Who’s actually responsible for Sweden’s coronavirus strategy?

Who's actually responsible for Sweden's coronavirus strategy?
Prime Minister Stefan Löfven (L) and state epidemiologist Anders Tegnell. Photos: Ali Lorestani and Jessica Gow / TT
Who is responsible for the decisions taken in Sweden in the fight against the coronavirus? A different political situation to many neighbouring countries means the answer might not be as clear as you'd expect.

The title of state epidemiologist or statsepidemiolog was probably little known to many people in Sweden before the coronavirus outbreak.

Now the holder of the title, Anders Tegnell, is one of the most-discussed people in the country. Tegnell gives daily updates on the situation in Sweden, reminding the public of official recommendations introduced to fight the outbreak, on behalf of the Public Health Agency (Folkhälsomyndigheten).

State agencies, including the Public Health Agency, are not able to pass laws themselves, but they can give recommendations to the government. Some of the rules that have been brought in to deal with the virus outbreak, such as restrictions for restaurants and cafes and a ban on public events over 50 people, have come following consultation with the agency.

It is written into the national constitution that Sweden's public agencies are independent of the government. There are two main goals of this: ensuring that decisions are made based on knowledge and expertise, and limiting corruption, because ministers cannot have influence in agency decision-making.

A minister who tries to issue direct commands to an agency over how to handle a specific issue — either an individual case, or day-to-day decision-making — could find themselves accused of 'ministerial rule' (ministerstyre) by political opponents. Overruling government agencies or disregarding their advice is usually seen as politically risky, even though it's not specifically forbidden in most circumstances.

“There is a strict line of division when it comes to responsibility, and in the corona crisis this is quite visible. The government has its role in taking the overall lead, but all the time has to respect the expertise and independence of the agencies,” Li Bennich-Björkman, a professor in the Department of Government at Uppsala University, tells The Local.

“This division goes back very far in time to the 17th century. There is a strong idea in Sweden that civil servants should be safeguarded from the pressures that come from the political side. It lives on, and I think it's done what it was meant to do. There is very little corruption in Sweden.”


Anders Tegnell speaks to journalists after a press conference. Photo: Ali Lorestani / TT

Each weekday at 2pm, there is a press conference with representatives from various government agencies relating to the coronavirus. As well as the Public Health Agency, this sometimes includes the National Board of Health and Welfare, the Swedish Public Employment Service, the Civil Contingencies Agency, and any other agencies with updates to share.

The Public Health Agency has existed in Sweden since 2013, when the centre-right government of the time appointed Johan Carlson to be its director, a post he still holds. Although governments appoint the directors of state agencies, these positions are usually kept even following changes in governments, as in the case of Carlson, who remains in his role under the current centre-left government.

For comparison, in neighbouring Denmark and Norway, the national equivalents to Sweden's Public Health Agency advised against the closure of schools. In both countries, the governments decided to take this measure anyway, with Denmark's health minister saying: “We have no evidence that everything we are doing works. But we would rather take a step too far today than find in three weeks that we have done too little.”

And Public Health Agency general director Johan Carlson told Swedish TV that his colleagues in other countries are “concerned” about the impact of strict lockdowns.

“If you want to succeed with measures that need to be kept in place for months, you have to have acceptance and understanding. There are lots of things that are banned in society, drug use for example, but it does not disappear for that reason. Basically, the population must have their own insight and understanding. This is how we have worked in infection control,” Carlson explained.

But as Tegnell has become the figurehead for the Swedish response, his predecessor and former state epidemiologist Johan Giesecke told the TT newswire he wondered if epidemiologists had been given “a bit too much power”.

“The government should make other considerations, but they let us decide,” he said, pointing to the Norwegian and Danish school closures as an example of how Sweden sticks more closely to expert guidance.

Unlike in other countries where prime ministers hold daily press conferences on the virus, it is a rare occurrence for Stefan Löfven to give a national address. But he's still the one ultimately responsible for the decisions made. Photo: Anders Wiklund / TT

How successful the measures are in Sweden will not only be down to authorities, but also the general population. Political professor Li Bennich-Björkman also highlights the responsibility of the individual in reducing the spread of the virus.

Aside from the new regulations for events and restaurants — and several measures to mitigate the economic impact of the virus — most of the measures from Sweden have come in the form of 'recommendations' from the Public Health Agency.

This includes strong recommendations to follow good personal hygiene, avoid non-essential domestic travel, for over-70s to avoid all non-essential social contact, and for everyone in the country to work from home if possible.

“There is a very high level of confidence among Swedish citizens towards authorities and the government, and I think this shown very clearly now because people's behaviour is still affected even though it's not legally enforced,” says Li Bennich-Björkman.

“And it's important to underline the confidence from the government and authorities towards the citizens. It's important for the trust to go both ways, because if authorities start to be more harsh in pushing people to do things, you could see citizens respond by having less trust and confidence in them in future. It's not just about the model of ministries and government, it's also about safeguarding the confidence we have between individuals and the government.”

This presents some challenges, and authorities have to work hard to reach those individuals who may not share the overall high trust for the government, including the immigrant community.

After reports that Swedish-Somalis were over-represented in Stockholm's coronavirus patients, for example, an information campaign was launched to share guidance and information about the virus through posters in multiple languages in Stockholm suburbs.

But Bennich-Björkman says that despite the prominent role of the authorities and the calls for everyone to act responsibly, it is still clear that ultimate responsibility and accountability for decisions taken lies with the government.

“In Sweden there's collective responsibility for the government, so all decisions in the government are taken collectively. The government is accountable for what its agencies and authorities do, but it is not the government that decides on a day-to-day level what they do,” she explains.

“The government can override them, if there's a state of emergency and things are changed constitutionally, which is highly unlikely in Sweden. But for me, it's a hypothetical question because why should the ministers think that you shouldn't listen to the experts?”

 


Member comments

  1. Thank you for this excellent article! It provides a much needed explanation of how things are done in Sweden, which I think is quite baffling for many people from other countries. The set up in Sweden has certainly drawn international attention (see NYT 28 March).
    I was originally skeptical of the disbursement of authority in relation to the coronavirus policy in this country. This article goes a long way of convincing me that many of my fears are unsubstantiated. But it doesn’t totally eliminate them. Time will only tell if a responsible government in the absence of central command over all important policy decisions performs as well or better than the typical set up of senior government taking advice from experts, but retaining all decision-making power explicitly in the hands of elected leaders.
    Two points to raise: First, the voluntariness / optionality of the strategy. At first, I was skeptical of this as well, but have since come around. The Swedish people do show more restraint than we are witnessing around the world. And anyone who has come from another country knows without a doubt that the Swedish people are unique. 🙂 I like living in a country in which social responsibility is exercised voluntarily and wouldn’t want the government to tamper with that unless absolutely necessary (eg., 90 days from now when the healthcare system might be bursting at the seams). The Easter holiday will be a litmus test for this I think. I hope things don’t change for many reasons. I certainly wouldn’t like to have to fill out a form (France) just to go out for a walk, or a drive for that matter. And while in some ways I think my elder teenage son should be homeschooling, after 90 days of isolation I can easily see that devolving into a scene from The Simpsons. If we’re at Day Zero in Stockholm, we are likely at least 80-90 days to peak. It is going to be hard psychologically to get through this, and in that context the least draconian / non police state approach is on balance preferable. For those of us who are worried the Swedish government is not doing enough, we all need to take a deep breath and be careful about what we wish for.
    The second point is one of transparency / independent evaluation. Tomorrow, Dr Fauci, arguably one of the world’s most experienced and highly regarded epidemiologists, will release his department’s models for understanding the spread of coronavirus. Donald Trump (love him or hate him), will stand beside Dr Fauci and endorse his conclusions. Once that model and its results have been released, thousands of universities and think tanks in the US and around the world, including here in Sweden, will vet that model and the press will report criticism and/or support, discrepancies, strengths and weaknesses. I have read articles that the FHM fall far short of this standard. Reports that epidemiology experts at universities here in Sweden have not been given ADEQUATE access to the models used by the FHM. This strikes me as a huge failing. While the people interviewed in this article go to great lengths to ensure that there is inter departmental responsibility, ie., between the various organs of the Swedish government, why is the FHM reluctant to engage with public with more transparency, and to embrace independent review by experts more willingly? The government asks the people to behave responsibly, like intelligent adults. In this regard so should it be responsible, and it should be willing to treat citizens as intelligent persons who can understand complex scientific and mathematical issues, if presented coherently and in their simplest form. If the defense for a more opaque way of doing things is that it would only cause unnecessary debate, or speculation of possible panic, then it’s a poor one at best.

  2. 333 beautiful souls have lost their lives to this beast of a virus in this state. Denmark is vastly more densely populated and have lost less than half that number.
    The government’s model has not worked, they tweak it almost every day. The only thing still in place is open stores and open schools. Almost, everything else is now in align with other countries apropos safety measures, and thanks to restraint from businesses such as Skistar, not nearly enough credit has been given to them, they have literally saved lives.
    Obviously this is sadly far from over, but, it looks like Sweden acted far too slowly, and when that happens, people die. We must hold the governments feet to the fire, that’s our job, we give them awesome power to protect our collective security.
    Wanting to spread this virus through the state to create so called herd immunity is reckless when there is no evidence on how long that immunity even lasts, it’s a dreadful waste of life. I am keeping my eye on the NZ model.

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