Decision making under deep uncertainty for pandemic policy planning

•Health policymaking in a pandemic is characterized by decision making under deep uncertainty.•Pandemic policy planning requires a shift from 'predict and act' to 'prepare, monitor, and adapt’ policymaking.•Monitoring in pandemic policy planning should be based on identifying pre-planned outcome measures and their trigger points, coupled to contingency measures.•Sufficient reserve capacity is a precondition for resilience of health care to respond adaptively. Policymakers around the world were generally unprepared for the global COVID-19 pandemic. As a result, the virus has led to millions of cases and hundreds of thousands of deaths. Theoretically, the number of cases and deaths did not have to happen (as demonstrated by the results in a few countries). In this pandemic, as in other great disasters, policymakers are confronted with what policy analysts call Decision Making under Deep Uncertainty (DMDU). Deep uncertainty requires policies that are not based on 'predict and act' but on ‘prepare, monitor, and adapt’, enabling policy adaptations over time as events occur and knowledge is gained. We discuss the potential of a DMDU-approach for pandemic decisionmaking.