STOCKHOLM—Almost all countries in the West dealing with the coronavirus pandemic have by now arrived at the same lockdown strategy, with some local variations. Only one major exception stands out. Sweden, while facing an undisputed high-risk outbreak of the virus, has committed to going its own way in combating it.
The Swedish government appears to be betting that its national culture is distinctive enough to pull off public health policies other countries can’t. Whether it will regret doing so remains to be seen.
Stockholm’s coronavirus efforts stand out as markedly measured—or, as some would have it, dangerously tame. Two weeks after the country’s Public Health Agency (on March 10) raised the risk level of a community spread of the virus to “very high”—the highest grade on a five-point scale—primary schools remain open, borders are only partially closed, there are no compulsory quarantines or shutdowns of restaurants, bars, or public spaces. While there is a ban on public gatherings, the 500-person limit is more generous than in other countries.
Sweden is far from unaffected by the coronavirus epidemic, with markets in free fall, mass unemployment on the horizon, and the health services under growing pressure. As of Tuesday, a total of 36 Swedes have died after contracting the novel coronavirus and there are more than 2,000 confirmed cases of COVID-19, although the real number is not known since testing is generally limited to hospital patients and elderly home residents who show symptoms of COVID-19. Moreover, the Public Health Agency has refused to make public risk assessments or prediction models for the spread of the virus.
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So why has Sweden chosen to steer clear of the draconian regulations imposed in other countries? The explanation, some analysts say, lies in Sweden’s combination of politically independent public agencies—including the Public Health Agency, which is front and center of the current crisis management—and the high level of public trust in them.
While the government in Sweden sets the remit for public agencies’ missions—determining their objectives and budgets for instance—the agencies are guaranteed freedom from so-called ministerial rule, which means politicians do not have the power to intervene directly in a public agency’s day-to-day operations. This is a tradition that is enshrined in the Swedish Constitution, said Lars Trägårdh, a historian and public commentator whose research centers on the Nordic welfare state.
“We’re seeing that tradition at work right now,” said Trägårdh, “since the Public Health Agency is tasked with being the leading authority on the coronavirus crisis, and the prime minister and his government are expected to listen to and follow their advice.”
Sweden’s scientific community is not unanimous, and several experts have taken issue with the Public Health Agency. On March 20, a professor in epidemiology and a professor in mathematical statistics published a joint op-ed in the daily newspaper Svenska Dagbladet urging the country to change course. “The Public Health Agency must swiftly and unambiguously recommend social distancing for everyone, not just for those above 70,” they wrote, suggesting “far-reaching measures may be needed.” But on Sunday, the same newspaper carried a profile of Sweden’s state epidemiologist, Anders Tegnell, who heads the Public Health Agency and has become the face of Sweden’s fight against the coronavirus. Commenting on the media pressure he is under, Tegnell said: “Everything has become so political. Closing borders is a classic example. We had many such discussions during the 2009 (swine flu) pandemic and there was a consensus then among global experts that closing borders has never and will never work.” When neighboring Norway and Denmark announced border closures earlier this month, Tegnell told Swedish media that the moves had no scientific basis.
But while there are disagreements within the scientific community and beyond as to whether Sweden’s strategy has been sound or reckless, the sentence “We’re following the Public Health Agency’s recommendations” has also become somewhat of a mantra over the past few weeks, as government representatives have leaned on the agency’s directives when formulating, and defending, the measures taken to deal with the epidemic.
“By contrast,” Trägårdh said, “in Denmark and Norway, political leaders have gone against the local public health agencies’ advice on key matters like closing borders. That hasn’t happened in Sweden. Yet.”
But it’s not just the formalized prohibition on ministerial rule and a general preference for evidence-based politics that have colored Sweden’s strategy to contain the coronavirus outbreak. Another factor is at play, too—namely Sweden’s vastly above-average level of social trust, which has been documented in the World Values Survey, where Sweden, along with other Nordic nations, is a global outlier.
There are three aspects to the Nordic high-trust society, said Trägårdh. “First, citizens tend to place a lot of faith in public agencies and trust that they act in the public interest. Second, the authorities on their part trust citizens to heed their advice. Third, there is a high level of interpersonal trust where Swedes trust one other to act responsibly.”
Applied to the current situation, it means that public health experts and politicians alike act on the presumption that there is neither a general acceptance of nor a need for draconian legislation. Instead, there is an expectation that citizens will conform, that they will take personal responsibility and avoid crowds, work from home, keep a distance on public transport, and so on, without being strong-armed into doing so.
“Whether this is working is ultimately an empirical question that remains to be answered, but anecdotal evidence would at least suggest that people are practicing social distancing despite the absence of measures taken in other countries, where you need a special permit to leave your home and so on,” said Trägårdh.
Indeed, when the Swedish government did fast-track a new piece of legislation limiting public gatherings to a maximum of 500 people, some theaters flagged that they would allow 499 ticket holders into their premises. They were widely castigated, and soon they stepped in line by canceling performances until further notice. And when Prime Minister Stefan Löfven addressed the nation in a televised speech on Sunday evening—just hours after Germany banned gatherings of two or more people —he emphasized the need for individual responsibility and personal sacrifices.
“The only way to manage this crisis is to face it as a society, with everyone taking responsibility for themselves, for each other and for our country,” Löfven said. He warned that new restrictive measures may lie ahead, but so far the most dramatic steps have been the ban on mass gatherings and compelling high schools and universities to switch to remote teaching, as well as canceling spring-term national exams for school pupils.
“We don’t need to introduce emergency legislation or surveillance measures to ensure people stay at home because the authorities trust that citizens will follow their advice and citizens trust one another to act responsibly,” said Mikael Rostila, a professor in public health.
“When it comes to social distancing, it does seems like both individuals and employers took the message to heart pretty speedily, encouraging members of staff to work from home and forbidding them to come into work if they show just mild symptoms of the flu. That includes my employer, Stockholm University, which follows the Public Health Agency’s recommendations,” said Rostila.
“I’d say Swedes have a high degree of faith in science and evidence and right now we’re facing a public health crisis where epidemiological insights are crucial. So the experts at the Public Health Agency, with Sweden’s state epidemiologist Anders Tegnell at the helm, have taken center stage at this acute stage. But in the longer term, the economic impact may well become the more overriding concern and then we’re likely to turn to other experts,” said Rostila, adding that there is “also a paradox at work because the high level of trust in public agencies also means we have high expectations and low acceptance for failure. So the fall can be high if they fail to deliver.”
By the same measure, it can be precarious for the Public Health Agency and government to lean on the presumption of trust. “If any of the three levels of trust—the mutual trust between citizens and authorities and the interpersonal trust—falter then the foundation of the high-trust society crumbles,” said Trädgårdh. “And if we do end up facing a major and devastating epidemic here, then the citizens’ trust in authorities—and in the government which has been guided by them—will be at stake, too.”
But Johan Giesecke, Sweden’s former state epidemiologist and a current advisor to the World Health Organization, insists that, so far, “there is no indication that we need to fear a breakdown in trust.” He believes the Public Health Agency, which he once headed, has been too drastic rather than too lenient.
“Banning public gatherings is an idiotic idea,” said Giesecke, “and if you’re not feeling sick you should go to work or school. There’s no reason why people who feel well should stay at home and there is no evidence that shows closing national borders or restaurants reduces the spread of viruses. The only preventative measure that has sound scientific backing is washing your hands. But we’ve known that for 150 years.”
Giesecke believes the Public Health Agency can safely presume that Swedes will be both trusting and conformist. In fact, the agency has even suggested Swedes may be interpreting their advice too strictly. For instance, many sports clubs have on their own accord canceled youth activities, which prompted the agency’s director-general, Johan Carlson, to urge them to reconsider. It’s “unreasonable” to cancel football or ice hockey practice for kids, he said during a press conference last week. Such measures “paralyze society” and counteract public health targets, he said.
At the same time, criticism of the Public Health Agency has been fierce in media and in social media, with the editor in chief of Sweden’s biggest daily newspaper one of its most vocal critics. Moves that are at odds with actions taken by countries in the rest of Scandinavia and beyond—not least when it comes to school closures, enforced quarantines, and policing—have caused consternation and ire.
Currently, much of the critique centers on the lack of any suggestion so far that the government will restrict domestic travel or shut down ski resorts ahead of the Easter break, when thousands of Swedes flock to northern mountain region. The Public Health Agency has warned that there is a major risk of the virus spreading from the cities, but has stopped short of enforcing bans.
For critics, this is a dangerous move, not least because the virus only took hold in Sweden after the winter school break, when a large number of people returned from skiing trips in the Italian Alps.
Yet surveys by pollster Novus suggest that there is a discrepancy between the media and the public as trust in the Public Health Agency is growing. The latest poll, from March 18, shows that when it comes to institutions’ handling of the coronavirus, the Public Health Agency is the second-most trusted, after the health services. All media outlets rank lower.
“I’m with the people on this one,” said Trägårdh. “I don’t want to paint too rosy a picture or make any certain predictions in these precarious times but I do think that Sweden stands a good chance of coming out of this relatively unscathed when it comes to navigating the public health threat and protecting basic liberties.”
“Sweden’s response and outcome will surely be analyzed for years to come,” Trägårdh continued, “but we do have some structural advantages here. Not just in relation to our particular form of governance and the high level of trust, but also because we are a pretty sparsely populated country where there are a lot of single households and social distancing is basically a national characteristic. Like the Swedish actress Greta Garbo famously said: ‘I want to be let alone!’ Well, it turns out that during a pandemic that peculiarly Swedish preference may well be an advantage.”