Sweden's coronavirus strategy: The Public Health Agency and the sites of controversy

• Published date: 01 September 2022
• Author: Arash Heydarian Pashakhanlou
• Date: 01 September 2022
• DOI: http://doi.org/10.1002/wmh3.449

World Med. & Health Policy. 2022;14:507–527. wileyonlinelibrary.com/journal/wmh3

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507

Received: 12 November 2020

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Revised: 11 March 2021

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Accepted: 13 April 2021

DOI: 10.1002/wmh3.449

ORIGINAL ARTICLE

Sweden's coronavirus strategy: The Public

Health Agency and the sites of controversy

Arash Heydarian Pashakhanlou

Department of Military Studies, Swedish

Defence University, Stockholm, Sweden

Correspondence

Arash Heydarian Pashakhanlou, Department

of Military Studies, Swedish Defence

University, Box 278 05, Drottning Kristinas

väg 37, Stockholm 115 93, Sweden.

Email: arash.heydarian.pashakhanlou@

fhs.se

Funding information

Swedish Defence University

Abstract

In contrast to the vast majority of Western countries,

Sweden left large segments of the society open instead

of imposing a lockdown to combat the spread of the

coronavirus. As a result, the Swedish COVID‐19 mea-

sures, largely devised by its expert agency on health,

garnered widespread international attention. Despite the

global interest in the corona strategy of the Public Health

Agency of Sweden (PHAS), there are currently no sys-

tematic studies on their COVID‐19 policy. The present

investigation focuses on the controversies that have

characterized PHAS' work with reference to risk as-

sessments, facemasks, voluntarism, testing, and the

protection of the elderly during the pandemic. Overall,

this inquiry demonstrates that PHAS' risk assessments

were initially overly optimistic and their facemask re-

commendations in conflict with large segments of the

scientific community for an extensive period. Yet, their

voluntary measures worked moderately well. In their

testing, PHAS did not manage to deliver on their pro-

mises in time, whereas several measures implemented

to protect the elderly were deemed inadequate and late.

Key Points

•The Public Health Agency of Sweden (PHAS) was

initially overly optimistic in its risk assessments re-

garding the spread of COVID‐19 within the country.

•The facemask recommendations of PHAS was in

conflict with large segments of the scientific commu-

nity for an extensive period.

This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which

permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no

modifications or adaptations are made.

© 2021 The Authors. World Medical & Health Policy published by Wiley Periodicals LLC on behalf of Policy Studies Organization

[Article updated June 9, 2021 after first online publication: Four small typos were corrected.]

•PHAS did not manage to deliver 50,000–100,000

coronavirus tests per week as promised in a timely

fashion.

•Several measures that the PHAS implemented to

protect the elderly were deemed inadequate by the

Corona Commission in Sweden.

KEYWORDS

controversy, COVID‐19, facemasks, pandemic, public health agency,

risk, Sweden, testing, the elderly, voluntarism

INTRODUCTION

Sweden pursued a rather unique strategy in tackling the coronavirus pandemic. It allowed

bars, restaurants, schools, and shops to stay open when most Western countries opted for a

lockdown. According to Oxford's Government Stringency Index, Sweden had the most le-

nient COVID‐19 policy possible with a score of zero up until March 8, 2020 (Hale

et al., 2020).

1

This approach received both international praise and criticism. Dr. Mike Ryan,

director of the World Health Organization (WHO), stated that “if we are to reach a ‘new

normal’, in many ways Sweden represents a future model”(Russell, 2020). Conversely, the

former President of the United States, Donald Trump, tweeted that “despite reports to the

contrary, Sweden is paying heavily for its decision not to lockdown. As of today (April 30,

2020), 2462 people have died there, a much higher number than the neighboring countries

of Norway (207), Finland (206), or Denmark (443)”(Bowden, 2020).

2

Although the merits of the Swedish coronavirus strategy have been hotly debated

(Campos‐Mercade et al., 2021; Drefahl et al., 2020; Irwin, 2020; Kavaliunas et al., 2020;

Pierre, 2020; Yan et al., 2020), there are currently no comprehensive examinations of the

policies of its public health agency. This is a major oversight as the Public Health Agency of

Sweden (PHAS; Folkhälsomyndigheten in Swedish) has been central in devising the

country's response to the COVID‐19 pandemic. The present inquiry helps to fill this im-

portant gap in the literature by assessing some of the most controversial and debated issues

concerning PHAS' corona efforts. These include PHAS' risk assessments, its policy on

facemasks, voluntarism, testing, and the protection of the elderly.

This article, therefore, aims to address these topics through a careful in‐depth analysis of

primary sources by PHAS, WHO, European Centre for Disease Prevention and Control

(ECDC) as well as scholarly publications and media reports, in which information regarding

PHAS' COVID‐19 policies has been disseminated. To ensure the timely completion of the

article, material published after February 17, 2021 will not be considered here. An evaluation

of the vast array of data up until this date reveals that PHAS' risk assessments were overly

positive between January 31, 2020 and March 10, 2020. In addition, the scientific com-

munity increasingly challenged PHAS' stance against facemasks until the agency altered its

decision and recommended the general use of facemasks under specific conditions. These

new recommendations were introduced on January 7, 2021. Yet, the agency's voluntary

approach has been moderately successful. Finally, PHAS failed to deliver sufficient and

agreed quantities of tests on time and their policy concerning the elderly has been

considered insufficient in several aspects.

These arguments are developed at length in the forthcoming sections. The first section

takes a closer look at PHAS as an agency and its mandate during the COVID‐19 pandemic.

The ensuing five sections are devoted to the analysis of the controversies concerning PHAS'

risk assessments, facemask policy, voluntarism, testing and the protection of the elderly.

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