Edited and introduced by Henry Milner, with contributions from Thomas Lundén, Donald Lavery, Jan Otto Anderson, and John Erik Fossum.
In late March, we learned that Sweden, in its response to the COVID-19 pandemic, did not intend to “lock down” the population and mandate social isolation. Instead, Anders Tegnell, Sweden’s head government epidemiologist, and Johan Giesecke, Tegnell’s mentor, argued that a modest set of regulations (for example, protection of centres for the elderly) and good common sense among Swedes was preferable. Sweden became a notable outlier in the global fight against the novel coronavirus.
Many speculated, as did Simon Rosenblum on the Inroads listserv, that the Swedes were “only fooling themselves and will pay a price for their delay in implementing the necessary public health measures.” More widely, we wondered how this “model” progressive country could be lined up with Donald Trump and Brazil’s Bolsonaro in resisting lockdown. Why was Sweden deviating so dramatically from its Nordic and northern European cousins? This was unexpected. The Nordic countries have much in common and are closely linked through binding Nordic and European cooperation, with a long history of policy learning from one another. As John Erik Fossum notes in this section, they share high levels of trust in government, which plays an active and transparent role in macroeconomic governance and public welfare to attain a fair and equitable distribution of benefits and burdens.
The COVID-19 pandemic tests the very fibres of modern societies and economies, including the four Nordics (Norway, Sweden, Denmark and Finland – Icealnd is not included here because of its small size). In comparing their responses to it, we can gain an insight into the resilience and pertinence of the Nordic model. And Inroads is in an exceptional position to do so. As regular readers know, over the years we have published many insightful contributions on relevant issues from well-informed correspondents in the Nordic countries. I approached four of them, and what follows is based on their responses updated through to late April.
They were asked to describe the steps taken in their own countries and in the Nordics more widely, and, in that context, address the various aspects, as well as outcomes, of Sweden’s approach. To begin, we should note that numbers may more accurately reflect reality in Sweden than in other countries. Every Swede has a 10-digit personal number and is required to self-identify with this number, validated by an ID card, at every contact with authorities and medical professionals. This means that Sweden systematically checks the list of people who have tested positive for the virus against the population register. Every time the government discovers that someone who had the virus has died, that person is registered as a COVID-19 death if it happened within 30 days of the diagnosis – even if the cause of death was cancer or a heart attack. Other countries typically only count a death as caused by COVID-19 if a doctor so concludes.
We should also note that the proportion of immigrants in the Swedish population, at about 15 per cent, is larger than in most European countries. In Norway and Denmark, immigrants make up roughly 10 per cent of the population, while in Finland the proportion of immigrants is half what it is in Sweden. Still, the comparison with its neighbours makes clear that Swedish numbers, as presented in the chart, are higher than they should be. And we want to know why. It is not, as in certain countries with comparable numbers, that Sweden lacks for hospital beds or ventilators. In fact, the number of COVID-19 patients newly admitted to intensive care units stabilized as early as March 23. Quite early, in mid-April, the Swedish government announced that testing was to be ramped up to a respectable 50,000 to 100,000 tests per week.
For a Canadian from Montreal, there is something almost déjà vu in these numbers. If we average the Nordic numbers, they are similar to Canada’s. And Quebec is similar to Sweden.
There is a clue in these numbers that helps us make sense of Sweden’s results. Roughly half of Sweden’s deaths are in the Stockholm region, as is the case for Montreal vis-à-vis Quebec. Sweden proved especially vulnerable because, like Quebec, a large proportion of the elderly in the metropolitan area are in care centres, which are often staffed by new immigrants. While Quebec’s numbers were especially high because many of these workers work in more than one institution, the Swedish high numbers primarily reflect the fact that many of the staff were from communities living in densely populated ethnic suburbs – the places where people were least likely to follow, or even be aware of, suggested guidelines about physical distancing and self-isolation.
At the time of writing, Tegnell and Giesecke have resorted to the argument that, in the long run, after second and maybe third waves of COVID-19 cases, Sweden’s strategy will prove to be as efficient in saving lives as a lockdown. Why? In Sweden, a higher share of the population will have been exposed to the virus than in locked down countries, and this will provide an element of “herd immunity.” Finally, they predict that, in locked down countries, public support for unlocking will rise and generate intense conflict with those favouring lockdown. Swedish authorities may be right, but this seems doubtful. Second-wave fatalities in other countries are likely to be better kept in check since there will have been much more testing and contact tracing by then. In the first three months of 2020, Sweden’s excess of deaths compared to the same period in 2019, as well as its decline in its GDP, was greater than that of its neighbours. This is not to suggest that all Swedish choices were erroneous: it seems likely that keeping younger students in school was, on balance, a good decision, since evidence shows that periods of schooling lost by children with poorly educated parents and without access to elite schools are never made up.
What follows, in edited and updated form, are contributions from John Erik Fossum, Thomas Lundén, Donald Lavery and Jan Otto Andersson on and off the Inroads listserv in the first three weeks of April, ordered by country rather than by the date they were originally submitted.
From Thomas Lundén in Stockholm
Sweden has for a long time had a structure of governance different from most other countries. The ministries are small, and their role is to develop and introduce legislation. Linked to each ministry are several state agencies whose responsibility is to implement the legislation with, in theory if not always in practice, a strict boundary between ministry and agency. As stated on its web page, “The Public Health Agency of Sweden has a national responsibility for public health issues and works to ensure good public health. The agency also works to ensure that the population is protected against communicable diseases and other health threats.”
Government ministers are often accused of ministerstyre – that is, intervening in the agencies’ duties, with journalists often instigating them to do just that. In the COVID-19 case, the measures have been taken by the Public Health Agency with the State Epidemiologist as spokesperson. If and when the agency (like others) finds it necessary to involve the legislature, it can do so, and this has happened recently since some laws had to be changed. So far, Swedish policy has effectively been set by the medical experts, with the government voicing support for the measures taken. These measures include distance education for upper-level institutions, with schools for those under 15 remaining open so that parents can work and kids are kept off the streets; a ban on visiting care homes for the elderly; and rules requiring cafés, bars and restaurants to offer table service only and limit crowding by spacing out tables. All meetings involving more than 49 people are banned, with people gathering advised to leave an empty chair between participants.
In addition, the Public Health Agency has put in place a set of recommendations for individuals that are supposed to be followed, although they aren’t being legally enforced. These include that people work from home if able to do so, keep a distance from other people in public spaces, and stay at home if sick. Clearly, Swedes reduced their mobility substantially, even without police enforcement. Cell phone data show that the inhabitants of Stockholm reduced their trips to the most popular Swedish holiday destinations during Easter by around 90 per cent.
There are some alarming signs: in the Stockholm area, several homes for the aged have been hit by the infection, in spite of seemingly rigid measures. Forty-two per cent of deaths took place in nursing homes for the elderly – deaths that in many countries and some U.S. states would not appear in the data. Moreover, concentrated among the victims were elderly Somali immigrants who, though information was soon provided in most of the immigrant languages, are both difficult to reach and, unlike native Swedes, tend to live together multigenerationally. And immigrants are overrepresented among nursing home workers.
In my opinion, it is a mistake to link the unacceptably large number of deaths in Sweden to our policy vis-à-vis COVID-19. It rather reflects a deficiency in the treatment of people who are very old and/or have multiple pathologies, in institutions or at home. Their medical, social and nutritional needs have to be met by far too large a number of individuals, many of whom work part-time, are not eligible for paid sick live, and are immigrants with a lower knowledge of Swedish language and culture. If a home for the aged is served by 50 different people, one who is infected and not protected may be enough to cause deaths.
At this point we cannot say that the “Swedish model” of relative openness under strict recommendations has not been successful: the number of infected people without serious illness has grown, hopefully reaching a level of stability and immunity, while the hospital side has been able to cope without using the emergency hospitals provided by the military. Where failure lies is in the integration of a large immigrant population, both service providers and receivers. This is bad enough.
One final point. To understand the Swedish approach, we should note that we are sensitive to the dangers of overly rigid measures leading to a reduction of trust in public institutions and, as we can see in Hungary and Poland, rulers potentially taking advantage of this situation to impose dictatorial rule. History may also be a factor. An insight here was provided in a newspaper column on April 6 by Uppsala political science professor emeritus Leif Lewin, replying to articles critical of the Swedish position as a manifestation of its being ¨peace-damaged” (i.e. naive and not understanding the gravity of the situation) as a result of having stayed outside of wars. Lewin’s article was entitled “No, it’s the others who are war-damaged.” He responded that Sweden’s neutrality during World War II entailed hardships which, in meeting them, gave rise to a consensus involving almost all parts of society. It is the other Nordic countries, he argued, where the wars and occupations during the war left scars that make solutions based on consensus less effective.
From Donald Lavery in Stockholm
The Swedish government has followed the recommendations of the Public Health Authority (PHA) concerning restrictions very closely. The Minister of Social Affairs recently commented that the government has carefully deliberated each measure it has taken and has judged the recommendations of its experts on their own merits, in effect responding to critics’ dissatisfaction with what they see as the government simply rubber-stamping what the authorities recommend. Generally speaking, there has been practically no political debate about the restrictions that have been introduced on the advice of the health authorities. The three right-of-centre parties as well as the Left Party have chimed in on this. On the other hand, the government has been criticized for the measures it has taken to keep the economy going.
The dry, matter-of-fact approach of Anders Tegnell, the head epidemiologist at the PHA, has endeared him to the Swedish people. In the polls measuring popular trust in various institutions, the PHA has had a high ranking. Tegnell’s approach was echoed by Prime Minister Stefan Löfven, who was quoted as saying, “We are going to number the dead in the thousands. We might just as well get used to the fact.” According to Tegnell, the PHA does not focus on providing prognoses for the number of dead: “That is not what we consider to be most important; it is more important that health services get figures about how many people need intensive care and the like. We have been using models the whole time to do this. The number of deaths depends on so many different things that all such figures are very, very difficult both to calculate and to interpret.”
In the early period at least, the ability to test whether people have been infected with the virus has been inadequate in Sweden. The PHA has had to establish priorities with an eye to keeping health services running. In this regard Iceland stands out among the Nordic countries. Home to one of the world’s leading biochemical firms, and with a population of only 360,000 people, Iceland has set up a testing regime that has reached a much larger proportion of the country than anywhere else, making it available for free for anyone who wants it.
The Swedish position was defended in the main Stockholm Daily Dagens Nyheter in an interview with Johan Carlson, head of PHA. Here are some excerpts I have translated.
I try to tell politicians how important it is that measures are accepted by the population. That way people are more likely to follow them … There is no law that parents must have their children vaccinated. There is no law to prevent doctors from prescribing too many antibiotics. Nevertheless, work better than in many other places …
In the Nordic countries my colleagues … and I have been very much in agreement … have had a different impact on policy …The Danish authority for the prevention of infectious disease made a public statement to disassociate itself from the business of closing the border, which is meaningless in the struggle against the epidemic.
The key is not the number of people who die from the coronavirus. The key is what we see after four or five years. What effect will the outbreak of the coronavirus have on the health situation in Sweden on the whole? Each year 850,000 people are hospitalized – we must take care of all the other ailments as well. To what extent will corona push these aside? … And how will the psychic health of children be affected? That is one of the reasons we are against closing the schools. Many children live in broken homes, under difficult social conditions. School is their lifeline …
Many countries have an authority that is solely responsible for the prevention of infectious diseases. We have an agency with a wider mandate that includes both prevention of infectious diseases and public health. We have it built into us to ponder this balance, to see the whole picture. I think that this is a great advantage. We are forced to lift our gaze.
In views expressed in an interview on April 22 in Svenska Dagbladet, Frode Forland, the director for the prevention of infectious diseases at Norway’s Public Health Institute, the closest equivalent to Sweden’s PHA, suggests that in taking charge early of measures to check the novel coronavirus, Norwegian politicians adopted a rhetoric – Prime Minister Erna Solberg talked about “beating down the infection” (“slå ner smittan”) – which the experts maintain is unrealistic. Forde’s comment recalls the quote from Johan Carlsson that he and his colleagues in the other Nordic countries differ not on content but in their impact on policy.
We should not assume that Swedish political leaders understate the severity of the challenge. As the Prime Minister put it on April 22, “The road ahead is long, and it will be rather a question of months than of weeks before the crisis is over.” Unlike in the United States, understandably, the coronavirus crisis seems to have provided an opportunity to take and bring the Swedish nation together. On the economy, the government has proposed a system of temporary support to employers and self-employed workers to continue employment during short-term layoffs. It has been made easier to qualify for unemployment insurance, which is restructured to provide greater financial security. More funding is proposed for the Swedish public employment service to allow more people to participate in employment training and other programs improving labour market access and ensure equivalent service levels throughout the country. More spaces are being provided at universities and other institutions of higher and vocational adult education.
Prime Minister Löfven even replaced the party pin on his lapel with a Swedish flag during his regular press conferences. The result was a record-breaking increase of 6.8 percentage points in the SvD/SIFO poll for his Social Democrats, up to 30.6 per cent. According to SIFO, because of the outbreak of the coronavirus the political debate has been completely dominated by the issues of the economy, unemployment and health care. That development particularly favoured the Social Democrats, who gained voters from almost all the other parties as well as among abstainers. The populist Swedish Democrats are 11 percentage points behind, tied with the Conservatives for second place.
To take the necessary measures, the government has had to negotiate with the other parties to pass a bill that gave it the needed powers to limit restaurant and public transit use and the like, and such measures must nonetheless be presented within two days to the parliament, which can rescind them. Unlike in the case of Finland, the Swedish constitution does not have a provision to allow the government to take emergency measures in times of peace. Finland, with its terrible war experience, kept such a clause, which the government applied in no uncertain terms. In addition, while Sweden disbanded its civil defence after the Cold War and sold off the stockpiles of medical supplies and food it had maintained since World War II for emergencies, Finland assessed the risks differently and kept its stockpiles, finding itself now in the enviable position of having adequate supplies of protective clothing for medical workers.
From Jan Otto Andersson in Turku/Åbo, Finland
Despite its affinities with Sweden, Finland more closely followed Norway, Denmark and Germany. Nurseries, schools and universities were closed, and students had to follow distance education. However, young children of parents engaged in necessary work were allowed daycare and education as they would be normally. Groups were limited to 10, with working from home becoming the rule. Restaurants were only allowed to offer takeout food. The metropolitan region of greater Helsinki (Uusimaa/Nyland) was isolated for 19 days. Cases outside the region are still few. Skiing resorts were closed, and all who arrive from abroad – even Sweden – are quarantined for two weeks. People over 70, or with respiratory diseases, are urged to stay at home, but also, if possible, to go outside for a walk. Shops remain open, but sales have been considerably reduced, and the streets are rather empty. Nature walking tours have increased perceptibly, and mass migration to summer cottages has raised critical comments. Restrictions will be gradually reduced by mid-May, but all big summer festivals will be cancelled.
Finland has a ministry of social affairs and health and a public research organization, THL, which has been consulted by the government on all restrictive measures. Cuts by earlier governments have reduced the reliability of THL’s assessments of the ongoing situation, which have been the subject of some criticism.
Gallup polls showed 70 per cent of Finns think that the restrictions are the right ones, with 84 per cent satisfied with Prime Minister Sanna Marin, who heads a centre-red-green coalition government. As in Sweden, her Social Democrats have benefited at the expense of the populists, known in Finland as the True Finns. But there is an economic price to pay. The Finance Minister calculates that Finland must take up to €20 billion extra in loans this year, with state indebtedness expected to rise from 60 to 80 per cent of GDP. Like other countries, Finland has started to give support to firms and individuals hurt by the restrictions and not covered by the general welfare system. Services, especially hotels and restaurants, along with cultural workers, are the most affected. The trade union federations and employer organizations agreed to make temporary layoffs easier and to relax conditions for unemployment benefits.
Finland is constrained because of its slow recovery from the financial and euro crisis. Unlike the other Nordics, it adopted the euro from the start. (Denmark linked its krona to the euro, but is not a member of the eurozone; Sweden kept its monetary independence and was able to steer clear of the euro crisis; Norway, not a member of the EU, can use the revenue from its oil industries as an economic stabilizer.) Moreover, among European countries, Finland was the most affected by the sanctions directed towards Russia.
Finally, Finnish exports are dependent on machinery and other investment goods as well as shipbuilding, both badly hurt by the economic depression. The building of luxury cruise ships could be affected as the companies have been shaken by COVID-19 incidence on board. The shipyard in my hometown of Turku has orders for eight ships until 2025. The 20,000 employees continue to work on these orders – but for how long?
From John Erik Fossum in Oslo, writing about developments in Denmark as well as Norway
In Norway, the government seems to have gone further in the lockdown than what the experts advised. This is in part simply because the economic repercussions were not as great, the government in Norway having more financial leverage as a result of the massive petroleum fund. That is not the entire story though, because it does not explain the fact that Denmark preceded it into serious lockdown. Indeed, part of the story is simply that Norwegian politicians copied Danish policies.
Differences in political culture help us understand the contrast between Denmark and Norway on one side, and Sweden on the other. Both Denmark and Norway are generally speaking more nationalist than Sweden, which has traditionally been more internationalist and open to foreign influences. Hence, other things being equal, it is easier to get cross-partisan agreement for a lockdown in Denmark and Norway than in Sweden.
Very extensive support measures were put in place to deal with the effects of the shutdown, though in Norway the emergency legislation instituted as required in the constitution was quite different from what the Solberg government initially proposed. Alert law professors first drew attention to the hasty, secret deliberations between the government and leaders of the opposition to forge the new legislation, as well as the danger of giving the government extremely wide powers, which sidelined parliament’s legislative role. Evidently, the professors won the attention of the opposition, who scaled down the government’s emergency powers considerably, forcing the government to go back to parliament to have the legislation extended on a monthly basis.
To a large extent, like Finland and unlike Sweden, Norway and Denmark locked things down, preventing the virus from spreading by minimizing contact. Fearing that a rapid spread of the virus would overburden the public health system, lockdown was instituted to ensure that the public health system could deal with the infection over time. This strategy is highly interventionist in people’s lives and typically requires invoking a set of exceptional measures available only in emergency situations during which governments are granted special authorization.
The Swedish strategy has also been to prevent the virus from spreading so quickly that the health system breaks down under the burden, but it differs from the other Nordic countries in the means used to achieve that goal. It combines recommendations to the general public and regulations affecting those prone to (spreading) infection, but all placed in the context of the broader socioeconomic and psychological effects of a period of lengthy shutdown. It is not the same as what we saw in Britain and still see in Brazil, Mexico, parts of the United States and, inconsistently, from Donald Trump – that is, downplaying the hazards and the need for a coherent, science-based and publicly orchestrated and conducted response, and instead leaving responsibility to local and regional authorities.
Finland, Denmark and Norway on one side, and Sweden on the other, produced a comprehensive public response anchored in expert knowledge. This was most visible in Sweden, though not all Swedish epidemiologists agreed with the position of chief epidemiologist Anders Tegnell. Sweden’s refusal to go further in locking down the economy may be due to its being more attentive to economic expertise than the others. Such expertise is typically less supportive of state intervention and more sensitive to international openness, though in Norway at least, many economists take a different stance, for instance opposing membership in what they consider to be a too neoliberal European Union.
The main concrete difference between the two strategies is in the invocation of emergency powers. Denmark was first to introduce such legislation (adopted by a unanimous Folketing on March 12, 2020, and due to expire on March 1, 2021). It allowed the minister of health and elderly affairs to require persons assumed to be infected to isolate themselves, and authorized the government to prohibit large gatherings of people and block access to means of transportation. The legislation also provided the authorities with increased tracking options, including rules obliging people to provide information. On March 14, Denmark closed its borders and shut down kindergartens and schools. One month later, Denmark, like Germany, Austria and Switzerland, relaxed lockdown rules. It allowed daycare centres and elementary schools to open, followed by hairdressers, beauticians, dentists and opticians, who are required to sanitize the work area between clients.
Norway basically followed Denmark’s approach, introducing emergency legislation on March 18. Nevertheless, there was more controversy surrounding the Norwegian version and the legislation that was adopted was less comprehensive, with the timeframe shortened from six months to one month. As I write, the government wants to extend the legislation. While some opposition parties have voiced reservations, it is likely that it will be renewed.
A measure specific to Norway, with its large northern hinterland, was a prohibition on persons seeking to stay in their vacation homes when these were located outside the municipality where they lived. This measure was urged on the government by municipalities where these are more numerous than permanent homes and where it was feared that the limited medical capacity could not deal with a large influx of infected people.
Both Denmark and Norway introduced wage compensation to allow people to keep their jobs during the lockdown. The Danish arrangement is slated to expire on June 9. Both the Danish and Norwegian governments introduced measures to compensate businesses for income losses. In these measures, we see clear elements of the Nordic model: tripartite cooperation between government and organizations of large employers and employees. Significant resources were channelled into the economy as well as the health sector, and both Denmark and Norway have shown a clear commitment to sheltering people from fallout from the measures.
In this they rely on a key feature of the Nordic model: trust. The Swedish strategy is primarily one of the government trusting the citizens to follow its recommendations. For their part, Norway and Denmark’s social distancing and lockdown strategy called on high levels of trust and sense of community and belonging. Public communications included reassurances from the government that it trusts the population to put up with the lockdown for the greater good. The Norwegian statements sought to couch this paternalism in positive terms: Prime Minister Solberg labelled the fight against the virus a collective “dugnad.” This is a word used to depict “voluntary” work that housing and other cooperatives organize to address community needs. Clearly, this has been working. In a recent poll, 77 per cent declared that they supported the government’s handling of the coronavirus. The main governing party, Solberg’s conservative party (Høyre), saw a dramatic rise in support between mid-March and mid-April (up from 17.9 to 25.2 per cent).
Even if we operate with two different coronavirus response models, we should not overstate Sweden’s differences from Norway and Denmark. Norway stands in between Denmark and Sweden historically, in that it was ruled by Denmark from 1389 to 1814 and by Sweden from 1814 to 1905. There have been no internecine wars in the Nordic region since 1815, and the three Scandinavian countries’ languages are fully mutually understandable. Language is therefore also a factor explaining why the Danish and Norwegian responses are so similar, and why emulation happens so frequently. In this case Norway copied from Denmark, whereas in the postwar period it constantly looked to Sweden as the model welfare state.
Postscript from Henry Milner
As I write, Denmark and Norway have joined Austria, Switzerland and Germany, among others, in beginning to end the lockdown, with shops and schools reopening. Norway is set to return to normal by summer. Sweden is sticking to its guns but, as in Quebec, cases continue to emerge. When it coms to the pandemic, so far, Denmark, Norway and Finland are the countries that can legitimately lay claim to constituting the Nordic model.