosocial, and social issues emanating from the COVID-19 pandemic based on social media comments: Text mining and thematic analysis approach. JMIR Med Inf 9(4):e22734. https://doi.org/10.2196/22734 Pasquini-Descomps H, Brender N, Maradan D (2017) Value for money in H1N1 influenza: A systematic review of the cost-effectiveness of pandemic interventions. Value Health 20(6):819–827. https://doi.org/10.1016/j.jval.2016.05.005 Pohl C (2020) Actor constellation. In: td-net toolbox for co-producing knowledge. Swiss Academies of Arts and Sciences. Available via Zenodo. https://doi.org/10.5281/zenodo.3716720 Accessed 20 Jan 2025 Pohl C, Klein JT, Hoffmann S, Mitchell C, Fam D (2021) Conceptualising transdisciplinary integration as a multidimensional interactive process. Environ Sci Policy 118:18–26. https://doi.org/10.1016/j.envsci.2020.12.005 Pohl C, Krütli P, Stauffacher M (2017) Ten reflective steps for rendering research societally relevant. GAIA 26:43–51. https://doi.org/10.14512/gaia.26.1.10 Pohl C, Krütli P, Stauffacher M, Modolo L (2018) Teaching transdisciplinarity appropriately for students’ education level. GAIA 27(2):250–252. https://doi.org/10.14512/gaia.27.2.14 Pohl C, Truffer B, Hirsch-Hadorn G (2017) Addressing wicked problems through transdisciplinary research. In: Frodeman R (ed) The Oxford handbook of interdisciplinarity, 2nd edn. Oxford University Press, Oxford, pp 319–331. https://doi.org/10.1093/oxfordhb/9780198733522.013.26 Pohl C, Wuelser G (2019) Methods for coproduction of knowledge among diverse disciplines and stakeholders. Strategies for team science success, 1st edn. Springer, Cham, pp 115–121. https://doi.org/10.1007/978-3-030-20992-6_8 Remington-Doucette SM, Connell KYH, Armstrong CM, Musgrove SL (2013) Assessing sustainability education in a transdisciplinary undergraduate course focused on real-world problem solving: A case for disciplinary grounding. Int J Sustain High Educ 14(4):404–433. https://doi.org/10.1108/IJSHE-01-2012-0001 Rittel HWJ, Webber MM (1973) Dilemmas in a general theory of planning. Policy Sci 4(2):155–169. https://doi.org/10.1007/BF01405730 Roy SG, de Souza SP, McGreavy B, Druschke CG, Hart DD, Gardner K (2020) Evaluating core competencies and learning outcomes for training the next generation of sustainability researchers. Sustain Sci 15(2):619–631. https://doi.org/10.1007/s11625-019-00707-7 Schiefloe PM (2021) The corona crisis: A wicked problem. Scand J Public Health 49(1):5–8. https://doi.org/10.1177/1403494820970767 Scholz RW, Zscheischler J, Köckler H, Czichos R, Hofmann KM, Sindermann C (2024) Transdisciplinary knowledge integration – PART I: Theoretical foundations and an organizational structure. Technol Forecast Soc Change 202:123281. https://doi.org/10.1016/j.techfore.2024.123281 Stockman M, Plasència A, Larson H, Lin L, Ana A, Drost J, Froeschl G, Skordis J, Vandamme AM (2024) EGHRIN conclusions on pandemic preparedness: No whole-of-society approach without society. BMC Health Serv Res 24(1):1561. https://doi.org/10.1186/s12913-024-12104-7 Sultana F (2021) Climate change, COVID-19, and the co-production of injustices: A feminist reading of overlapping crises. Soc Cult Geogr 22(4):447–460. https://doi.org/10.1080/14649365.2021.1910994 van Kerkhoff L (2005) Integrated research: Concepts of connection in environmental science and policy. Environ Sci Policy 8(5):452–463. https://doi.org/10.1016/j.envsci.2005.06.002 Van Poel E, Vanden Bussche P, Pétré B, Ponsar C, Collins C, De Jonghe M, Donneau AF, Gillain N, Guillaume M, Willems S (2024) Quality of care in Belgian general practices during the COVID-19 pandemic: Results of the cross-sectional PRICOV-19 study. BMC Prim Care 24(1):282. https://doi.org/10.1186/s12875-024-02305-8 Wolfensberger MVC (2012) Teaching for excellence: Honors pedagogies revealed. Waxmann World Economic Forum (2025) The future of jobs report 2025. World Economic Forum :1–290. https://www.weforum.org/reports/the-future-of-jobs-report-2023 World Health Organisation (2018) Essential steps for developing or updating a national pandemic influenza preparedness plan. World Health Organisation :1–12. https://www.who.int/publications/i/item/WHO-WHE-IHM-GIP-2018.1 Tables Tables 1 to 5 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files CPPSupplementaryInformation.docx Tables.docx Cite Share Download PDF Status: Under Review Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5932329","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":420348478,"identity":"9b2824f5-b70c-4623-9a1b-700995c8d6a9","order_by":0,"name":"Jan-Peter Sandler","email":"data:image/png;base64,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","orcid":"","institution":"KU Leuven","correspondingAuthor":true,"prefix":"","firstName":"Jan-Peter","middleName":"","lastName":"Sandler","suffix":""},{"id":420348479,"identity":"16dc476f-61c7-44d9-80ba-ce300497ca3a","order_by":1,"name":"Tam Nguyen","email":"","orcid":"","institution":"KU Leuven","correspondingAuthor":false,"prefix":"","firstName":"Tam","middleName":"","lastName":"Nguyen","suffix":""},{"id":420348480,"identity":"52dec9d8-d6af-4fba-86fc-b291cbc8cb20","order_by":2,"name":"Angelina Konnova","email":"","orcid":"","institution":"University of Antwerp","correspondingAuthor":false,"prefix":"","firstName":"Angelina","middleName":"","lastName":"Konnova","suffix":""},{"id":420348481,"identity":"4edecd89-3cd9-4b88-98f4-c0bf5c20e3db","order_by":3,"name":"Ramila Mennens","email":"","orcid":"","institution":"KU Leuven","correspondingAuthor":false,"prefix":"","firstName":"Ramila","middleName":"","lastName":"Mennens","suffix":""},{"id":420348482,"identity":"e15daacc-4162-4a88-914d-ef0bd49a56df","order_by":4,"name":"Séverine Bouvy","email":"","orcid":"","institution":"KU Leuven","correspondingAuthor":false,"prefix":"","firstName":"Séverine","middleName":"","lastName":"Bouvy","suffix":""},{"id":420348483,"identity":"9ac77942-d4ec-4b48-80c5-8aa97ccefc93","order_by":5,"name":"Lise Ceulemans","email":"","orcid":"","institution":"KU Leuven","correspondingAuthor":false,"prefix":"","firstName":"Lise","middleName":"","lastName":"Ceulemans","suffix":""},{"id":420348484,"identity":"2d465548-f109-409e-86af-17044e846263","order_by":6,"name":"Maria Nankova-Douglas","email":"","orcid":"","institution":"KU Leuven","correspondingAuthor":false,"prefix":"","firstName":"Maria","middleName":"","lastName":"Nankova-Douglas","suffix":""},{"id":420348485,"identity":"3ef42b62-02b5-46aa-90a7-bb7f88336ea5","order_by":7,"name":"Tim Van Laere","email":"","orcid":"","institution":"KU Leuven","correspondingAuthor":false,"prefix":"","firstName":"Tim","middleName":"Van","lastName":"Laere","suffix":""},{"id":420348486,"identity":"f03be96f-a51d-4e83-b6c0-f96a4e556a38","order_by":8,"name":"Jef Baelen","email":"","orcid":"","institution":"KU Leuven","correspondingAuthor":false,"prefix":"","firstName":"Jef","middleName":"","lastName":"Baelen","suffix":""},{"id":420348487,"identity":"3aef568b-f244-4788-8b2a-ff690e2cdac9","order_by":9,"name":"Joachim Langeraet","email":"","orcid":"","institution":"KU Leuven","correspondingAuthor":false,"prefix":"","firstName":"Joachim","middleName":"","lastName":"Langeraet","suffix":""},{"id":420348488,"identity":"8675a1bb-eb65-42d9-8afc-9751b8b218a5","order_by":10,"name":"Pieter Thyssen","email":"","orcid":"","institution":"KU Leuven","correspondingAuthor":false,"prefix":"","firstName":"Pieter","middleName":"","lastName":"Thyssen","suffix":""},{"id":420348489,"identity":"5996840c-39e9-49dc-bd30-90d0be66569e","order_by":11,"name":"Anne-Mieke Vandamme","email":"","orcid":"","institution":"KU Leuven","correspondingAuthor":false,"prefix":"","firstName":"Anne-Mieke","middleName":"","lastName":"Vandamme","suffix":""}],"badges":[],"createdAt":"2025-01-30 19:23:27","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5932329/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5932329/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":77715009,"identity":"00fe18d6-8abe-4dc3-bf6f-6c4f2434edab","added_by":"auto","created_at":"2025-03-04 13:52:32","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":5273293,"visible":true,"origin":"","legend":"\u003cp\u003eA visualisation of the deeper causes of gaps in relation to their gaps. On the left side of the figure the thematic deeper causes are listed, while on the right side all gaps of the renewed gaps list are added. The arrows in between show that there are different deeper causes underlying a single gap and that many gaps share similar deeper causes. (Created with Miro.com)\u003c/p\u003e","description":"","filename":"CPPFigure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5932329/v1/734be4d42ab8036cce0bf817.jpg"},{"id":77716906,"identity":"697c853f-ac1d-4770-a72f-7c4da6123c01","added_by":"auto","created_at":"2025-03-04 14:24:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":5985157,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5932329/v1/7c2fc232-0243-4f03-83b4-44f1ad6e4a33.pdf"},{"id":77715004,"identity":"9b990373-aa5a-44f3-82bd-f2af6104699a","added_by":"auto","created_at":"2025-03-04 13:52:32","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":942387,"visible":true,"origin":"","legend":"","description":"","filename":"CPPSupplementaryInformation.docx","url":"https://assets-eu.researchsquare.com/files/rs-5932329/v1/67f176ccd6b82696a401e82e.docx"},{"id":77715032,"identity":"b5391aa4-4cbe-49e9-bc3d-b44284a75096","added_by":"auto","created_at":"2025-03-04 13:52:33","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":22790727,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-5932329/v1/07456a40fc18ca75f98220bb.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Integrative learning through student-led transdisciplinary investigation of Belgium’s COVID-19 pandemic preparedness","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe COVID-19 pandemic caught the world off guard despite humanity\u0026rsquo;s past experiences with deadly disease outbreaks. Prior to COVID-19, pandemic preparedness plans included installing pathogen surveillance and infection control measures aimed to minimise the number of infected people to reduce morbidity, mortality, and social disruption (World Health Organisation, 2018; Public Health England, 2014; Government of Canada, 2018). Yet, the pandemic and the strong restrictive measures introduced by authorities also had a significant effect on the global economy (International Labour Organisation, 2020). Recently, Stockman and colleagues argued for a transition from epidemiology-centred strategies for pandemic preparedness, to an approach that encompasses the societal and cultural interests in addition to healthcare concerns for a multifaceted pandemic preparedness plan (Stockman et al., 2024). Pandemic preparedness plans lacked comprehensive assessments of the impacts beyond the health sector such as economic and social impacts, and considerations of the various costs and benefits of such strategies to different sectors of the economy and socioeconomic classes (Keogh-Brown et al., 2010; Pasquini-Descomps et al., 2017). Other than public health and economic issues, there was a global rise in psychological distress caused by fear of infection, sudden disruption of daily activities, and loss of family and friends amongst others (Oyebode et al., 2021; Armbruster \u0026amp; Klotzb\u0026uuml;cher, 2020).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThrough the unfolding of the effects of the pandemic, researchers have drawn comparisons between the climate crisis and the COVID-19 pandemic, conceptualising both as wicked problems (e.g. Schiefloe, 2020; Auld et al. 2021; Klasche, 2021; Sultana, 2021). Wicked is understood as a problem resisting definition and solving due to its complexity. The term was coined in 1973 by planning scientists Rittel and Webber (1973) and has been further elaborated more recently (Alford \u0026amp; Head, 2017). A wicked problem continuously evolves and requires an adaptive approach. For example, the COVID-19 crisis started as a health-crisis, but quickly became a plethora of different crises such as mental health and economic crisis. Attempts to solve a wicked problem inevitably make it turn into a different problem. This evolving nature calls for a different approach to problem-framing, problem-analysis, and (re)solving that relies on a deep understanding of the components and dynamics that make up the problem, which we understand as systems knowledge. Through systems knowledge it becomes possible to identify important factors to be addressed for change. This type of knowledge requires researchers to have a wide understanding of the problem, which can be achieved through participatory research such as transdisciplinary research approaches where lived experience and scientific knowledge are integrated (Pohl et al., 2021).\u003c/p\u003e\n\u003cp\u003eThis study presents a student-led transdisciplinary learning project performed in an honours degree context at [Redacted Institution]. The authors explored the gaps in Belgium\u0026rsquo;s pandemic preparedness and response during the period of the first year of the pandemic. They designed, organised and facilitated an online co-creation workshop. The results of this student project provide an elaboration on how Belgium\u0026rsquo;s pandemic preparedness plans can be enhanced to take into account and prepare the wide array of dimensions affected. We also illustrate our reflections on participating in a transdisciplinary honours program.\u003c/p\u003e\n\u003cp\u003eTransdisciplinary honours education focusses on fostering an appreciation of systemic relationships and interpersonal dynamics, prioritising competences such as innovation-, critical thinking-, and collaboration competences (Eronen et al., 2019; OECD, 2020; Remington‐Doucette et al., 2013; Pohl et al., 2018). In this light transdisciplinary education has gained recognition as one promising approach to prepare students for their future careers (Roy et al., 2020; World Economic Forum (WEF), 2025) as employers seek employees who possess the competences to navigate the complex changes in society (Bushell, 2024; McGunagle \u0026amp; Zizka, 2020; WEF, 2025). Honours pedagogy makes the learning experience deeper, more meaningful, and transformative (Wolfensberger, 2012) by offering bounded freedom (Kingma et al., 2018), engendering academic competences (Canrinus et al., 2020), and creating a committed community (Heijne-Penninga \u0026amp; Wolfensberger, 2018; Canrinus et al., 2021).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eBackground of the research\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn February 2020, [a redacted research institution] set up a transdisciplinary research project with a transdisciplinary learning team to learn lessons from the COVID-19 pandemic while it unfolded, in order to be better prepared for a next pandemic. We will refer to this team as the COVID-19 Pandemic Preparedness (CPP) learning team. The goal was not to make an impact on the COVID-19 pandemic, but to learn from this pandemic and push society towards a gradual transformation to become more resilient and ready for future pandemics. During the first wave of infections (March-September 2020), the CPP learning team compiled their systems knowledge into a list of twenty gaps in Belgium\u0026rsquo;s pandemic preparedness (table 1). In October 2020, a group of students from [redacted name of programme] was invited to join the project (October 2020 \u0026ndash; May 2021), we call this team CPP student team.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e[Table 1]\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis paper describes the transdisciplinary project of the CPP student team, who are also the authors of this paper. Through following [redacted name of programme] workshops and interacting with the CPP learning team they decided upon their objective to obtain stakeholder-validated systems knowledge of what went wrong during the COVID-19 pandemic through a co-creation workshop. The CPP student team sought to explore the following research questions:\u003c/p\u003e\n\u003cp\u003eRQ 1: What are the gaps in pandemic preparedness perceived by the Belgian population?\u003c/p\u003e\n\u003cp\u003eRQ 2: What are the underlying causes to Belgium\u0026rsquo;s pandemic preparedness gaps?\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003eThe CPP students were enrolled in the [redacted name of programme] between October 2020 and May 2021. [redacted name of programme]\u0026nbsp;provides students with the opportunity to learn about transdisciplinary research by offering a challenge-based approach, asking student teams to address a specific wicked challenge, in this case pandemic preparedness. Throughout the academic year the students meet with their coaches on a weekly basis and participate in several workshops on problem framing, systems thinking, and futures thinking during which they do exercises for co-creating knowledge around their challenge. They also learn how to involve stakeholders at multiple levels. These workshops are linked to the research approach used by [redacted name of research institute] named [redacted research approach name]. This approach consists of an iterative cycle for transdisciplinary research to generate three types of knowledge: systems (what is?), target (what should be?), and transformation (how to get there?) (Pohl \u0026amp; Wuelser, 2019). DF3 is an adaptation of the 10 reflective steps approach for transdisciplinary research described by Pohl and colleagues (2017). By taking their challenge through this framework and designing and executing an “action” (in this case the co-creation workshop with stakeholders) related to their challenge, the students are ‘learning by doing’.\u003c/p\u003e\n\u003cp\u003eThe CPP student group consisted of one bachelor’s, one doctoral, and six master’s students from the [redacted name of university] (7 students) and the [redacted name of university] (one student). The team was supported by three coaches: 2 master’s students and one postdoctoral researcher, who was also a member of the CPP learning team. The group covered diverse disciplinary fields of knowledge with philosophy, business administration, medicine and health sciences, intellectual property and ICT law, business engineering, data science and biostatistics, biomedical sciences, social sciences and clinical and epidemiological virology all being represented by different members.\u003c/p\u003e\n\u003cp\u003eThe CPP learning team went through a total of three iterations of the DF3 and collaborated with the students during the second iteration to enhance and validate the systems knowledge of gaps in pandemic preparedness through stakeholder interaction.\u0026nbsp;The results of the CPP learning team are available online at\u0026nbsp;[Redacted link]. The CPP student team supported the CPP learning team’s research by validating the systems knowledge through stakeholder interaction.\u003c/p\u003e\n\u003cp\u003eThe CPP student team designed, prepared and facilitated an online knowledge co-creation workshop through Zoom. The aim was to discuss, refine and validate the list of gaps in pandemic preparedness (Figure 1) with diverse stakeholder groups. Before the workshop, stakeholders were provided information about the gaps list through an introductory video and stakeholder guide. The video can be viewed here: \u003cu\u003e[Redacted link]\u003c/u\u003e the stakeholder guide can be found online in supplementary doc. S1.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRelevant categories of stakeholders were identified through an actor constellation exercise inspired by the methodology described by (Pohl, 2020), a copy of the resulting actor constellation can be found in Supplementary fig. S2 online. Individuals in these categories were identified through internet search, and from a list of stakeholders known to the CPP learning team. 158 stakeholders were then invited through e-mail, using addresses publicly available online. For missing categories, we asked stakeholders if they knew someone in those categories who we might contact.\u0026nbsp;The stakeholder’s invitation email can be found in Supplementary Document S3 online.\u003c/p\u003e\n\u003cp\u003eThirty-two stakeholders accepted the invitation, which is a response rate of 20%, and 30 took part in the workshop.\u0026nbsp;The participating stakeholders’ backgrounds covered the domains of Medical research (5 stakeholders, or SH), Healthcare (5 SH, which included a patient), Medicine (2 SH); mental health (2 SH), business and economics (5 SH), social sciences (5 SH), law and politics (2 SH), and others (4 SH). The entire overview of participants including their demographics can be found Supplementary Table S4. Participants were predominantly from Flanders (27 SH), with a few participants from Brussels (1 SH) and Wallonia (2 SH). The predominance of Flemish stakeholders is most likely due to the location of the university in Flanders and possible language barriers as invitations were sent in Dutch and English, while French is the most prevalent language in Wallonia and Brussels\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe stakeholders were divided into 5 groups of 6 individuals which were each guided by two facilitators from the CPP student team. Special attention was given that each group had a maximum diversity of stakeholders to encourage discussions among people with different mindsets. The team constitutions are displayed in table 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e[Table 2]\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eWorkshop design\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eDue to the COVID-19 pandemic restrictions, an in-person meeting with all stakeholders was not possible, so we organised it online through Zoom. The\u0026nbsp;CPP student team designed three 45-minute exercises to guide a focus group discussion around the gap list and further knowledge co-creation using Miro, an online whiteboard software for collaboration (\u003cu\u003ewww.Miro.com\u003c/u\u003e). The workshop was facilitated by members of the CPP student team. In the first exercise the gaps list (Figure 1) was provided and discussed, in the second exercise one of the gaps was discussed more deeply and in the third exercise all the gaps including eventual newly identified gaps were used once more. These exercises were tested in a pilot run with students of [redacted name programme] and several friends two weeks before the workshop took place. This provided the opportunity to spot any remaining issues that may have been overlooked and get a first experience of the dynamics and how to facilitate the exercises.\u003c/p\u003e\n\u003cp\u003eEach exercise was followed by a 10–15-minute break, during which the results would be gathered from each group's board by the CPP student team to be shared in\u0026nbsp;the\u0026nbsp;plenary, allowing participants to learn about and react to the other group’s results. This gives insight into how the other groups are solving the exercises and how diverse answers can be. This process was repeated for each of the exercises. All groups performed the same exercises.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eExercises\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe first exercise aimed to assess stakeholders’ reactions and opinions about the existing list of gaps that the CPP learning team had compiled. First, participants were asked to share their feedback about the list of gaps, which had been shared in advance and was also visible on the Miro board. At this stage participants could add missing gaps to the list. Next, the group voted for a top three most important gaps. These would then be used as the starting point in the next exercise. To prepare the group a scaffolding task for ranking the societal importance of gaps was done before voting.\u003c/p\u003e\n\u003cp\u003eIn the second exercise participants had to identify the deeper cause(s) of the top three gaps. The image of a waterfall was used as a metaphor: ‘We are searching for the source’. Starting from one of the team’s most important gaps, participants moved up towards the source by writing down and explaining the deeper causes behind the gap on sticky notes. The participants would first write down causes individually, before discussing the answers collectively, bringing together the causes that were similar. When the discussion reached a point of saturation, the team moves on to the next level to identify possible causes for the causes. In this way, deeper, and underlying issues were identified by the team every level they went up. Once the team reached a point of saturation (when no deeper causes could be found anymore) they had found one or possibly a few of the deepest causes of the gap.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn the third exercise, all the gaps from the list were grouped by their deeper causes. Participants could use the deeper causes they had uncovered in the previous exercise, come up with new ones or use some of deeper causes proposed by the CPP student-facilitators based on feedback from the CPP learning team. This exercise relied on group discussion, and in most groups the facilitator would take charge of editing the Miro board. An example image of a complete Miro board is available in Supplementary fig. S5.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData analysis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe employed thematic analysis (Braun et al., 2019) to examine the groups’ responses to the exercises. The analysis was based on an inductive process, meaning that no predefined themes were established prior to the analysis. Instead, themes emerged organically from the data itself. This approach allows for a richer understanding of the gaps that aligns closely with the participants’ responses, which was suitable for our goal to openly explore and elaborate on the gaps in Belgium’s pandemic preparedness with diverse stakeholders, and to uncover deeper causes to the gaps.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe analysis was performed in two steps: first two students of the student team compiled the responses and started coding responses looking for emergent themes. These coding and themes were then presented for verification and further refinement to the other team members in a second iteration.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStudent reflections\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAs part of the [redacted name programme] students present their project and reflect on their transdisciplinary learning experience during the [redacted name] symposium [redacted link] at the end of the academic year. This presentation has been captured on video and transcribed.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThis chapter is divided into two parts, presenting the results of exercise one first, and exercise two and three next. Each part seeks to answer one research question. All responses to the exercises by each group have been added in this article or are available as supplementary tables online (Supplementary Table 6 and 7). The analysis of the exercise results is structured according to how they address the research questions. The first exercise relates to the gaps in the Belgian pandemic preparedness, as perceived by our group of stakeholders, addressing the first research question. Exercises two and three were designed around research question 2 aiming to uncover deeper causes behind the gaps.\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eExercise 1: Analysis of the gaps list and most important gaps\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eThe first exercise resulted in the confirmation of the 20 proposed gaps, and the discovery of three new gaps.\u0026nbsp;The results of the exercise of each group can be found in supplementary materials (cfr. Supplementary Table S6). The first new gap was \u0026ldquo;the insufficient involvement of, communication with, and funding for primary care workers working with infected patients\u0026rdquo;. Second, \u0026ldquo;the lack of strategic logistical supply chains for medical equipment and household products\u0026rdquo;. Third, \u0026ldquo;the lack of preventing pandemic events by taking care of our ecological environment, because massive deforestation and large-scale animal industry bring humans into contact with animal virus populations more frequently\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eOther reported missing gaps were similar to gaps already in the list, enhancing their understanding. We present here how these discussions led to reinterpreting the gaps and in some cases also reformulation. For the purpose of the article, we elaborate on four gaps which were reported as missing gaps, but which after lengthy discussions in all groups appeared to relate to existing gaps in the original list. This discussion was very informative to reinterpret and reformulate the original gap. These four gaps were the lack of transdisciplinarity (gap #1), pandemic illiteracy (Gap #5), lack of involvement of human sciences in decision making processes (Gap #12), and fragmented authority (Gap #9). Other gaps were also discussed in some groups. For example, gap #15 focussed on learning from countries that preceded us in the pandemic (cfr. table 1), while the gaps that were reported missing were \u0026lsquo;[We] don\u0026rsquo;t look to [the] far east for pandemic control, why?\u0026rsquo; and \u0026lsquo;learn from pandemic history\u0026rsquo; pointing towards insufficient learning from previous pandemic events, these were both close to gap #15. Participants discussed the lack of international cooperation emphasising that Belgium did not open itself up towards non-Western countries to learn about how to handle a pandemic, even though especially eastern countries had more recent experience. Not seeking to learn from others also constituted a barrier for cross-border and even cross-regional collaboration and data communication. We reformulated the gap as: \u0026lsquo;Insufficient learning from previous pandemic experience such as other countries or historical pandemics\u0026rsquo;.\u003c/p\u003e\n\u003cp\u003eFirst, the lack of transdisciplinarity relates to gap #1 the absence of a transdisciplinary advisory board for the government\u0026rsquo;s handling of the crisis and gap #3 insufficient funding to explore, test, and implement transdisciplinary approaches, which stakeholders based on observed neglect of diverse information channels that held valuable input for decision making. Some missing gaps which\u0026nbsp;we grouped under this theme were: \u0026lsquo;multidimensional communication strategy\u0026rsquo;, \u0026lsquo;more than just a procurement issue - create an integrated vision away from \u0026apos;crisis mode\u0026apos; reactivity\u0026rsquo;, \u0026lsquo;places to discuss among different fields of science to support decision-making\u0026rsquo;, \u0026lsquo;lack of use of master educated nurses in advisory board\u0026rsquo;, and \u0026lsquo;neglecting student wellness\u0026rsquo;. Additionally, one team mentions the lack of transdisciplinarity in education as a missing gap due to which linear thinking remains prevalent in solution-oriented thinking. Through the input of participants, we reformulate gap #1 to: \u0026lsquo;lack of transdisciplinary collaboration in policy making\u0026rsquo;, including the lack of involving practitioners of affected fields to formulate strategies to handle the crisis and identify a way out.\u003c/p\u003e\n\u003cp\u003eSecond, some missing gaps related to the theme pandemic illiteracy, which was already listed as a gap (#5): \u0026lsquo;accessible and easy to understand information about how the virus spreads and how vaccines work\u0026rsquo;, \u0026lsquo;lack of systemic knowledge of biology\u0026rsquo;, and \u0026lsquo;reflecting on the implication of mass vaccinations vs. emergence of a super-virus\u0026rsquo;. We further specify the gap to \u0026lsquo;pandemic illiteracy in population and decision makers about infectious disease control\u0026rsquo;. In part caused by the lack of involvement of multiple disciplinary fields, and a primary focus on virological knowledge by government officials at the start of the pandemic.\u003c/p\u003e\n\u003cp\u003eThird, different groups mentioned that insufficient attention was given to the legal and psychological aspects of measures such as lockdowns, stay home orders, closing hospitals for non-emergency patients, quarantining or social distancing. This relates to the theme of insufficient involvement of human sciences in designing pandemic measures. It is important for decision makers to take into consideration that measures may also inadvertently affect the population negatively, and to incorporate this into the planning through studies on risk acceptance and proper communication of decisions. These responses add to gap #12: not sufficiently involving human sciences into the design of pandemic measures, but do not require reformulation\u003c/p\u003e\n\u003cp\u003eThe fourth theme to emerge from the groups responses was fragmentation of responsibility, related to the legal gap (#9) in the assignment of and taking up of political responsibility and accountability for pandemic preparedness and response, and responsibility amongst the population. Originally described from a political perspective, referencing the complex political structures of Belgium, the responses add a lack of guidelines and juridical frameworks for crisis situations. The responses grouped under this theme are: \u0026lsquo;lack of financial and juridical framework or clinical nursing specialists\u0026rsquo;, \u0026lsquo;need for more guided interaction between hospitals and other care centres (homes for elderly, ...)\u0026rsquo;, \u0026lsquo;clear role/responsabilities/hierarchies\u0026nbsp;\u0026reg;\u0026nbsp;clear communication\u0026rsquo;, \u0026lsquo;ideology (neoliberal) inhibited strongly the investment in psycho-social \u0026quot;support\u0026quot; and interventions towards the population\u0026rsquo;, \u0026lsquo;the advice was strongly given, repetitively, but not implemented massively\u0026rsquo;, and the \u0026lsquo;lack of commitment of nursing leadership\u0026rsquo;. We reformulate gap #9 as: fragmented authority and responsibility across societal levels.\u003c/p\u003e\n\u003cp\u003eAfter compiling these results with the original gap list, we come to the following renewed list of gaps (table 3). We added the new gaps and elaborated the phrasing of the other gaps to better cover the different viewpoints towards these gaps. This list addresses our first research question, \u0026ldquo;what are the gaps in pandemic preparedness perceived by the Belgian population\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e[Table 3]\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe groups also voted a top three of the most important gaps to be addressed for pandemic preparedness. These were chosen from the existing gaps list and new gaps. The results of these votes are aligned with the four emergent themes we have just described, the most discussed gaps were also seen as the most important gaps. The most important gap (number 1) was clear in each group, while in two groups the second or third most number of votes was shared by two or more gaps. Table 4 displays the results of the voting. These gaps were subsequently used in exercise 2.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e[Table 4]\u003c/strong\u003e\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eExercise 2 and 3: Identifying deeper causes to gaps\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003eWe addressed our second research question using the discussions during the second and third exercises. Each group first discussed the deeper causes behind their most important gap in exercise two. Groups who finished early also identified deeper causes behind the second most important gap. The identified deeper causes in exercise two are listed in table 5 below per group. In exercise 3 groups then discussed and identified whether there are deeper causes shared by many gaps. Starting with the deeper causes identified in the previous exercise. The groups also came up with additional shared deeper causes. The detailed results of exercise 3 can be found in Supplementary Table 7 online. A selected summary is described in the text below.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e[Table 5]\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results from exercise 2 and 3 are addressing our second research question: what are the underlying causes to Belgium\u0026rsquo;s pandemic preparedness gaps according to our stakeholders? The second and third exercise, brought forth a wide array of deeper causes to the gaps in pandemic preparedness that can be grouped into five major groups: principal agent problem (relates to politicians taking decisions in their own interest instead of in the interest of the people they represent) (1), distrust in authority (2), government incompetence (3), apathy, or inconsiderateness for the needs of others, on individual and group level (4), and lack of transdisciplinarity (5).\u003c/p\u003e\n\u003cp\u003eFirst, the groups understood the principal agent relationship of politicians to the public as an unwillingness to take unpopular, yet necessary, preventative actions. Politicians are not prepared, or are not given the opportunity, to learn from mistakes, because unpopular policy decisions required for long-term thinking in the context of a pandemic can be costly in the short term for the approval ratings of politicians. They appear reluctant to admit when they do not know, need help or are making mistakes in trying to address the crises caused by the pandemic. Conversely, unscientific measures with uncertain impact on the spread of COVID also undermined public trust.\u003c/p\u003e\n\u003cp\u003eSecond, the distrust in authority was perceived as a deeper cause of the unwillingness amongst the population to listen to and/or follow advice, instructions, and regulations mandated by political or intellectual authorities, such as medical experts and government officials. It was also discussed that disregard for experts and government officials who do not always say or make policy suggestions people feel comfortable with was a deeper cause behind the lack of involvement of human sciences. A comparison was made with the choice for quick and easy meals over healthy foods. Short-term solutions provide only temporary resolvement yet have unwanted consequences in the future.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThird, government incompetence was identified amongst the focus groups as the cause of flawed reasoning, tunnel vision, and short-sighted perspectives from political and bureaucratic leadership. Similar to the principal agent problem this incompetence is perceived as a lack of taking necessary risks and long-term planning, but in this case for the government as an institution rather than the individual politicians who make up the government.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFourth, the apathy (understood as the opposite of sympathy) on individual and group level is perceived as not considering interests of other individuals, groups, or countries. In general, it refers to the tendency to make decisions based on one\u0026apos;s own experiences and feelings and on personal interests and losses. As some of our stakeholders noted at individual scale refusing to wear a mask or not isolating while infected indicated a lack of empathy for others. On a group or national scale this was perceived in cases where countries refused to cooperate or share their knowledge and resources to combat the pandemic.\u003c/p\u003e\n\u003cp\u003eFifth, the lack of transdisciplinarity is understood as the absence of a transdisciplinary mindset, transdisciplinary advisory boards, and funding for transdisciplinary initiatives in pandemic prevention, preparedness and response. Interestingly, this theme was both a gap and now also identified as a cause of other gaps. It envelops a lack of shared understanding that there is no such thing as no-risk in a pandemic event and that shared leadership should be harnessed.\u003c/p\u003e\n\u003cp\u003eThough these deeper causes are here presented separately, they were seen as interconnected by the groups. The groups often identified multiple causes to gaps; with 14 out of 20 gaps having more than one underlying deeper cause. In figure 1, we show how the gaps of the gaps list were linked to the six themes of deeper causes by the groups. It shows for example that the initial lack of transparency of decision-making processes was the result of the principal agent problem, government incompetence, apathy, and distrust in authority.\u003c/p\u003e\n\u003cp\u003eOur learning experience allowed us to build an understanding of pandemic preparedness through a transdisciplinary research project, but through performing the research we also developed a deeper understanding of transdisciplinary research itself. As a group we reflected on whether the workshop could be called a succesful example of transdisciplinarity, the importance of good facilitation for knowledge integration, and whether there are limiting factors to consider.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;We all went beyond our academic backgrounds and tried to find stakeholders, engage with them, also as moderators. I think we had some really interesting discussions, and I think, for me that\u0026apos;s our transdisciplinary achievement. So, I think we succeeded\u0026rdquo; (author 4)\u003c/p\u003e\n\u003cp\u003eA transdisciplinary approach entails the co-production of an understanding beyond the limits of our disciplines. We found that mapping stakeholders in an actor constellation (cfr. supplementary fig. S2) and facilitating a workshop with a diverse group of participants were useful to start thinking beyond the borders of our own disciplines. However, we also found it difficult to moderate and guide the focus group discussions. \u0026ldquo;we really need a good guide, a person that can really guide a transdisciplinary team,\u0026rdquo; because otherwise, \u0026ldquo;it\u0026rsquo;s very difficult to get a meaningful result and a meaningful discussion\u0026rdquo; (author 6). Not only is a meaningful discussion dependent on good facilitation, but \u0026ldquo;it\u0026apos;s also the willingness of everyone else to collaborate and to move forwards and to stop walking in circles and to listen to the opinion of people that differ from our own and to appreciate them and to understand them and to try to agree or disagree with them but in a constructive manner. And I think that something that\u0026apos;s even more valuable than the collection of very intelligent people is the collection of enthusiastic people [...]\u0026rdquo; (author 3).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUp to now our results have shown what knowledge we have gained. But transdisciplinary education also aims to foster the development of future skills and competences in students. It was beyond the scope of this project to study this development in detail, but we do wish to share two exemplary testimonies taken after the course to give readers a feeling of the course\u0026rsquo;s transformative potential.\u003c/p\u003e\n\u003cp\u003eBy working in a transdisciplinary team, I encountered myself. I was confronted with Otherness on a different level than before, breaking through the worldview I had built up over the years about the world, society, and myself. It allowed me to become more open, more communicative, more in-the-world. It empowered me to go beyond what I took as my personal limits and I have not experienced that anywhere else in my higher education curriculum.\u0026nbsp;(Author 1)\u003c/p\u003e\n\u003cp\u003eThanks to the corona pandemic preparedness challenge, I have learned and developed immensely in my communication, critical and systems thinking skills and my understanding of the Belgian society and people. Regarding communication skills, the corona measures have prevented my coaches, teammates and me to have face-to-face conversations, so I have to find ways to communicate efficiently via text messages on Slack and conversations in Zoom meetings. I have noted that it is extremely important to deliver concise and to-the-point messages so that others can pay attention more easily and understand more quickly. Furthermore, I have realized that when debating with my teammates, I need to try my best to see things from their point of view and when I state my opinion, I should concede their points first so that they are more likely to listen and accept my points. With regards to critical and systems thinking skills, I have experienced growth in the way I think about problems, especially complex problems and potential solutions. Before doing the programme, I am quite convinced that the way my country, Vietnam, has been handling the pandemic is an optimal answer to this crisis, but after many in-depth conversations with my team, I have acknowledged that all solutions implemented, while capable of solving the target problem, will give rise to other issues in other areas, and in my country\u0026apos;s case, we have completely ignored mental health and human rights. Moreover, I have profoundly realized that crises are inevitable no matter how well we prepare ourselves, but we can move forward by living more sustainably in order to be more adaptable to our increasingly volatile world. Finally, thanks to this project, I have built meaningful friendships with my Belgian teammates which allow me to understand the reasons behind the diversity as well as the divisive nature of the Belgian society. They have helped me find similarities between their culture and mine and also supported me in my Dutch learning process. All in all, this project has been very enlightening and thoughtprovoking for me, and I genuinely felt that it has enriched my experience as an international student in Belgium. (Author 2)\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eWe here discuss the research results of a student team of [redacted programme information]. This CPP student team worked with a research team that had listed 20 gaps in Belgium\u0026rsquo;s pandemic preparedness (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), focussing on their observations during the first wave of infections in Belgium [redacted webpage]. Through a co-creation workshop with 30 diverse stakeholders, the CPP student team expanded this understanding of gaps in pandemic preparedness at the start of the COVID-19 pandemic, and mapped their deeper causes. Dividing the stakeholders in 5 groups and taking each group through three identical exercises using online Miro boards, facilitators from the CPP student team guided online focus group discussions and subsequently analysed the results of those discussions.\u003c/p\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eLearning from a poor start\u003c/h2\u003e \u003cp\u003eOur results paint a rather negative picture of Belgium\u0026rsquo;s response to the COVID-19 crisis through our study, while later studies appear to have more positive conclusions. For example, in response to the many critiques voiced in Belgian media and social media with regard to how the pandemic was dealt with over the first few years (2020\u0026ndash;2022) the government ordered an independent evaluation of its response by the Organisation for Economic Co-operation and Development (OECD) (OECD; \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). They collaboratively evaluated with the governments and drew \u0026ldquo;on a wide variety of qualitative and quantitative data, including survey data collected from the country\u0026rsquo;s ministries, municipalities, hospitals, general practitioners and schools\u0026rdquo; (p. 4). This wide collaboration for the OECD report after the first few years of the pandemic appears to be in contrast with our finding of a major lack of transdisciplinarity during the first wave. Additionally, the OECD found that \u0026ldquo;Belgium demonstrated economic and social resilience through a whole-of-government response to the crisis that was closely co-ordinated between the federal and federated public authorities. This co-operative approach, in areas including health, education, employment and the economy, enabled Belgium to address and adapt to the considerable challenges of the COVID-19 pandemic\u0026rdquo; (p. 3). So the country did demonstrate at least some exemplary responses such as maintaining and ensuring pedagogical continuity and a robust and adaptive health system that prevented overwhelming of hospitals.\u003c/p\u003e \u003cp\u003eThe timeframe of the evaluations may be a major factor in explaining the difference in tone in our study. The OECD report covers a 4-year period in which the government had time to improve on earlier mistakes, whereas our study only focusses on the first year of the pandemic, and took place when events were still unfolding. The OECD also indicates that Belgium fared rather poorly over the first year of the crisis due to several weaknesses in pandemic preparedness (Luyten \u0026amp; Schokkaert, 2021; OECD, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2023\u003c/span\u003e, p.113). For example, over this period Belgians saw how their politicians were unable to form a majority government, experienced drastic, and unpopular measures being imposed to navigate the crisis by a minority government without widespread political support. Taken that these events took place over a period of only a few months amid a growing crisis and that we collected data just about a year after the first measures were introduced it becomes more understandable why our stakeholders identified government incompetence as a deeper cause of Belgium\u0026rsquo;s pandemic preparedness.\u003c/p\u003e \u003cp\u003eSimilar to our results, the OECD recommends Belgium to improve coordination of government crisis management and whole-of-government approach (2023), as well as: \u0026ldquo;structuring a robust and credible system to provide multidisciplinary science advice in times of crisis\u0026rdquo; (p. 35), and promoting trust, societal resilience, and citizen engagement in \u0026ldquo;the design and implementation of policies\u0026rdquo; (p. 36) which is very similar to the call for more transdisciplinarity, more involvement from human sciences from our stakeholders, and to several other gaps in our list. Another suggestion, to address inequality, was not flagged as a gap by our stakeholders. However, several other major concerns by our stakeholders were not addressed in the OECD report, especially the need to improve pandemic literacy across several layers of the society, including politicians and scientists.\u003c/p\u003e \u003cp\u003eIn summary, although Belgium displayed a good response compared to other countries, our work adds that there is still room for improvement in pandemic preparedness. Belgium may have acted well in response to its initial weaknesses, but we acknowledge that those weaknesses were an indication that the country was not sufficiently prepared.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eLooking back at the gaps list\u003c/h2\u003e \u003cp\u003eOur findings show what must be improved for a next pandemic according to our 30 stakeholders. Compared to the original list of 20 gaps set up by the CPP learning team, three new gaps were identified and other gaps in the gap list were further elaborated by participants, leading to a revised list of 23 gaps (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The most discussed gaps in Belgium\u0026rsquo;s pandemic preparedness relate to a lack of transdisciplinarity (gap #1), pandemic illiteracy (gap # 5), insufficient involvement of human sciences in decision making processes (gap #12), and fragmented authority (gap #9) which align with the problems arising during the unfolding of events throughout the first wave of infections. \u0026lsquo;The lack of involving, communicating and funding primary care workers\u0026rsquo;, \u0026lsquo;the need for strategic logistical supply chains\u0026rsquo;, and \u0026lsquo;the care for the natural environment\u0026rsquo; were three gaps added to the list. In addition, the most important gaps, according to the stakeholders were the same as the most discussed gaps (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA study found that 70% of Belgian general care practices reported at least one safety incident (when a general practitioner is unable to provide treatment in time) due to for example performing consultations on the phone and patients no longer finding their way to the doctor during the first pandemic year (Van Poel et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). This is symptomatic of the first new gap: \u0026lsquo;insufficient involvement of, communication with, and funding for primary care workers\u0026rsquo; which led to problems such as not always being able to follow all safety protocols while trying to maintain a good level of service and quality. The second new gap was also reported by Ivanov (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2021\u003c/span\u003e): it is important to have strategic logistical supply chains in place before the pandemic starts that can keep the provision of medical, food and other necessary commodities running efficiently (Ivanov, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). These shortages resulted from export controls imposed by affected countries (Gereffi, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) and can be addressed through installing more redundancy and reducing the dependency of one or two production locations for more robust and resilient supply chains. The third new gap related to insufficient respect for the natural environment both with respect to pandemic preparedness and pandemic prevention. Indeed, research has already shown relations between the health of our ecological environment, the frequency of zoonotic spillovers and the spread and impact of diseases (Beyer et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). For example, early on during the pandemic positive correlations have also been found between air pollution and transmission rates (Ali \u0026amp; Islam, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), showing how ensuring a healthy environment is an important factor for reducing the impact of pandemic events on society (Guo et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). A symptomatic relationship between two wicked problems is also a typical characteristic of wicked problems (Rittel \u0026amp; Webber, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e1973\u003c/span\u003e, p.165).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003ePandemic preparedness requires systems thinking\u003c/h2\u003e \u003cp\u003eWe argue that addressing pandemic preparedness would require systematically addressing these deeper causes. There is never an end to identifying gaps which are only symptoms of deeper problems that need to be addressed, a hallmark of wicked problems. We did not yet find published reports that search for deeper causes of the gaps in Belgium\u0026rsquo;s pandemic preparedness. Through analysis of the stakeholder group discussions, we found that the gaps of pandemic preparedness are symptomatic of important underlying causes which can be clustered in five emergent themes: principal agent problems, distrust in authority, government incompetence, apathy, and lack of transdisciplinarity (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). All of these themes contribute to the wickedness of the COVID-19 pandemic problem. Participants rarely identified just one linear cause and effect relation between a gap and deeper cause, which might indicate that each gap is a wicked problem by itself. Our focus lay on mapping out the problem of pandemic preparedness. However, future research can look into each of the gaps separately to investigate how they might be symptoms of a wicked problem. Our data suggests that most of the gaps appear to be part of a complex system of interrelated deeper causes.\u003c/p\u003e \u003cp\u003eAuld et al. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) point to four key features that make the COVID-19 pandemic a \u0026ldquo;super wicked problem\u0026rdquo; (Levin et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2012\u003c/span\u003e, p. 124). First, there is an urgency to address the problem, as waiting to intervene results in exponential growth of infections and consequences running out of hand. Second, individual behavioural change is needed to curb the spread of the virus, while individuals are also the cause of the spread. Third, a pandemic does not respect country borders making it a global challenge. However, authoritative powers lie within the national and regional governments, indicating that fragmented authority is a major issue in the face of global crises. Global organisations such as WHO have no power to dictate what countries should do. Fourth, the political decisions irrationally discount the future by rapidly committing to decisions that cover the most direct impacts but discount the ones that are more abstract or indirect. This results in policy decisions inconsistent with scientific evidence on what is required in the long-term. For example, an initial overreliance on epidemiological knowledge indirectly impacted the economy. Measures were redrawn in the summer of 2020 to take this into account but then neglected the warnings of a second wave of infections by virologists and epidemiologists (Schiefloe, 2020; Auld et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Luyten \u0026amp; Schokkaert, 2021). This shift reflects how the emergence of the pandemic as more than a health crisis did not translate into policies based on a transdisciplinary understanding of the crisis as a complex system, nor into the prioritisation of long-term thinking.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eFacilitating a knowledge integration processes\u003c/h2\u003e \u003cp\u003eOur reflections are in line with some ongoing research questions found in literature on transdisciplinary research about facilitating knowledge co-production and integration processes. The need for socially robust knowledge to navigate complex real-world problems through the integration of theory and practice has been a main driver of transdisciplinary research approaches (e.g. Van Kerckhoff, 2005; Klein, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2005\u003c/span\u003e; Pohl et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Klein, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Pohl et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Scholz et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Different methods of integration have been described such as \u0026lsquo;weaving\u0026rsquo; or \u0026lsquo;consensus\u0026rsquo; (cfr. Pohl et al. \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), and these imply different ways of stakeholder interactions ranging from informing to empowering activities (Stauffacher et al. 2008).\u003c/p\u003e \u003cp\u003eWorking in a diverse group brings about a linguistic challenge that the facilitator must be attentive to. We experienced firsthand that the transdisciplinary context makes communication even more difficult if people do not in some way speak the same language, i.e. share an understanding of concepts. The facilitator must be able to navigate differences and nuances of understanding that each person brings in to facilitate a knowledge integration process. In literature this role has been described as the \u0026ldquo;integration expert\u0026rdquo; (Hoffmann et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). This is a person capable of building bridges, crossing boundaries, mediating conflicts, translating different perspectives, evaluating, facilitating and contributing to integrative processes (p.3).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eWith only 3 non-Flemish stakeholders out of 30, our participants are not representative of the entire Belgian population. Our results must therefore be interpreted as Belgium\u0026rsquo;s pandemic preparedness evaluated through the eyes of the Flemish population. In this regard the CPP learning team was able to strike a better balance, consisting of members from all Belgian regions. Handing back our results to them therefore provides an opportunity for further review of the gaps with a regionally more diverse group. Additionally, the sample size of 30 is perhaps too small for reliable results. However, this number was close to the maximum number of participants we could accommodate taking into account that we had little previous experience with facilitating we felt that it would be better to facilitate groups in pairs. A smaller group size allows for active participation and more meaningful discussion, yet will require more facilitators for bigger samples.\u003c/p\u003e \u003cp\u003eThis leads to a fundamental question about inclusivity in transdisciplinary research. During our reflections we talked about as one of us summarised: \u0026ldquo;how to do [transdisciplinary research] in an optimal way\u0026rdquo; (Author 2):\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eYes, we did a workshop and we invited as many participants as we could. But the participants that we invited were mostly from an academic background, were representatives of very big companies. Does that make our project transdisciplinary? Because I thought the idea of transdisciplinarity is [that] you try and get the voices that aren't easily heard, to get them into the decision making processes. (Author 1, own addition)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003ePerhaps a first condition is that \u0026ldquo;the voices that are not being heard need to want to be heard\u0026rdquo; (JL). We did not set out to exclude particular profiles, and invited many diverse backgrounds to our workshop, but not everyone who was invited was able to participate. We invested a lot of effort in identifying and contacting stakeholders outside of academia and beyond the already listed stakeholder group of the project. We assume that this representation bias is due to obvious barriers such as lack of time, language, resources. For example the absence of stakeholders who had a stake in economic resilience can be due to the fact that they had suffered a lot of economical losses from the restrictive measures of the first wave and could not afford to spend half a day taking part in a workshop. In hindsight we believe that an additional investment in invitiation methods, besides e-mail could potentially have improved the attendance. Also, a shorter workshop may have made attendence more attractive. However, we were able to organise an online workshop in line with the restrictions that brought together a diverse and manageable number of participants to run the co-creation workshop effectively.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eThe future of pandemic preparedness\u003c/h2\u003e \u003cp\u003eFuture research on pandemic preparedness could be inspired by our workshop, and apply our concepts to other countries. Due to the uniqueness of wicked problems the gaps and underlying causes may differ depending on country and participants. Additionally, further investigation of the gaps list remains possible with a regionally more diverse group of participants. This would provide a deeper understanding of the gaps in pandemic preparedness as experienced by the Belgian population. The methodology may be of value to identify emergent elements in varying gaps across countries that might be crucial to establishing worldwide pandemic preparedness plans. It would also be interesting to explore how this co-creation workshop methodology can be used to study other wicked problems. The results of this workshop have resulted in an enhanced gaps list for the CPP learning team that has been validated by insights and opinions of stakeholders that were not yet included in the original co-creation process of the main project. The CPP learning team has drawn inspiration from this list to formulate recommendations sent to the federal parliament\u0026rsquo;s special corona commission for future pandemic preparedness. The results have also been incorporated in a policy advice for establishing pandemic preparedness goals [redacted reference]. These reports are available online on the project website: [redacted link]\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe COVID-19 pandemic caught the Belgian government off-guard. Lessons are to be drawn before the emergence of similar crises in the future to ensure that next time we are prepared. Our study applied a transdisciplinary approach to gain a more in-depth understanding of the complexity of Belgium\u0026rsquo;s pandemic preparedness. We conclude that the country was ill-prepared to tackle the complexity of a pandemic due to a lack of transdisciplinarity, lack of involvement of social sciences in decision making processes, pandemic illiteracy, and fragmented authority. The wide array of gaps and deeper causes that were discussed by the groups confirm that the COVID-19 pandemic is a wicked problem in need of a transdisciplinary collaborative approach. To address the wicked problem of pandemic preparedness in a systematic and sustainable way, we must consider these gaps and their causes as an interrelated whole characterised by complex relationships between diverse fields. Rather than addressing gaps of wicked problems as individual problems, addressing their deeper causes is needed (Abson et al., 2016). Such a systems approach requires both top-down and bottom-up support, for which close collaborations between individuals, scientists and policy makers in transdisciplinary and other types of participatory research are needed to share information and seek closer agreements on goals, strategies, and actions (Head, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Towards the future the country will have to adopt a systemic approach and invest in adressing their deeper causes: principal agent problems, distrust in authority, government incompetence, apathy, lack of transdisciplinarity.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe anonymised datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author(s) declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical statements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data was collected in accordance with the GDPR regulations, as confirmed through the clearance given by the [Name institute’s ethical committee] under the number [file number]. Approval was obtained prior to the workshop on\u0026nbsp;[date]. Verbal informed consent for participation in the workshop, for further academic use of the results. Consent was collected from all participants on the day of the workshop\u0026nbsp;(27/03/2021), before\u0026nbsp;starting the activities. Participants were assured no personal identifiers would be published.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSupplementary Information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor supplementary materials we refer to the document ‘CPP supplementary information’ supplied with this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have read and agreed to the submission of the latest version of the manuscript. The authors have made various substantial contributions to the research as detailed below.\u003c/p\u003e\n\u003cp\u003eAuthor 1, Author 2, author 3, author 4, author 5, author 6, author 7 and author 8 contributed equally to the research conception, research design, data acquisition, data analysis.\u003c/p\u003e\n\u003cp\u003eAuthor 9, author 10, author 11, and author 12 have jointly supervised the research and supported the design of the research, data acquisition, and data analysis.\u003c/p\u003e\n\u003cp\u003eA first draft of the manuscript was jointly written by author 1, author 2, author 3, and author 4 in the summer of 2021.\u003c/p\u003e\n\u003cp\u003eAuthor 1 and 12 thoroughly revised and rewrote the manuscript together in 2024. They are corresponding authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe student team would like to express great appreciation for the opportunity, support and guidance by the \u003cstrong\u003e[name research institute],\u0026nbsp;\u003c/strong\u003ethe CPP learning team, and the Honours programme organisers. We send our gratitude to the students who participated to our test run of the workshop, amongst whom were many of our friends and colleagues. We thank the participants for their valuable contribution during the co-creation workshop. A special thank you goes out to \u003cstrong\u003e[redacted name],\u003c/strong\u003e who joined from the CPP learning team to fill in as a facilitator during the workshop.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAbson DJ, Fischer J, Leventon J, Newig J, Schomerus T, Vilsmaier U, von Wehrden H, Abernethy P, Ives CD, Jager NW, Lang DJ (2017) Leverage points for sustainability transformation. Ambio 46(1):30\u0026ndash;39. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s13280-016-0800-y\u003c/span\u003e\u003cspan address=\"10.1007/s13280-016-0800-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlford J, Head BW (2017) Wicked and less wicked problems: A typology and a contingency framework. Policy Soc 36(3):397\u0026ndash;413. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/14494035.2017.1361634\u003c/span\u003e\u003cspan address=\"10.1080/14494035.2017.1361634\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAli N, Islam F (2020) The effects of air pollution on COVID-19 infection and mortality: a review on recent evidence. Front Public Health 8:580057. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpubh.2020.580057\u003c/span\u003e\u003cspan address=\"10.3389/fpubh.2020.580057\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArmbruster S, Klotzb\u0026uuml;cher V (2020) Lost in lockdown? Covid-19, social distancing, and mental health in Germany. Albert-Ludwigs-Universit\u0026auml;t Freiburg, Wilfried-Guth-Stiftungsprofessur f\u0026uuml;r Ordnungs- und Wettbewerbspolitik, Freiburg i. Br:34. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.13140/RG.2.2.17900.39043\u003c/span\u003e\u003cspan address=\"10.13140/RG.2.2.17900.39043\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAuld G, Bernstein S, Cashore B, Levin K (2021) Managing pandemics as super wicked problems: Lessons from, and for, COVID-19 and the climate crisis. Policy Sci 54(4):707\u0026ndash;728. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s11077-021-09442-2\u003c/span\u003e\u003cspan address=\"10.1007/s11077-021-09442-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeyer RM, Manica A, Mora C (2021) Shifts in global bat diversity suggest a possible role of climate change in the emergence of SARS-CoV-1 and SARS-CoV-2. Sci Total Environ 767:145413. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.scitotenv.2021.145413\u003c/span\u003e\u003cspan address=\"10.1016/j.scitotenv.2021.145413\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBraun V, Clarke V, Hayfield N, Terry G (2019) Thematic analysis. In: Liamputtong P (ed) Handbook of research methods in health social sciences, 1st edn. Springer Singapore, Singapore, pp 843\u0026ndash;860. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/978-981-10-5251-4_103\u003c/span\u003e\u003cspan address=\"10.1007/978-981-10-5251-4_103\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBushell A (2024) Tackling talent shortages in Europe: Evolving strategies for 2024. TALiNT Partners Insights. Available via Manpowergroup \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://insights.talintpartners.com/tackling-talent-shortages-in-europe-evolving-strategies-for-2024/\u003c/span\u003e\u003cspan address=\"https://insights.talintpartners.com/tackling-talent-shortages-in-europe-evolving-strategies-for-2024/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e Accessed on 14 Jan 2025\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCanrinus ET, Heijne-Penninga M, Wolfensberger M (2021) About creating community. CoTalent. Available via E-library. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cotalent.eu/wp-content/uploads/2021/01/Creating-Community_English.pdf\u003c/span\u003e\u003cspan address=\"https://www.cotalent.eu/wp-content/uploads/2021/01/Creating-Community_English.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e Accessed 16 Jan 2025\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEronen L, Kokko S, Sormunen K (2019) Escaping the subject-based class: A Finnish case study of developing transversal competencies in a transdisciplinary course. Curriculum J 30(3):264\u0026ndash;278. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/09585176.2019.1568271\u003c/span\u003e\u003cspan address=\"10.1080/09585176.2019.1568271\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGereffi G (2020) What does the COVID-19 pandemic teach us about global value chains? The case of medical supplies. J Int Bus Policy 3(3):287\u0026ndash;301. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1057/s42214-020-00062-w\u003c/span\u003e\u003cspan address=\"10.1057/s42214-020-00062-w\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuo Y, Gu K, Garber PA, Zhang R, Zhao Z, Xu L (2024) A comparative analysis of influenza and COVID-19: Environmental-ecological impacts, socioeconomic implications, and future challenges. Biosaf Health 6(6):369\u0026ndash;375. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.bsheal.2024.10.001\u003c/span\u003e\u003cspan address=\"10.1016/j.bsheal.2024.10.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHead BW (2022) Political governance of wicked problems. Wicked problems in public policy, 1st edn. Palgrave Macmillan, Cham, pp 37\u0026ndash;60. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/978-3-030-94580-0_3\u003c/span\u003e\u003cspan address=\"10.1007/978-3-030-94580-0_3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHeijne-Penninga M, Wolfensberger M (2018) Creating community as a teaching strategy for honors students. J Eur Honors Counc 2(1):1\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.31378/jehc.8\u003c/span\u003e\u003cspan address=\"10.31378/jehc.8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHoffmann S, Deutsch L, Klein JT, O\u0026rsquo;Rourke M (2022) Integrate the integrators! A call for establishing academic careers for integration experts. Humanit Soc Sci Commun 9(1):1\u0026ndash;10. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1057/s41599-022-01138-z\u003c/span\u003e\u003cspan address=\"10.1057/s41599-022-01138-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eInternational Labour Organization (2020) Almost 25 million jobs could be lost worldwide as a result of COVID-19, says ILO. International Labour Organization: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ilo.org/resource/news/almost-25-million-jobs-could-be-lost-worldwide-result-covid-19-says-ilo-0\u003c/span\u003e\u003cspan address=\"https://www.ilo.org/resource/news/almost-25-million-jobs-could-be-lost-worldwide-result-covid-19-says-ilo-0\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIvanov D (2021) Supply chain viability and the COVID-19 pandemic: A conceptual and formal generalisation of four major adaptation strategies. Int J Prod Res 59(12):3535\u0026ndash;3552. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/00207543.2021.1890852\u003c/span\u003e\u003cspan address=\"10.1080/00207543.2021.1890852\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKeogh-Brown MR, Wren-Lewis S, Edmunds WJ, Beutels P, Smith RD (2010) The possible macroeconomic impact on the UK of an influenza pandemic. Health Econ 19(11):1345\u0026ndash;1360. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/hec.1554\u003c/span\u003e\u003cspan address=\"10.1002/hec.1554\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKlasche B (2021) After COVID-19: What can we learn about wicked problem governance? Soc Sci Humanit Open 4(1):100173. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ssaho.2021.100173\u003c/span\u003e\u003cspan address=\"10.1016/j.ssaho.2021.100173\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKlein JT (2005) Integrative learning and interdisciplinary studies. Peer Rev 7(4):8\u0026ndash;10\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKlein JT (2020) Sustainability and collaboration: Crossdisciplinary and cross-sector horizons. Sustainability 12(4). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/su12041515\u003c/span\u003e\u003cspan address=\"10.3390/su12041515\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Article 4\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e[Redacted reference]\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLevin K, Cashore B, Bernstein S, Auld G (2012) Overcoming the tragedy of super wicked problems: Constraining our future selves to ameliorate global climate change. Policy Sci 45(2):123\u0026ndash;152. https://doi.org/10.1007/sl 1077-012-9151-0\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLuyten J, Schokkaert E (2022) Belgium\u0026rsquo;s response to the COVID-19 pandemic. Health Econ Policy Law 17(1):37\u0026ndash;47. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1017/S1744133121000232\u003c/span\u003e\u003cspan address=\"10.1017/S1744133121000232\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcGunagle D, Zizka L (2020) Employability skills for 21st-century STEM students: The employers\u0026rsquo; perspective. High Educ Skills Work-Based Learn 10(3):591\u0026ndash;606. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1108/HESWBL-10-2019-0148\u003c/span\u003e\u003cspan address=\"10.1108/HESWBL-10-2019-0148\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMormina M, M\u0026uuml;ller B, Caniglia G, Engebretsen E, L\u0026ouml;ffler-Stastka H, Marcum J, Mercuri M, Paul E, Pfaff H, Russo F, Sturmberg J, Tretter F, Weckwerth W (2024) Where to after COVID-19? Systems thinking for a human-centred approach to pandemics. Humanit Soc Sci Commun 11(1):1\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1057/s41599-024-03246-4\u003c/span\u003e\u003cspan address=\"10.1057/s41599-024-03246-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOECD (2020) Addressing societal challenges using transdisciplinary research/ OECD Science. Technol Ind Policy Papers 88:1\u0026ndash;80. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1787/0ca0ca45-en\u003c/span\u003e\u003cspan address=\"10.1787/0ca0ca45-en\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOECD (2023) Evaluation of Belgium\u0026rsquo;s COVID-19 responses: Fostering trust for a more resilient society. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1787/990b14aa-en\u003c/span\u003e\u003cspan address=\"10.1787/990b14aa-en\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. OECD:1-291\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOyebode O, Ndulue C, Adib A, Mulchandani D, Suruliraj B, Orji FA, Chambers CT, Meier S, Orji R (2021) Health, psychosocial, and social issues emanating from the COVID-19 pandemic based on social media comments: Text mining and thematic analysis approach. JMIR Med Inf 9(4):e22734. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2196/22734\u003c/span\u003e\u003cspan address=\"10.2196/22734\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePasquini-Descomps H, Brender N, Maradan D (2017) Value for money in H1N1 influenza: A systematic review of the cost-effectiveness of pandemic interventions. Value Health 20(6):819\u0026ndash;827. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jval.2016.05.005\u003c/span\u003e\u003cspan address=\"10.1016/j.jval.2016.05.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePohl C (2020) Actor constellation. In: td-net toolbox for co-producing knowledge. Swiss Academies of Arts and Sciences. Available via Zenodo. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.5281/zenodo.3716720\u003c/span\u003e\u003cspan address=\"10.5281/zenodo.3716720\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e Accessed 20 Jan 2025\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePohl C, Klein JT, Hoffmann S, Mitchell C, Fam D (2021) Conceptualising transdisciplinary integration as a multidimensional interactive process. Environ Sci Policy 118:18\u0026ndash;26. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.envsci.2020.12.005\u003c/span\u003e\u003cspan address=\"10.1016/j.envsci.2020.12.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePohl C, Kr\u0026uuml;tli P, Stauffacher M (2017) Ten reflective steps for rendering research societally relevant. GAIA 26:43\u0026ndash;51. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.14512/gaia.26.1.10\u003c/span\u003e\u003cspan address=\"10.14512/gaia.26.1.10\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePohl C, Kr\u0026uuml;tli P, Stauffacher M, Modolo L (2018) Teaching transdisciplinarity appropriately for students\u0026rsquo; education level. GAIA 27(2):250\u0026ndash;252. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.14512/gaia.27.2.14\u003c/span\u003e\u003cspan address=\"10.14512/gaia.27.2.14\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePohl C, Truffer B, Hirsch-Hadorn G (2017) Addressing wicked problems through transdisciplinary research. In: Frodeman R (ed) The Oxford handbook of interdisciplinarity, 2nd edn. Oxford University Press, Oxford, pp 319\u0026ndash;331. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/oxfordhb/9780198733522.013.26\u003c/span\u003e\u003cspan address=\"10.1093/oxfordhb/9780198733522.013.26\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePohl C, Wuelser G (2019) Methods for coproduction of knowledge among diverse disciplines and stakeholders. Strategies for team science success, 1st edn. Springer, Cham, pp 115\u0026ndash;121. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/978-3-030-20992-6_8\u003c/span\u003e\u003cspan address=\"10.1007/978-3-030-20992-6_8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRemington-Doucette SM, Connell KYH, Armstrong CM, Musgrove SL (2013) Assessing sustainability education in a transdisciplinary undergraduate course focused on real-world problem solving: A case for disciplinary grounding. Int J Sustain High Educ 14(4):404\u0026ndash;433. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1108/IJSHE-01-2012-0001\u003c/span\u003e\u003cspan address=\"10.1108/IJSHE-01-2012-0001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRittel HWJ, Webber MM (1973) Dilemmas in a general theory of planning. Policy Sci 4(2):155\u0026ndash;169. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/BF01405730\u003c/span\u003e\u003cspan address=\"10.1007/BF01405730\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoy SG, de Souza SP, McGreavy B, Druschke CG, Hart DD, Gardner K (2020) Evaluating core competencies and learning outcomes for training the next generation of sustainability researchers. Sustain Sci 15(2):619\u0026ndash;631. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s11625-019-00707-7\u003c/span\u003e\u003cspan address=\"10.1007/s11625-019-00707-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchiefloe PM (2021) The corona crisis: A wicked problem. Scand J Public Health 49(1):5\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/1403494820970767\u003c/span\u003e\u003cspan address=\"10.1177/1403494820970767\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eScholz RW, Zscheischler J, K\u0026ouml;ckler H, Czichos R, Hofmann KM, Sindermann C (2024) Transdisciplinary knowledge integration \u0026ndash; PART I: Theoretical foundations and an organizational structure. Technol Forecast Soc Change 202:123281. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.techfore.2024.123281\u003c/span\u003e\u003cspan address=\"10.1016/j.techfore.2024.123281\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStockman M, Plas\u0026egrave;ncia A, Larson H, Lin L, Ana A, Drost J, Froeschl G, Skordis J, Vandamme AM (2024) EGHRIN conclusions on pandemic preparedness: No whole-of-society approach without society. BMC Health Serv Res 24(1):1561. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12913-024-12104-7\u003c/span\u003e\u003cspan address=\"10.1186/s12913-024-12104-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSultana F (2021) Climate change, COVID-19, and the co-production of injustices: A feminist reading of overlapping crises. Soc Cult Geogr 22(4):447\u0026ndash;460. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/14649365.2021.1910994\u003c/span\u003e\u003cspan address=\"10.1080/14649365.2021.1910994\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan Kerkhoff L (2005) Integrated research: Concepts of connection in environmental science and policy. Environ Sci Policy 8(5):452\u0026ndash;463. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.envsci.2005.06.002\u003c/span\u003e\u003cspan address=\"10.1016/j.envsci.2005.06.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVan Poel E, Vanden Bussche P, P\u0026eacute;tr\u0026eacute; B, Ponsar C, Collins C, De Jonghe M, Donneau AF, Gillain N, Guillaume M, Willems S (2024) Quality of care in Belgian general practices during the COVID-19 pandemic: Results of the cross-sectional PRICOV-19 study. BMC Prim Care 24(1):282. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12875-024-02305-8\u003c/span\u003e\u003cspan address=\"10.1186/s12875-024-02305-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWolfensberger MVC (2012) Teaching for excellence: Honors pedagogies revealed. Waxmann\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Economic Forum (2025) The future of jobs report 2025. World Economic Forum :1\u0026ndash;290. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.weforum.org/reports/the-future-of-jobs-report-2023\u003c/span\u003e\u003cspan address=\"https://www.weforum.org/reports/the-future-of-jobs-report-2023\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organisation (2018) Essential steps for developing or updating a national pandemic influenza preparedness plan. World Health Organisation :1\u0026ndash;12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/i/item/WHO-WHE-IHM-GIP-2018.1\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications/i/item/WHO-WHE-IHM-GIP-2018.1\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 5 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"humanities-and-social-sciences-communications","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"palcomms","sideBox":"Learn more about [Humanities \u0026 Social Sciences Communications](http://www.nature.com/palcomms/)","snPcode":"41599","submissionUrl":"https://submission.springernature.com/new-submission/41599/3","title":"Humanities and Social Sciences Communications","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"COVID-19, pandemic preparedness, transdisciplinarity, co-creation, Belgium","lastPublishedDoi":"10.21203/rs.3.rs-5932329/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5932329/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe COVID-19 pandemic emerged as a healthcare crisis and quickly evolved into a crisis for all levels of society. A systemic preparedness for the complexity of a pandemic is required that integrates knowledge from researchers and practitioners alike. However, countries such as Belgium were not prepared to handle the crisis in a systemic way. Here we show how an interdisciplinary group of students in the context of their honours degree designed, organised, and facilitated a transdisciplinary co-creation workshop to evaluate Belgium\u0026rsquo;s pandemic preparedness with stakeholders after the first year of the pandemic. We find that a lack of transdisciplinarity, pandemic illiteracy, insufficient involvement of human sciences in decision making processes, and fragmented authority are some of the most important gaps in pandemic preparedness according to the Belgian stakeholders. They identified important underlying causes which we have clustered in five emergent themes: principal agent problems (politicians taking decisions in their own interest instead of in the interest of the people they represent), distrust in authority, government incompetence, apathy, and lack of transdisciplinarity. Additional student reflections on the experience of guiding the workshop show that the students developed their understanding of the concept of transdisciplinarity, experienced difficulties in facilitating transdisciplinary knowledge integration, and developed critical career skills. More general, our results demonstrate how students in the context of transdisciplinary education designed an innovative method for co-creation which led to improved systems knowledge of Belgium\u0026rsquo;s pandemic preparedness and the development of important skills.\u003c/p\u003e","manuscriptTitle":"Integrative learning through student-led transdisciplinary investigation of Belgium’s COVID-19 pandemic preparedness","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-04 13:52:27","doi":"10.21203/rs.3.rs-5932329/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"humanities-and-social-sciences-communications","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"palcomms","sideBox":"Learn more about [Humanities \u0026 Social Sciences Communications](http://www.nature.com/palcomms/)","snPcode":"41599","submissionUrl":"https://submission.springernature.com/new-submission/41599/3","title":"Humanities and Social Sciences Communications","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"7df832b9-c128-43db-9ced-00f3ebb30dd9","owner":[],"postedDate":"March 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":44810410,"name":"Humanities/Complex networks"},{"id":44810411,"name":"Humanities/Health humanities"},{"id":44810412,"name":"Humanities/Medical humanities"},{"id":44810413,"name":"Social science/Complex networks"},{"id":44810414,"name":"Social science/Education"},{"id":44810415,"name":"Social science/Social policy"}],"tags":[],"updatedAt":"2025-03-04T13:52:27+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-04 13:52:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5932329","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5932329","identity":"rs-5932329","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}