For decades, the world has been talking about the ‘Swedish Model’ – a strategy the Scandinavian country has adopted since the mid-19th century for its inclusive growth. However, in the last two months, there is another ‘Swedish Model’ which is being discussed, debated, criticized and praised and that is about how Sweden is facing the coronavirus crisis. While most of the countries in the world, including its Scandinavian neighbours, closed their borders, stopped the movement of the people within their countries, and imposed strict restrictions on their residents, Sweden has adopted quite a different approach. It has stopped classroom teachings in the universities and high schools; postponed the soccer season; and, banned the gathering of more than 50 people. Aside from this, life goes on in the country, as usual. Offices, schools, shops, bars, and restaurants are open like before, as are the spas and hairdressers. Very few people are wearing masks while walking outside.
No one should construe this as nonchalance of Swedish authorities regarding the coronavirus crisis; it is rather the opposite. The Swedish government, media, and society understand the seriousness of threats posed by the pandemic, though in the beginning, they were caught somewhat unawares as the virus entered the country in a big way not from Wuhan, China but from the Italian Alps, as Swedish families returned home after their ski trips in February the school break.
The Swedish Prime Minister regularly holds press conferences and addresses newspapers and television channels covering the crisis. Even the King has addressed the country, which does not happen often. Most of the academic activities have become web-based. People have been avoiding gathering at public places and while they are outside, they keep a distance. People over 70 years of age have been recommended to stay at home and others have been told to avoid meeting elderly persons.
Anyone with even slightest COVID-19 symptoms can avail sick leave and stay at home without a doctor’s certificate. University towns, like Uppsala and Lund, did not celebrate this year’s ‘Spring Festival’ on 30 April. Large meetings, conferences, and most official travels have been cancelled or postponed till Autumn. At the same time, there is also a warning that if any restaurant or bar breaks the social distancing guidelines, it would be shut down.
Each day, Sweden’s Public Health Agency releases the latest data on confirmed COVID-19 cases; of people being treated in intensive care; and, those who have died due to the coronavirus. Only medically tested, confirmed cases are being included in this data, so it shows a much smaller number of actual cases. Sweden has tested fewer people compared to many countries, particularly its neighbours. If their condition is not serious, COVID-19 patients are being asked to stay at home and recover.
At the surface level, this strategy seems to have not worked in April 2020 as the death rate in Sweden was almost three times higher than its neighbours, Denmark, Norway, and Finland and even higher than that of the United States. Though it is mostly the middle-aged who have contacted the virus in the country, most of the deaths have taken place among the elderly. A major portion of Sweden’s COVID-19 deaths has taken place in place in elderly care homes. It is another matter that many European countries, and also the US, are recording deaths only from hospitals and they do not include the deaths taking place in nursing homes or other long-term care facilities.
The high death rate in elderly care homes has surprised the Swedish authorities as they seem to have not anticipated this. They are trying to find ways to stop the virus from entering care homes, so have banned all visits from outside. Not only old people, but the death rate among several immigrant communities, particularly from Somalia, Iraq, Syria, and Afghanistan is also quite high. Lack of sufficient information and also housing density in some immigrant ‘ghettoes’ in Stockholm has probably contributed to this.
Stockholm, the capital city, has witnessed more than 50% of the total COVID-19 deaths in the country, though it hosts only 10% of the country’s population. More deaths have taken place in Stockholm not only due to more deaths among elderlies and immigrants but also because its school break in February fell in the week when the outbreak in Italy became serious. Whatever may be the reasons, the higher number of deaths in Sweden has made some to question the Swedish strategy.
Sweden defends its ‘unique’ approach saying that it aims at flattening the curve as soon as possible as its healthcare system cannot cope with a sudden and steep rise in the number of COVID-19 cases. Day-cares and junior schools are open as it allows healthcare workers to be at the hospitals as complete closure of schools will keep at least 30% of them at home to be with their children.
Sweden also realizes that the fight against coronavirus will continue for some time as the effective pharmacological intervention is still being searched for, and the country cannot afford to keep its economy in abeyance so long. Trade to GDP ratio in Sweden is above 90% and so there are serious limitations to the country’s freedom to bring a complete lockdown of the country for months. Even without the lockdown, the unemployment rate in Sweden has gone up after the coronavirus crisis from 6.5% to almost 11% and there is a possibility of GDP of the country shrinking between 4 to 10% in the year 2020. Moreover, lockdown is not the cure, it is just to postpone the infection affecting a larger population for a certain period of time.
Paul W Franks argues that the lockdown might limit the number of deaths in the beginning, but once the lockdown is relaxed and no medical cure becomes available, the death rate will catch up as, ‘protecting a population from becoming infected with aggressive containment is like protecting a forest in the path of wildfire – unless continuous fire-fighting efforts are made, the forest will eventually burn’.
Herd immunity strategy
Therefore, the strategy of Sweden in adopting limited restriction, but not the total lockdown, is to reach a herd immunity for its population from the coronavirus. Herd immunity strategy, though not officially admitted as being adopted, aims at bringing immunity to the Swedish population from the infection by making the majority of the population recovering from the COVID-19 disease. There are some reports that Stockholm city might reach herd immunity soon and Sweden is likely to get to that stage in a few weeks. There are, of course, question marks over whether one-time infection can provide immunity or not. If the mathematical models on community spread of the virus are correct and post-infection immunity is achieved, then Sweden would be soon successful in bringing down its death rate drastically while keeping its economy in a relatively manageable shape and not adopting drastic public security measures.
As the pandemic is still evolving and the vaccine is yet to be found, time will only tell if the Swedish approach would be successful or not. But many countries who had opted a military-style lockdown and have restricted the infection rate for more than a month are now being forced to ease the restrictions due to popular demand and market pressure, would certainly witness the COVID-19 death number climbing up. They have failed to flatten the curve like Sweden and at the same time, have already flattened their economy.
The Swedish policy has its admirers and critics. One of the surprising admirers are the Right-wing groups in the United States, who have always been critical of Sweden, and have been particularly vicious since 2014 when Sweden opened its door to a large number of Syrian refugees. However, in the last few weeks, these same groups have started opposing the lockdown in their countries and have demanded that the US follow the Swedish Model in addressing the coronavirus crisis. It is, however, important to understand the rationale behind the Swedish approach.
The Swedish authorities trust that people will obey the government prescribed guidelines and they do not need to bring in a police state to enforce the rules for public safety. Sweden is famous for the abundance of trust between the state and the society and within the society itself. Moreover, Sweden is also a law-abiding, educated, non-religious, science-trusting society that follows the Jantelagen principle — no one considers herself or himself special, which limits the risk of breaking government prescribed guidelines. Over and above, social distancing is not alien to Sweden as more than half of the country’s population lives in single-person households. Working from home is quite a common practice in the country and an almost universal faster internet connection facilitates it further.
Lessons for India
In this context, this Swedish model of a restrained middle of the road lagom approach in facing the coronavirus crisis, even if it becomes successful in the end, is not possible to be emulated fully by other countries, in general, and by India, in particular. As we know, the golden principle of policymaking is that there is no golden principle. However, there are several lessons from the Swedish strategy, which India can learn from.
The coronavirus crisis is a massive public health crisis, of the scale that the world has never witnessed before. The policymaking, in this case, should be led by the professionals who know and understand the virus and its threats and weaknesses much better than the political leadership or bureaucracy. In Sweden, the person responsible for forming the strategy and communicating it to the citizens is the country’s chief epidemiologist, Anders Tegnell, not the Prime Minister, Stefan Löfven. Political leadership has given that space to Tegnell to operate despite demands from many, including a group of epidemiologists, for the government to seize control.
As Sweden’s neighbouring countries are being forced to lift restrictions, Sweden’s politicians are being seen as doing the right thing in entrusting the decision-making to a professional expert and his team. India needs to bring public health professionals to lead the strategy, not its politicians.
The Swedish strategy has also shown that a country should have a precise policy about handling a crisis, and the government should openly communicate it to the people. As there are several unknowns, it is also important for the government to remain open to adjusting and changing the policy if needed. Free, honest, and regular communication from the political leadership with the people helps to get their trust and cooperation. People need to feel that they are part of the decisions and no group should feel that they are being asked to sacrifice for others.
Government policy at the time of such a huge uncertainty should not only be impartial but should also be seen by all sections of the society as the compassionate, considerate, and correct one. India needs to come out with a precise pro-active policy taking into consideration its size, economy, culture, and weather rather than reacting or blindly copying the policies and actions of others.
A country needs to come together, and its people should help each other at the time of a crisis like this. It is, thus, important for the government and media to act responsibly and communicate cautiously to avoid creating divisions in society. In spite of many COVID-19 deaths among immigrants, no one in Sweden named or blamed the immigrants for the crisis. Though, Stockholm became the epicentre of the crisis in the country, no one in the country blamed the city nor the parents who had taken their kids to Italy in February for a sports break.
Even if Sweden’s bilateral relations with China have deteriorated on the issue of human rights for some months now, Sweden is also not blaming China for the coronavirus nor calling it the Wuhan-virus. It is critical for India at the time of this crisis to stay united and fight this pandemic together and the government and media can learn a lot from the Swedish approach of avoiding political blame-game in order to look for scapegoats.
Sweden is treating the coronavirus crisis as a health emergency and it is the economic need, not the political expediency that shaping the country’s policies. The number of COVID-19 patients in Sweden is quite high, still, its hospital system has not collapsed, like in Italy, nor has it gone for building new hospitals overnight, like in China. There are grumblings over the lack of sufficient medical protection equipment, but the government has been trying to support health workers as much as it can. To make it possible for the health workers to carry out their duties, the government has decided to keep pre-school and junior schools open. Many people are coming out voluntarily to assist healthcare facilities. Even one of the Swedish princesses has started working in the hospital to help fight the COVID-19 pandemic.
There is no showing of public appreciation of healthcare professionals nor showering of petals over the hospitals, but doctors and nurses are not suffering from lack of basic equipment nor being mistreated in their neighbourhoods on suspicion of carrying the virus. In India, the government and civil society, instead of spending its resources on public spectacles, need to spend their time and resources to support healthcare professionals with economic incentives and basic medical equipment.
Finally, it is important for India to accept the fact that lockdown cannot keep coronavirus away for long. It is, thus, necessary to find ways to survive with it. In Sweden, the COVID-19 has been limited to certain urban centres, particularly in the central part of the country. That has made it possible to augment the supplies in these areas with the help of other parts of the country.
Stockholm region, which is the most affected, is probably reaching or has already reached its herd immunity. Social distancing and following the prescribed guidelines, Sweden has been able to keep COVID-19 confined to certain clusters, though not by design in following the cluster-wise containment strategy, like China or Japan. India should actively work towards compartmentalizing the virus to certain regions and try to get the herd immunity region after region and city after city rather than being forced to expose the whole country to a one-time peak period. The virus might be global but the war against it has to be won at the local level.
(Author is the Professor of Peace and Conflict Research at Uppsala University, Sweden. He tweets at @ashoswai)
The article was originally published in University Practice Connect, Azim Premji University. To read the original article, click here.