In early July 2020, Swedish Prime Minister Stefan Lofven announced a commission of inquiry into Sweden’s response to the ongoing coronavirus pandemic. This announcement was prompted by a rising discontent with the national pandemic strategy, which has been linked to a much higher rate of infections and a higher mortality when compared with its Nordic neighbours, as well as the fifth highest per capita death rate in the world.
When it comes to assessing national responses and health outcomes, the coronavirus pandemic has exposed many deficiencies in political leadership, economic infrastructure and healthcare systems across the world. But meaningful comparisons between countries require that you ideally compare like with like. Sweden’s performance can be thus be reasonably compared with those of the other Nordic nations (Denmark, Finland, Iceland and Norway). Despite Sweden’s small population of ten million, we have much to learn from the way it has responded to the current global public health crisis, with 5, 420 deaths from Covid-19 as of 4 July 2020.
The Swedish approach has been frequently cited and lavishly praised by conservative commentators and others favouring freedom of personal choice over state enforcement of restrictive pandemic control policies. This libertarian approach has been led from the outset by Anders Tegnell, state epidemiologist at the Swedish Public Health Agency. The calm, softly-spoken and previously unknown doctor, a veteran of Ebola virus outbreaks in the Democratic Republic of Congo, has delivered a widely popular message of personal liberty and responsibility, thereby transforming himself into a folk hero, at times even approaching rock star status.
The Swedish approach, in some ways reminiscent of the earliest responses of the British government, has been driven by a deep faith in the collective action of the Swedish people, relying largely on common sense and on voluntary compliance with social distancing measures. Sweden thus chose not impose a national total lockdown, unlike the rest of Western Europe. Life progressed as if there was nothing much to fear. Shops, cafes, restaurants, gyms, salons, workplaces, and schools (up to the age of 16 years) functioned as normal. Only high schools and universities were closed. In the only concessions to lockdown, large gatherings of people (initially up to 500 and later reduced to 50) were banned, and visits to care homes prohibited from late March onwards.
Sweden appears to have opted for a deliberate strategy of herd immunity, subsequently denied, whereby Covid-19 would initially be allowed to spread rapidly and unfettered within communities. There would be little necessity for mass community testing in the absence of a need to identify and then isolate “cases”, followed by contact tracing. Given that many infected people, particularly those under the age of 65 years, either have minimal or no symptoms, soon the majority of people (at least 70 per cent of the population) would be expected to develop natural immunity, thereby limiting continued community transmission of the coronavirus. Deaths of older people from Covid-19 would be accepted as an inevitable consequence of this strategy, being considered as a form of “collateral damage” in the pursuit of the greater public good.
Anders Tegnell has consistently defended his strategy, while admitting, in June 2020, that with hindsight he might have done things differently. He has cited a lack of scientific backing for draconian, previously untried and untested, lockdown strategies, and has pointed to the catastrophic economic consequences of strict lockdowns. Tegnell is almost unique among healthcare professionals in prioritising the economy over the nation’s health. In his defence, he has repeatedly provided alternative explanations for the relatively high death toll in Sweden, such as a decentralised healthcare system and deficiencies within care homes, which have accounted for the majority of deaths.
With time, Tegnell’s message is proving to be less popular. Recently there have been many calls for his resignation from opposition political parties, including the populist Sweden Democrats. Multiple death threats mean that he has to travel in public in the company of personal bodyguards. When it comes to reopening its borders and its citizens being allowed to travel abroad, Sweden is also discovering a certain lack of international appreciation for its light-touch, laissez-faire pandemic strategy of doing as little as possible.
The Covid-19 pandemic is far from over, and Sweden has yet to pass judgement on its own response to the crisis. What is undoubtedly clear is that we have a lot to learn from the way the pandemic has been dealt with, and that Sweden can provide us with many of those lessons.
Ashis Banerjee