The European continent is, in this moment, experiencing a tremendous lockdown. Public spaces, meeting areas and shops have been provisionally shut down across Europe. Despite the stricter or looser approaches undertaken in order to contain the spread of COVID-19, different parts of Europe have all answered in a similar manner to the crisis. Also the UK, which at first opted for a different strategy based on the attainment of herd immunity, made a blatant U-turn in the past two weeks, due to a tragic and unmanageable rise in the infection rate. In such a general situation, Sweden stands out as an exception. What are the reasons for pursuing a path against the general approach?
Sweden has opted for a recommendation-based strategy wherein the population has a lot of freedom of action and responsibility. Instead of enforcing lockdown measures and limiting the personal freedom of citizens, Sweden chose an approach that relies on the population cooperating by free will. It is also notable that the government, guided by Stefan Löfven, has taken a firm step to the side, letting the Public Health Agency of Sweden (Folkhälsomyndigheten) heavily dictate the Swedish virus response. The Agency’s experts, such as state epidemiologist Anders Tegnell, are formulating the recommendations that people are encouraged to follow, and they have also guided the – admittedly few – legislative decisions the government has taken regarding the issue. To understand this approach one has to understand Swedish institutions as well as the country’s political and legal traditions.
While some countries have enforced shutdowns of domestic areas and restricted citizen movement, this is something Sweden has shied away from doing. While this might indeed be the result of guidelines presented by the medical experts at the Public Health Agency of Sweden, it is also closely related to the Swedish constitution. Freedom of movement is a part of Sweden’s grundlagar, the country’s strongest laws and thus the hardest to change. However, Sweden is not the only country to have similar laws on freedom of movement, the difference being that others have made legislative exceptions to the constitution for “times of crisis”. Why Sweden has no such exceptions is likely because of its long history of neutrality where no such ratifications have needed to be added. Indeed, in most of the cases, such legislative amendments have been incorporated as a result of war.
One thing that the Public Health Agency has pushed for, and something that all agencies in Sweden generally strive for, is the recommendation-based strategy mentioned before. This is a long, culturally-ingrained strategy, based on the very simple idea of mutual trust. Swedish agencies aim to show that they have trust in the population so that, in turn, the population will have trust in them. To “push people around”, telling them what to do, is seen as damaging to this trust, that – in a sense – compromises Swedish society. This trust-based system is also reminiscent of the agencies’ relation to the government, where, again, no part tells the other what to do but simply “recommends”. Strange as it may or may not seem, this appears to have a positive effect. Indeed, trust in Swedish agencies is amongst the highest in the world, and corruption is amongst the lowest measured. During the last month, people’s trust in the agency’s handling of the pandemic increased from 65 to 74 percent, according to survey data.
The Swedish Government’s current position in the fight against COVID-19 is raising concerns, both of political and scientific nature. Indeed, the wait-and-see policy adopted so far by Sweden is building tension with the World Health Organization. Following the decision, issued on the 11th of March, of declaring the COVID-19 outbreak as a pandemic, the WHO pushed nation states to take “urgent and aggressive action”. Indeed, the lack of strict measures undertaken by Sweden stands in stark contrast to the WHO’s recommendations.
Moreover, the Swedish government’s position is becoming increasingly controversial within the scientific community. A common petition signed by more than 2,000 people (including doctors, researchers, scientists and academics) across Sweden pleaded the government to implement stricter rules of containment and to adhere more to the protocols issued by the WHO.
Public statements and op-eds made by professionals tried to raise awareness of the risks related to the Swedish approach. Stefan and Claudia Hanson (respectively, an international health expert and an epidemiologist), urged for a change of approach, similar to the one undertaken by the UK. Cecilia Söderberg-Naucler, professor at the Karolinska Institute in Stockholm, criticized the authorities for a lack of transparency in the provision of data and in the explanation of the strategy. The immunologist Olle Kämpe, from the same Institute, described the strategy aimed at attaining herd immunity at the expense of hundreds, if not even thousands, of human lives, as “cynical”.
Some experts have directly criticized the strategy pursued by the Swedish Government, accusing it of preserving and prioritizing, as much as possible, the national economy, to the detriment of people. Joacim Rocklöv, professor of epidemiology at Umeå University, blatantly addressed the public authority: “How many lives are they prepared to sacrifice so as not to … risk greater impact on the economy?”.
State epidemiologist Tegnell disagrees with his critics, claiming that the Public Health Agency has the best material there is. He points out that they have support from the very top researchers and, while Olle Kämpe is an exception, the scientists of the world-renowned Karolinska Institutet are behind them. Tegnell also refutes claims that the agency is secretly adopting a herd immunity approach or that it is taking insufficient measures for the sake of the economy. He does however state that the core strategy is to ensure a slow increase of infections in order to avoid overloading the national healthcare services, as trying to stop infections completely isn’t seen as feasible.
Additionally, as an explanation for the country’s measures, Sweden’s lighter approach can be explained by its demography. In Sweden, almost 57 percent of households consist of only one resident. This is the highest proportion of single member households in all of Europe. Furthermore, Sweden is very sparsely populated with a population density of only 25 inhabitants per square kilometre. This can be contrasted with Italy’s 205 per square kilometre and the EU’s combined density of 121 per square kilometre. Due to these factors, it is estimated that less extreme measures fit better, as the spread of infection is “naturally” made harder.
In the midst of an atmosphere of skepticism nurtured by the scientific community, the population remains the biggest supporter of the Swedish Government and the disputed Public Health Agency. Besides surveys, which certify the trust people still put in the government, one instead has to poke his nose out of the door in order to understand the paradoxicality of the situation, when compared to the rest of Europe. Indeed, parks, pubs and shops are still full of people, conscious or not conscious of the fact that the region of Stockholm is running an infection rate similar, if not even worse, than Italy’s.
Should the current government manage to overcome the crisis without implementing any measure of containment, this will result in an historical win for the nation. Already certified as one of the finest healthcare systems in Europe, Sweden would also benefit from the continuity in its economic performance. It goes without saying that the ambitiousness of this strategy is offset by the risks raised by the scientific community. In conclusion, given our nescience of the dynamics the virus will undertake and the unpredictability of the situation, only the future will unravel whether or not the Swedish strategy will be successful.
Daniel Bergdal & Lorenzo Lombardi