Covid inquiry should reflect on Sweden’s success
Unlike Sweden’s successful strategy, the UK adopted restrictive policies to manage the pandemic – this must be the starting point for any inquiry
Judge me in a year,” said Anders Tegnell, Sweden’s state epidemiologist in July 2020, when his country was being attacked for sticking to its pandemic plan rather than adopting the novel intervention of lockdown. The latest World Health Organisation figures add to the evidence that has been accumulating since summer 2021. Sweden managed the pandemic more successfully than most, with much less disruption of everyday life and economic activity.
The WHO has published estimates of excess deaths globally for 2020 and 2021. This approach covers all deaths from Covid, formally diagnosed or not, plus collateral damage in deaths from other conditions that went untreated. Looking at Europe, where official data are usually robust, Sweden had half the excess death rate of the UK, Germany or Spain – and a quarter of that of many eastern European nations. In turn, the UK tends to be mid-table, in line with other large western European countries, while eastern European countries have had much worse experiences. There is a widely circulated view that the UK has had a uniquely bad pandemic. The data simply do not support this.
Nor do they support the view that the outcomes have much to do with the restrictions adopted by different governments, how soon they began, or the stringency of enforcement. The question, then, is how governments came to adopt highly restrictive policies in the first place. This must be the starting point for any national inquiry. Why was the experience of emergency planners, and two decades of pandemic preparation, abandoned everywhere except Sweden?
Sweden never “let it rip”. There were restrictions on large gatherings, on restaurants and other entertainment venues. Schools and universities switched to remote learning at some points. Masks were never thought to be useful but social distancing was encouraged. It was all based on the minimum intervention needed to manage the highest risk environments.
Mistakes were made and acknowledged. In the first wave of the pandemic, Sweden had a problem with Covid deaths in care homes, which tend to be larger than in the UK, so once the virus got into a home, it could circulate around a larger number of people than would be possible in UK homes. When additional infection controls were introduced, residents were as well shielded as anywhere. Unlike the UK where elites assumed that people should be told what was good for them, and then compelled or frightened into doing it, Sweden explained its public health thinking and invited citizens to cooperate.
Many UK problems can be traced to its top-down approach. No one asked academics who know about laws and rules whether they would work in this situation. Officials and politicians made those decisions on the basis of their own, often simplistic, beliefs. But rules are inflexible tools, which invite dispute. How can anyone comply with a law that cannot differentiate between a party and a work-related gathering? The Swedish approach allowed citizens to think about applying broad public health messages to the circumstances of their own lives.
Sweden shows that there was another path not taken, that could have brought the UK through the pandemic in far better shape. The inquiry must not be diverted into the minutiae of arguments about whether we should have locked down a week or two weeks’ earlier. It must be free to examine the whole strategy – in particular, why robust social science evidence on managing emergencies, and its contribution to pandemic planning since the early 2000s, was abandoned so precipitately.
Many UK problems can be traced to its topdown approach … Officials and politicians made decisions on the basis of their own, often simplistic, beliefs