Abstract Background Understanding of climate health adaptation and its organisation and implementation is limited. This presentation focuses on the adaptation to the oak processionary moth (OPM). The OPM spreads out northwards through Europe, and human contact leads to reactions in skin mucous membranes, conjunctivitis, pharyngitis and respiratory distress. Literature has focused largely on the ecology and epidemiology of the OPM. However, there is limited understanding of the organisation and implementation of climate health adaptation knowledge and coordinating an effective response. Methods In an explorative case study we examined the current OPM adaptation strategies in practice. Semi-structured interviews with 26 actors in The Netherlands were held to unravel the problem and the complexities involved in OPM adaptation. Results The results indicate that the context of OPM adaptation is multidimensional, given the involvement of many interdependent actors. At regional and local level early networks emerge aiming to improve the effectiveness of OPM adaptation. At the national level the Knowledge Platform OPM was set up, in which actors collaborate to collect and share knowledge and experience. Nevertheless, OPM strategies are based on ad hoc approaches with ambiguous tasks and expertise. In addition, actors have different perceptions and values concerning health, sustainability, risks and responsibilities influencing decision-making processes, collaboration and a coordinated approach. Conclusions The generation of knowledge and its translation into practical strategies calls for interdisciplinary cooperation in knowledge development. Climate health adaptation involves more than technical and organisational solutions alone. It also entails the development of a shared problem perception and solution space in which citizens are also engaged. Therefore, implementation of vertical and horizontal coordination climate health adaptation strategies are required.