Continuing the Debate on Sweden’s Pandemic Response

In Sweden, a center-left government’s pandemic response emphasized individual choice over state intervention.

A nurse wearing personal protective equipment in a tent on the grounds of the Sophiahemmet private hospital perform tests on a patient to see if she has symptoms of COVID-19 on April 22, 2020 in Stockholm, Sweden. (Jonathan Nackstrand / AFP via Getty Images)

First, we’d like to thank the former Swedish government adviser Daniel Johansson for responding to our article on how the Swedish pandemic response betrayed vulnerable populations. It gives us an opportunity to probe more deeply the ideological and moral failure of the Swedish left during the pandemic — a failure of historic proportions.

In spring 2020, Sweden opted for a pandemic response that predictably resulted in a very high level of COVID-19 spread. This led to thousands of deaths among vulnerable groups, at a time when Sweden’s Nordic neighbors and some other European countries kept contagion at much lower levels.

This high death toll was a direct consequence of Sweden’s divergent pandemic approach, which stalled on taking basic protective measures while other countries were proactively trying to stem the contagion (neighboring Norway, for instance, began to take robust measures already at the end of February 2020).

Sweden’s failures were many, as has been amply documented in the government-appointed Corona Commission’s highly critical report of the country’s response. Among other things, the Swedish Public Health Agency, which was empowered to lead the response, refrained from recommending that all Swedes returning from the disease-ridden Italian Alps in late February should self-quarantine. It refused to recommend that a large concert in Stockholm on March 7 be canceled, even though it was likely to become a superspreader event. It played down the need for personal protective equipment in health care. It delayed the introduction of mass testing until after the first pandemic wave, and not until December 2020 did it establish a recommendation that all members of infected households should quarantine.

These are a handful of examples of the Public Health Agency’s negligence. As the Corona Commission noted, the measures taken by the authorities in spring 2020 were “belated” and “insufficient.” We can only agree.

Behind these mistakes was a set of flawed assumptions about the viral contagion. Public Health Agency officials openly accepted, indeed even welcomed, an elevated rate of spread in spring 2020 in the errant belief that effective vaccines and improved treatments lay in the distant future. The agency deemed it better to build “herd immunity” through natural infection.

There is abundant evidence that it believed this. In an interview in mid-March 2020, Public Health Agency official and Swedish state epidemiologist Anders Tegnell admitted that Sweden was following the United Kingdom’s line on the pandemic, which was explicitly based on a herd immunity approach. In correspondence with a retired Swedish disease-control official, Tegnell unequivocally said that Sweden was pursuing herd immunity.

Other Public Health Agency officials, including Johan Giesecke — who was state epidemiologist from 1995 to 2005 and worked as a paid consultant to the Public Health Agency during the early pandemic response — and deputy state epidemiologist Anders Wallensteen, openly extolled the merits of allowing the virus to spread. In May 2020 Giesecke falsely claimed that 99 percent of people did not even notice being infected with COVID-19. Even in September 2020, with an impending second wave looming and vaccines well on their way, Giesecke was advising Ireland and other countries to allow the virus to spread in order to achieve natural herd immunity.

A cornerstone of Swedish pandemic thinking held that mass infection prior to vaccines or treatments was inescapable and that the proper task of the public health authorities was to manage the virus’s spread in a manner that would bring the least damaging effects to Swedish society.

Even Sweden’s then prime minister Stefan Löfven, in an interview on April 4, 2020, resigned himself to the belief, which became something of a self-fulfilling prophecy, that “we will have to count the dead in the thousands.” Sweden’s neighbors proved in spring 2020 that this need not be so. We wish Johansson would honestly acknowledge that the Swedish authorities made tragic mistakes at the start of the pandemic — again, an unequivocal conclusion of the government’s own Corona Commission.

The Unequal Outcomes of the Failure

If Sweden’s response was governed by official fatalism, the consequence was that the vast majority of the deaths were suffered by the most vulnerable. Primarily the elderly but also other socially and medically at-risk groups — including people with disabilities, people with medical risk factors, the foreign-born, the poor, people in need of daily assistance, and blue-collar workers — bore the brunt of Sweden’s higher levels of fatalities and ill health.

Despite Johansson’s talk about the response being aimed at equality, the tragic consequence of allowing a deadly virus to sweep through a population before effective vaccines and treatments are available and before workable protective measures have been introduced is that the most vulnerable will die. As Giesecke said with brutal frankness in an April 17, 2020 interview, “People who are frail and old will die first and when that group of people will thin out you will get less deaths.” Presumably Johansson agrees that vulnerable people have the right to protection from a deadly contagion. This, after all, is a basic progressive value, and the point on which our criticism of the Swedish response rests.

As Johansson observes — and as we mentioned in our previous article — Swedish authorities surely did take various measures in response to the virus. For example, they closed high schools and universities (though they kept bars, gyms, restaurants, and other commercial establishments open), imposed crowd restrictions, and temporarily removed the one-day qualifying period for sick-leave benefits, before restoring it. These and other measures were in most cases introduced too late, once contagion had already increased exponentially. They aimed at “flattening the curve” to allow for manageable spread in order to achieve the imagined “herd immunity” by infecting the large majority of Swedes.

Some local authorities followed the Public Health Agency’s strategy zealously, fining parents who had chosen to keep their children at home from school to protect them from the virus. Other public establishments banned the wearing of face masks. The most notable example is Samhall, a state-owned company tasked with providing jobs for disabled people, which banned its employees from wearing masks to protect themselves and the people they worked with.

In another case, a Stockholm bus driver prevented from wearing a face mask by his employer died after likely being infected at work. His death was not listed as a workplace accident, and his widow was deprived of compensation, because the authorities argued — in line with false information communicated by the Public Health Agency — that the virus spread through droplets, an unlikely vector of infection on the bus. This came at a time, i.e. May 2020, when there was already strong evidence for airborne transmission of the virus. Yet Public Health Agency misinformation was used as a means to deny vulnerable workers both protection and compensation. Almost no one on the Left in Sweden criticized this state of affairs, and those who did were frequently accused of fomenting distrust in the authorities.

In other words, Swedish authorities were not passive. Rather, some of their actions explicitly put the vulnerable at increased risk of infection, illness, and death.

A Failure to Protect

Our argument is that the introduction of limited public-infection control measures in Sweden was not based primarily on ensuring people’s right to protection from a potentially deadly or debilitating infection, but rather on ensuring the stability of public services and infrastructure. In particular the measures were aimed at preserving the health care services, which official government documents and statements by public health officials identified as a public sector that must not be overburdened.

Leaked internal documents from the Government Offices, dating from May 2020, explicitly stated that the government would consider introducing more extensive infection control measures during a possible second wave in fall 2020 only if there was a risk of the health service becoming overburdened. Put differently, these documents made it clear that the government would contemplate additional measures to protect people from the virus only once the level of illness risked presenting a serious challenge to the health services.

Confronted on this matter, Health Minister Lena Hallengren lied to the Swedish public by denying on repeated occasions that the policy described above ever existed. Yet authorities’ failure to protect vulnerable groups went even further. One main reason why Swedish hospitals did not collapse during the pandemic was that many people who might have benefited from treatment were not treated in them. Just as the supply of hospital care was increased during the pandemic by extending the working hours of hospital staff and redirecting health care capacity to the care of COVID-19 patients, demand was limited by keeping many elderly from accessing it.

In spring 2020, in the Stockholm region, guidelines were issued with the instruction that some categories of elderly patients should not be hospitalized. Instead, many elderly patients were treated in their care homes by nurses or deprived of treatment altogether. An unknown number were put on palliative care and administered morphine, even though oxygen might have saved their lives. There are accounts of elderly patients who were designated for palliative care, only to have family members step in and refuse. Many times family members were not even notified their relatives were being taken off treatment and relegated to palliative treatment. One Swedish geriatric researcher has called this “one of the greatest health care scandals of our time”.

Instead of equitable contagion control, the Swedish public received trite talk of “personal responsibility.” This was in a context where those who were least at risk had a minimal incentive to protect themselves and others, while those who were most at risk had to fend for themselves as best they could, placing their faith in the good behavior of others along with the limited public contagion-control measures.

This was obviously not a workable approach to pandemic control. According to a classified survey commissioned by the Public Health Agency in early summer 2020, reported on here and here, only 35 percent of Swedes said they complied with the voluntary pandemic guidelines “very well.” Meanwhile a survey in early May 2020 found that shockingly as many as 88 percent of Swedes who had been sick for less than a week said they had gone to work with symptoms. This was at a time when Sweden was suffering one of the world’s highest COVID-19 death rates, and the authorities were repeatedly stressing the importance of staying at home when sick.

So much for basing Sweden’s pandemic approach on voluntary compliance with public guidelines, as the authorities repeatedly claimed they did.

Shifting Responsibility to the Individual

Johansson argues that the Swedish pandemic response does not deserve to be labeled “neoliberal” because the Swedish state took some measures, a number of which benefited marginalized groups. This reflects a banal understanding of neoliberalism.

It is entirely uncontroversial that Swedish crisis management has undergone neoliberalization since the early 1990s, and that this has revolved around an increased delegation of responsibilities from the state to individual citizens. As we noted, this is well established in research, is evident in official documentation from the past three decades, and has time and again been evident in real-life crisis responses. As one key proposition tabled by the then Social Democratic government stated in 2006, the “starting point” for deciding the responsibilities of public actors is that “individuals and companies have a fundamental responsibility to protect lives and property and to take preventive measures.” This was preceded and followed by other official reports and propositions that likewise emphasized individualized responsibilities for crisis response.

The individualization peaked during the COVID-19 pandemic, when Swedes were handed primary responsibility for infection control — i.e. for protecting the lives of their fellow citizens — while the authorities played down their own responsibility. Between March and June 2020, Swedish authorities held almost daily press conferences about the pandemic, which were widely viewed and covered in the media. On these occasions, public officials spoke sixty-eight times of individuals’ responsibility to limit the contagion, but spoke of state bodies’ responsibilities (often in relation to testing) only eighteen times, according to transcripts. In media interviews, the authorities reinforced the same message of individual responsibility, which became a mantra in public discourse on the pandemic. As state epidemiologist Anders Tegnell said at a press conference on May 4, 2020, “the basic question, and here we have been very clear in Sweden, [is] that we should try to put as much responsibility on the individual as possible.”

While the discourse of personal responsibility was not successful in getting people to stay at home when they were sick, it did achieve various other effects. As in other instances of neoliberal governance, it delegated responsibility for public failures to individual citizens and thereby lessened public pressure on the authorities to step up to what should properly be their task, in this case ensuring everyone’s right to effective and equitable contagion control. The power to limit the contagion remained with the authorities, but the responsibility to do so was pushed onto the Swedish public through a pervasive discourse that constructed infection control as a matter of personal responsibility.

Like many other defenders of Sweden’s pandemic response, Johansson is quick to invoke low excess mortality figures between 2020 and 2023. In a false and weirdly reductive claim, Johansson calls excess mortality “probably the best indicator” of the success of a country’s pandemic response. This obviously disregards the well-documented problems with the metric, and the large number of other factors that also shape pandemic outcomes besides policy responses.

Among Sweden’s highly favorable preconditions at the start of the pandemic were its affluence, large share of single-occupancy households, low population density, high rate of digitalization, extensive social provisions, affordable health care, and the later onset of the contagion compared to other European countries. At that moment, Sweden was in an extremely strong position relative to most other countries, as were its Nordic neighbors, whose policies handled the contagion far better than Sweden. Furthermore, it is intellectually dishonest to use three years of excess mortality figures — a period that saw both the game-changing arrival of vaccines and the rolling back of contagion control measures in other countries — to somehow justify the Left’s uncritical support for Sweden’s divergent pandemic response in 2020 and part of 2021.

Knee-Jerk Nationalism

Johansson ignores all of this along with several independent reviews, including by the government-appointed Corona Commission, that blasted Sweden’s pandemic response. Rather than reflecting soberly on this, Johansson eagerly chalks up Sweden’s low excess mortality figures to its mistake-ridden pandemic response, displaying precisely the kind of patriotic reflex we had in mind when we spoke of Swedish “left-wing or progressive nationalism . . . that helped to solidify support for the Public Health Agency among leftists.”

Yet it is evident that Sweden’s authorities committed numerous gross errors and acts of negligence during the pandemic, and that this primarily hurt vulnerable groups. To put it simply, the Swedish pandemic approach purposefully allowed higher levels of infection than necessary, and this inevitably resulted in unnecessary death and suffering. To argue otherwise is to make the completely incomprehensible claim that higher levels of prevaccination infection did not translate into higher rates of death and serious illness.

In spite of this, very few Swedish left-wingers have attempted to hold the authorities and the government to account. With the exception of the journalist Martin Klepke, the Social Democratic pundit Daniel Suhonen, the journalist Erik Augustin Palm, the Feminist Initiative’s Martin Jordö, and a handful of others, the Left remained deferential to a Public Health Agency that has ridden roughshod over vulnerable groups and has played down the need for public contagion control measures.

So servile has the Swedish left been during the pandemic, that it has stayed silent even in the face of the most egregious official failings. For example, it kept its mouth shut when the Public Health Agency spread misinformation about face masks and the manner in which the coronavirus spread; when the Public Health Agency banned Swedish parents from vaccinating their children; when Tegnell publicly rubbed shoulders with anti-vaxxers and representatives of the international far right; when Sweden attempted to exert high-level pressure on the World Health Organization to employ Tegnell, indeed in breach of its recruitment procedures; when Tegnell, in violation of protocol, deleted a large number of his work emails, including one shown to have been highly compromising for him; when it was documented that in November 2020 the Public Health Agency actually advised the government against introducing the mRNA vaccine; and when the Public Health Agency time and again refused to disclose basic information about how it reached its decisions and assessments, many of which conflicted with international scientific consensus.

Indeed, the Left offered only weak murmurs of protest when Tegnell repeatedly blamed immigrants for Sweden’s high level of spread.

Today, the Left has a choice. Either it honestly reflects on the moral and ideological failure of aggressively endorsing a pandemic strategy aimed at shifting the responsibility to the individual and that assumed that the vast majority of society would be infected prior to vaccination, resulting in large number of deaths among vulnerable communities. Or, it can continue to attempt to rewrite history and invent a narrative where refusing to advocate for basic infection control to protect those most at risk somehow conforms with left-wing values.

If Sweden’s approach to the pandemic becomes widely misremembered and normalized, then we can be sure that this imagined experience will be used to justify the same mistakes during future crises — with similarly disastrous outcomes.