“I was intrigued by the Swedish government’s outright rejection of global public health orthodoxy on lockdowns and states of emergency.”
Social media platforms such as Facebook (FB) are often dismissed for violating our privacy and promoting “surveillance capitalism”1, as well as for producing unedifying and superficial information. But, like almost any technology, it really depends on how you use it. On 18 May, I had the opportunity of participating in an insightful FB discussion on a topic we are all obsessed with – COVID-19. Our discussion focused on the much celebrated “Swedish way” of dealing with the virus. At the time, South Africa was under a strict level four lockdown, while Swedes seemed to be going about business as usual. Towards the end of May, most countries in the world were easing their lockdown regulations – it seemed that we were now all becoming Swedes.
The FB discussions prompted me to read up on the “Swedish model”. I was curious about what made Sweden such an outlier and in what ways other countries would follow this model as they opened up their economies and societies. I was intrigued by the Swedish government’s outright rejection of global public health orthodoxy on lockdowns and states of emergency. Primary schools, restaurants, bars, gyms, shopping malls and other businesses remained open, high schools and universities went online, citizens were asked not to congregate in pubs, and those over the age of 70 who were not feeling well were encouraged to stay home. Swedes were also requested to comply voluntarily with social distancing, to stay at home if possible and to avoid attending public gatherings of over 50 people. There was also very little, if any, policing of compliance – it was assumed that Swedes are “responsible citizens” who can be trusted to “do the right thing”.
Reading up on the Swedish model, I was struck by the many references to Swedes’ high levels of trust in their government and experts such as Anders Tegnell, the chief state epidemiologist at Sweden’s Public Health Agency. At a time when citizens throughout the world were in a state of panic about the deadly virus, Swedes seemed to have complete faith in the policy choices of Tegnell and his Public Health Agency. Many Swedish journalists write glowingly of Tegnell’s popularity. He is also praised by “lockdown sceptics”, ranging from British Conservatives, the alt-right in the United States and libertarians of all stripes everywhere.2 Tegnell’s fans include conspiracy theorists in the US, who contrast “freedom-loving Sweden” with the Nazi-like lockdown promoted by Dr Anthony Fauci, the anti-Trump dissident and dangerous face of the “deep state”.3
I have read that Tegnell’s popularity has been propped up by his promotion of “herd immunity” as the most effective way to deal with the pandemic over the long-term – without having to close down schools, restaurants, bars or the economy! Tegnell continues to insist that immunity to COVID-19 will be achieved when more than 60% of the Swedish population have the virus, and his officials recently stated that Stockholm would reach herd immunity of between 40% and 60% by mid-June.4
Notwithstanding the compelling media narratives of “Sweden the outlier”, Tegnell’s predictions regarding herd immunity remain uncertain. A study by Sweden’s Public Health Agency found that by the end of April, only 7,3% of Stockholm’s residents had developed COVID-19 antibodies, raising serious doubts about Tegnell’s “herd immunity” strategy.5 Data also revealed that Sweden had a much higher death rate per capita than its neighbours.6 In fact, for two days in May, Sweden had the highest per capita death rate in the world on a seven-day rolling average, and towards the end of May, the overall death toll exceeded 4 000. By late May, per capita death rates in Denmark, Finland and Norway, countries that had introduced strict lockdowns, were four, seven and nine times, respectively, lower than that of Sweden.7 This means that Sweden’s number of deaths per one million people was significantly higher than in neighbouring Norway, Finland and Denmark (whose populations are about half of Sweden’s), but lower than in Belgium, Italy, the UK and the Netherlands.8 But especially disturbing was the fact that half of Sweden’s deaths had occurred in old-age homes, and a quarter were among those receiving care at home. A similar situation unfolded at nursing homes in France, Italy, Spain, Ireland and Belgium.9
Tegnell persisted in claiming that the high death toll among the elderly was not the fault of Sweden’s coronavirus response, but rather a result of the failures of local authorities, private healthcare companies and the social safety net to provide adequate protection of the aged in care homes.10 He also insisted that Sweden’s herd immunity approach would ultimately be vindicated. Responding to his critics, he cited recent studies showing that Swedes are taking their government’s advice when it comes to physical distancing. These studies indicate a 75% drop in mobility in Stockholm; travel over the Easter period declined by over 90%, while ski resorts decided to close, even though they were not required to do so.11 These findings seem to confirm the claims that Swedes trust their government and experts, and are responsible and compliant model citizens. In line with Sweden’s “soft touch” approach, the government has gone out of its way to protect the liberties of its citizens, to the extent of refraining from using surveillance and facial recognition technologies because of the threat this could pose to citizens’ privacy.
In recent weeks, the dominant narrative of Tegnell’s widespread popularity among Swedish politicians, the media and the public is being questioned by articles about a few researchers and academics who have begun to criticise his approach. Björn Olsen, a professor of infectious medicine at Uppsala University, recently claimed that herd immunity was both “dangerous and unrealistic”, and that it had been especially catastrophic for the elderly in care homes.12 Tegnell’s predecessor, Annika Linde – who, as state epidemiologist from 2005 to 2013, oversaw Sweden’s response to swine flu and SARS – recently broke ranks and became the first member of the public health establishment openly to criticise Sweden’s decision not to introduce a lockdown, which she now says would have given the country time to prepare for the protection of the elderly and other risk groups.13 In response to this escalating crisis and growing criticisms, the Swedish government reluctantly acknowledged its failings in care homes, and announced a large increase in funding for the sector. Despite these criticisms, in many parts of the world, Tegnell’s “Swedish model” continues to be seen as a success story.
“I have read that Anders Tegnell’s popularity has been propped up by his promotion of ‘herd immunity’ as the most effective way to deal with the pandemic over the long-term – without having to close down schools, restaurants, bars or the economy! Notwithstanding the compelling media narratives of ‘Sweden the outlier’, Tegnell’s predictions regarding herd immunity remain uncertain.”
Sweden’s “soft touch” style of governance, coupled with a trusting and “responsibilised” citizenry, appears to be diametrically opposed to South Africa’s paternalistic, if not authoritarian, approach to the COVID-19 crisis. As a colleague of mine recently observed, South Africa’s bans on the sale of cigarettes and alcohol are reminiscent of 19th century temperance movements, which were also based on extreme forms of public health paternalism.14 But is it simply a case of a stark contrast between libertarian Sweden and authoritarian South Africa?
The Democratic Alliance opposition, which would probably have preferred a variation of the Swedish model, recently launched a court challenge of level four lockdown bans on the purchase of tobacco and alcohol, the national curfew and exercise limits. The DA also challenged what it claimed were “irrational” and “unscientific” restrictions applied to e-commerce, online shopping, the exercise rules, the curfew and the use of the Disaster Management Act to circumvent oversight by parliament of the National Command Council (NCC).15
In the townships and informal settlements, where compliance to physical distancing is especially difficult because of overcrowding, enforcement of lockdown rules was particularly coercive. Minister of police Bheki Cele openly advocated tough policing of the regulations, and by mid-May, numerous incidents of violence and of human rights violations and nine deaths had occurred at the hands of police and soldiers enforcing lockdown in the townships.16 By 20 May, almost 230 000 people had been charged with contraventions of lockdown regulations, in many cases for very minor infringements.17
Given this “hard lockdown”, it is perhaps not surprising that Sweden’s “soft touch” approach has come to be seen as the polar opposite of South Africa’s response.
In fact, Greg Mills and Ray Hartley, two policy researchers from the Brenthurst Foundation, an economic think tank in Johannesburg, recently published an article in which they claimed that the coercive enforcement of lockdown is a clear sign of the start of a slippery slide into totalitarianism, along the lines of the former East Germany (the German Democratic Republic or GDR).18 Meanwhile, the chattering classes have saturated social media platforms with dire warnings about Soviet-style totalitarianism at the doorstep.
The president’s speeches suggest that a “hard lockdown” was deemed necessary to protect citizens, especially vulnerable groups such as the aged, those with comorbidities (HIV/AIDS, TB, hypertension, obesity, diabetes) and frontline essential workers. It was also seen as a strategy to ensure compliance in an “unruly population” – seemingly the antithesis of the docile, compliant and “responsibilised” Swedish citizenry. This approach was probably also a result of recognition of the substantial obstacles to physical distancing, social isolation and frequent handwashing in densely populated townships and informal settlements with poor access to water and sanitation. South Africa’s “hard lockdown” also seems to suggest that the state does not trust its citizens to comply with social distancing without stringent regulations backed up by coercive policing.
Given these developments in South Africa, it is perhaps not surprising that many middle-class (white) South Africans have come to see the Swedish model as the epitome of freedom from state tyranny and authoritarianism. Yet, not all South Africans have been seduced by the Swedish model. The labour movement – especially unions representing essential workers, nurses and teachers – has questioned the haste with which big business wants to open up the economy, even if this risks compromising the health and safety of vulnerable workers.
“Data also revealed that Sweden had a much higher death rate per capita than its neighbours. In fact, for two days in May, Sweden had the highest per capita death rate in the world on a seven-day rolling average, and towards the end of May, the overall death toll exceeded 4 000. By late May, per capita death rates in Denmark, Finland and Norway, countries that had introduced strict lockdowns, were four, seven and nine times, respectively, lower than that of Sweden.”
Responses to COVID-19 are highly contested all over the world. It was precisely the questioning of the dominant media narrative and uncritical celebrations of the Swedish model that kick-started our FB discussion on 18 May, which began with the following post from a Swedish citizen:
My position is this. The situation is really bad now in Sweden; the past week we had the highest level of corona-related mortality in Europe …. The bad result in Sweden comes from an unexpected lack of responsibility for protecting people in elderly care. Eighty percent of the deceased are over 75 …. The personnel working in elderly care have not been given protective gear, not been educated on how to deal with this virus. Moreover, many of them work on daily contracts and do not have the type of sickness insurance that almost all other working people in Sweden have. Thus, they have had a strong incentive not to stay home when they have had symptoms of being infected with this virus. This is a huge scandal; I have asked for a “disaster commission” to investigate this. There has been a vacuum in the chain of responsibility between the central and the local authorities here.
What followed was an animated online discussion about the scientific legacies of Sweden’s dark history of eugenics and how this could have contributed to Tegnell’s “herd immunity” strategies, which have ultimately failed to protect the elderly and frail in care homes. Compulsory sterilisation was done in Sweden from 1906 to 1975 on those considered insane or having a severe illness or physical disability, and from 1972 to 2012, sterilisation was also a condition for gender reassignment surgery.19 In a post from Gavin, it was suggested that Sweden’s eugenics past had led a national culture of “scientific engineering” and triage that had contributed to the tragic deaths at the elderly care homes:
The Swedes have a long history of practising eugenics, until even the 1960s, when “unsuitable” women were compulsorily sterilised. Stalin used to call social democracy “social fascism”, and there is something in that (although it was the pot calling the kettle black, of course!). Having lived in Scandinavia for a time, I’ve seen that the level of social control is scary. Apparent libertarianism actually disguises a deep-seated “scientific engineering” approach to public policy ….
The FB post by Sindre Bangstad, a Norwegian anthropologist, provided yet another angle on the tragic story of the homes for the aged, suggesting that this was the outcome of the neoliberal processes of the privatisation and outsourcing of public healthcare. This neoliberal logic, he argued, had also resulted in the neglect of the health and safety needs of contract care workers, mostly immigrants and minorities:
Here’s the rub: social democratic Sweden has, prior to this crisis, undergone the most intense privatisation of public healthcare of any Scandinavian country over a 15-year period, during which government power was also held by Swedish conservatives. It has left Sweden with fewer intensive care beds than any other Scandinavian country, and fewer emergency supplies. And with care workers on all kinds of temporary contracts.
Annika Teppo, an anthropologist working at Uppsala University, agrees with Bangstad’s analysis, and says that she also suspects that the legacy of Swedish eugenics could have been a contributing factor in this tragedy, which has essentially been brought on by neoliberal economic processes. As she notes, “They have even invented some newspeak: Tegnell referred to the oldest of seniors as ‘äldre äldre’ (older older) – the same group that has suffered the most.”
“Sweden’s ‘soft touch’ style of governance, coupled with a trusting and ‘responsibilised’ citizenry, appears to be diametrically opposed to South Africa’s paternalistic, if not authoritarian, approach to the COVID-19 crisis. As a colleague of mine recently observed, South Africa’s bans on the sale of cigarettes and alcohol are reminiscent of 19th century temperance movements, which were also based on extreme forms of public health paternalism. But is it simply a case of a stark contrast between libertarian Sweden and authoritarian South Africa?”
South Africa, like many other countries, has had its own failures when it comes to protecting vulnerable citizens, especially the elderly and the poor. One of the most recent cases was the Life Esidimeni tragedy involving the deaths – from neglect, starvation, hypothermia and dehydration – of 143 patients at psychiatric facilities in Gauteng. This incident occurred in October 2015 when the Gauteng Department of Health terminated an outsourced care contract with Life Esidimeni in order to cut costs and “deinstitutionalise” psychiatric patients.20 This privatisation and outsourcing of healthcare resulted in 1 300 patients being transferred from state institutions to the care of families, NGOs and other hospitals, which in most cases were ill-equipped to provide the specialised care that was needed.
The Life Esidimeni tragedy took place in a country where the elderly are seen to play a crucial role in cultural transmission, socialisation and caring for children. As John, a Cape Town-based senior lawyer, posted on 18 May:
Older people may be physically weaker, but they are very much needed to support the younger generation emotionally and spiritually through their life experience. Not to mention often acting as babysitters and childcare so the fit in the world can go about their business …. The elders are the backbone of society.21
A recent study by Alexandra Parker and Julia de Kadt on the impact of COVID-19 on the elderly in the urban regions of Gauteng found that “a very large proportion of people over the age of 60 identify themselves as head of the household. An equally high proportion identify themselves as the primary caregiver.”22 They concluded that households headed by the elderly were likely to be the most vulnerable in the COVID-19 pandemic. Could it be that the South African government introduced a “hard lockdown” to protect the elderly and other vulnerable groups, even if this had adverse consequences for the economy?
Whereas in South Africa the social and economic roles of the elderly in the social reproduction of the next generation seem to be valorised, Jenny Anderson’s recent interview with Lars Trägårdh, a Stockholm professor of history and civil society studies, suggests that Swedes believe that the rights of the elderly and sick need to be carefully calibrated and balanced with children’s rights.23 Tegnell made a similar argument at a press briefing in April when he claimed that the mental health of children would be compromised by not being allowed to attend school as a result of COVID-19. As Trägårdh concluded in the interview with Anderson: “You don’t destroy the social fabric to save individuals; you have to pay attention to and take care of society as much as you take care of individuals and people who are sick.”
Could it be that a forensic logic of triage and cold calculation of the differential values of lives is at play here? Should this be the case, it would not be simply a Swedish story –similar kinds of triage are everyday realities in hospitals and care homes everywhere. Whereas one might expect such forms of triage in the poorer countries of the global South, it was shocking to see this playing out live on television in Italy and many other advanced capitalist countries of the global North. Subsequent investigations into Life Esidimeni in 2015 revealed the devastating consequences of a neoliberal logic of saving money rather than saving lives.24 Is it also the case that the tragedy at Sweden’s elderly care homes resulted from neoliberal modes of calculation that valued lives differently?
The 143 deaths at Life Esidimeni exposed the sharp divide between the under-resourced public health system that poor black South Africans rely on, and the well-resourced, “first world” healthcare system of the middle classes. It would appear that the story of Sweden’s home care disaster leads not only to South Africa, but also to the US, UK and Europe, where healthcare cuts have also led to catastrophic outcomes for the poor and the elderly, and for broader pandemic responses. As anthropologist Carlo Caduff argues for the COVID-19 health disasters in the United States, Europe and many other parts of the world, neoliberal policies have led to the “systematic divestments in public health and medical care that have created fragile systems unable to cope with the crisis”.25
As the rest of the world begins to follow the “Swedish path” by opening up their economies and societies, many countries are likely to face all sorts of dilemmas about how to do this while simultaneously protecting the vulnerable in hospitals, old-age homes and workplaces. This could result in decisions that may compromise the health of citizens and undo all the effort and sacrifices they made during lockdown. It was therefore not surprising that there was such public outrage in response to President Ramaphosa’s 26 May announcement that with the shift to level three lockdown, religious gatherings will now be considered “essential services”. As Economic Freedom Front’s Mbuyiseni Ndlozi responded in an angry tweet:
Now, what about all those with COVID-19 who will be flocking to the church to ask for healing? Beyond holy water and anointing oil is the laying on of hands … by faith. They have surrendered the country to COVID-19! … How will a church determine which 50 people must come to church? And when the Holy Spirit enters a person, or makes a person fall, how will they ensure social distancing?
Now we are all Swedes – but without the trust that our public health systems will be able to cope as we enter the eye of the COVID-19 storm.
1 Shoshana Zuboff, 2019. The age of surveillance capitalism: The fight for a human future at the new frontier of power. Profile Books.
9 Anthony Stavrianakis, “Go suppress yourself: A chronicle”. 20 May 2020. Published in Dispatches from the pandemic.
14 Peter Redfield, May 2020, personal correspondence.