Background Comparative data collection in transborder areas can contribute to informed decision making processes when dealing with borderless health threats such as pandemics, and thus help minimize the negative health effects for its citizens. To examine the pandemic response over time and the impact of infectious disease control in a cross-border setting, a prospective longitudinal study was conducted in the border area between Germany, Belgium and the Netherlands. In the spring of 2021, a random sample of 26,925 adult citizens selected from governmental registries was invited to collect a blood sample at home for SARS-CoV-2 antibody testing and to fill in an online questionnaire on attitudes and behaviour towards infection prevention measures, cross-border mobility, social network and support, COVID-19 self-reported infection(s) and symptoms, vaccination, general self-reported health and socio-demographics. In autumn 2021, participants were invited for a follow-up round. An online tool was developed to coordinate fieldwork procedures, real-time monitoring of participation and consultation of antibody test results. Furthermore, a helpdesk in all three languages for participants’ support was set up. Results In the first round, 6,006 citizens in the Meuse-Rhine Euroregion participated. 15.3% of the invited citizens on the Belgian side of the border participated. In the Netherlands and Germany this was respectively 27% and 23.7%. In the follow-up round 4,286 (71.4%) citizens participated for the second time. The participation rate was highest in the age group 50–69 years and lowest in > 80 in all sub regions of the Meuse-Rhine Euroregion. More women participated than men. Overall, more blood samples were returned than completed questionnaires. In total, 3,344 citizens in the Meuse-Rhine Euroregion completed all components of participation in both rounds. Conclusions The collection of comparative data can help better assess the pandemic response and the impact of infectious disease control in a cross-border area. Recommendations for a longitudinal cross-border study include a centralized online environment, mapping out potential challenges related to national regulations in the preparation phase and organizing regional coordination centres to create more familiarity and trust towards the involved organisations.

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Background: Up to 30% of the European population lives in an European internal border region. In the Meuse-Rhine Euroregion (EMR) multiple challenges on pandemic response were brought to the attention early on in the COVID-19 pandemic. Citizens and border commuters in the EMR were confronted with difficulties related to divergent policies applicable in the three nations. A thorough analysis of the pandemic response in Euroregions through comparable cross-border data collection enables the evaluation of different infection prevention policies on public health. Methods: ‘Impact of COVID-19 on the EMR’ is a longitudinal study of SARS-CoV-2 antibodies in inhabitants of the EMR. The sampling design is stratified random sampling. Prospective data collection took place between April and November 2021, and consisted of two self-finger prick antibody tests and two online questionnaires. The study enables to evaluate (1) the prevalence of anti-SARS-CoV-2 antibodies and its determinants and (2) the practice and attitudes to COVID-19 measures on the population in the EMR over time. Discussion: The project is a unique example of a close interregional cooperation in the development of a shared research project; conceptual development, survey-approach, data-collection, data-analysis and reporting. Collection of comparative cross-border data can aid policy makers, health care providers and other stakeholders to better assess the impact of infectious disease control measures in border regions.

Studies show that European border regions -that account for over 30% of all European citizens- are faced with more deficits. Living in a border region still means fewer possibilities in the fields of employment, mobility, care and well-being. In order to tackle this, an absolute prerequisite is to dispose of relevant and comparable data across borders. The Euregional Health Atlas is an initiative that aims to collect and to visualize validated and comparable data for the municipalities of the Euregio Meuse-Rhine (EMR: Zuid Limburg (Nl), Zweckverband Aachen (De), the provinces Limburg, Liège, Ostbelgien (Be)). Themes addressed are: demographics (population, socioeconomic status, vulnerable groups), health care (care contacts, difficulties in daily living, chronic diseases, mortality), lifestyle (use of alcohol, smoking, weight, nutrition) and quality of life (perceived health, happiness). Data used to feed the Euregional Health Atlas are derived from registers, health surveys and from former and current Interreg projects like the Youth Euregional Scan (YES). During the COVID-19 pandemic, data on the daily number of cases and 7-day incidence, the number of tests performed, the hospitalisation rate and the number of reported deaths related to Covid-19 were processed and presented on our dashboard and this not only for the Euregio Meuse-Rhine, but also for other Euregios. The Euregional Health Atlas is a work in progress: existing data are continuously being updated to improve their suitability for comparison purposes and new data are added to broaden the perspective. It contributes to knowledge-sharing, mutual understanding and cross-border policy development. The Atlas is a free, easily accessible platform, available for everybody; health care professionals, policy makers and citizens, see www.euregionalhealthatlas.eu!

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