«It’s fascinating how easily these measures were implemented – and how difficult it proved to stop them»

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Five years after the WHO declared a pandemic, what lessons can we learn from Sweden’s approach to handling the virus?

It’s important to distinguish between the international level and the country-specific level. Context is incredibly important when dealing with a pandemic. You need to adapt your approach to your specific situation for it to be effective. While we should certainly share and understand solutions between countries, it’s not always easy to transfer one approach from one nation to another. Solutions must be adapted to the local context to work effectively.

 

Why did Sweden pursue a different strategy than most countries?

Actually, our approach wasn’t that different from others. Ultimately, we all had the same goal: reducing contact between people to slow the spread of the virus. Some countries thought they could stop the pandemic entirely, but once a pandemic starts, it will run its course. You can influence how it runs, but you can’t stop it completely. The key is slowing it down by reducing person-to-person contact, which limits the virus’s ability to spread. In Sweden, we handled this through our existing structures and the strong trust between the public, government, and agencies. Our experience showed that we could get very far with voluntary actions and telling people what we need to achieve instead of telling them exactly how to behave – so people can choose what fits them. I’m convinced that’s much more efficient than trying to get everybody to do the same thing.

 

So, you emphasize the importance of trust and personal responsibility.

Exactly. Personal responsibility is crucial. Some people can work from home, which is ideal. Others who need go to work can adapt by cycling instead of taking public transport or adjusting their working hours to avoid peak times. There is always a way to adjust your life. We have plenty of indication that people did adjust their lives very much during the pandemic.

 

In Sweden, you have had positive experiences with voluntary recommendations.

Yes, I often point to our childhood vaccination program, which has consistently achieved 98 percent coverage for decades.

 

What are your thoughts on Switzerland’s handling of the pandemic and the impact of its measures?

While I’m not very familiar with Switzerland, examining excess mortality data gives us insight into the pandemic’s impact across countries. Looking at the main pandemic years of 2020 and 2021, both the Nordic countries and Switzerland emerged as some of the least affected nations, showing very low levels of excess mortality.

 

To what extent were different countries’ measures based on evidence versus simply imitating other countries? For example, China had a big influence. After China took very strict measures, many other countries followed with similar strict lockdowns that they might not have pursued in a different scenario.

I sometimes wonder what would have happened if this disease had started in a country that doesn’t do lockdowns and strong measures like China did. The previous pandemic started in Mexico and the US, and such measures were never even thought about. Of course, what earlier countries did had a great influence. There are also studies showing that the most important factor for a country to lock down is neighboring countries locking down. Imitation is quite common in a situation where there is no evidence.

 

What did you do?

In Sweden – and eventually in other countries too – we tried to follow the data. Though we didn’t have evidence in a strict scientific manner at first, we quickly acquired data both locally and from other countries. This would also give us a good background for the kind of action we wanted to take. School closures are a good example: Children weren’t getting very sick and likely weren’t spreading the disease to others, especially with the first variants. This made it obvious to us in Sweden that we didn’t need to close schools.

 

«The previous pandemic started in Mexico and the US, and such

measures were never even thought about.»

 

Would you say the virus’s dangers were generally overestimated?

It’s difficult to say. When something like this begins, it’s dangerous to underestimate it. You need to be very careful and conscious about the risks. However, with previous disease outbreaks, we’ve consistently overestimated their impact. This happens because we only see the worst cases early on – all other cases remain a sort of black box. Therefore, mortality and morbidity rates are typically overestimated in the new wave of such diseases. This happened again this time. But also new things might turn up, like all these post Covid cases – something we haven’t seen before in any previous pandemic.

 

Still, it’s amazing that the measures in some countries lasted well over two years.

Yes, it’s interesting. When talking with colleagues, we’re all fascinated by how easily these measures were implemented, yet how incredibly difficult is proved to stop them. That’s another crucial lesson we must remember: before implementing harsh measures, we need a clear plan for phasing them out.

 

Why was it so hard to stop them?

There are many sources of pressure, both from the public and from others. When you start with harsh measures, people get scared, and it’s difficult to convince them that they no longer need to be afraid.

 

How did states and government agencies interact and cooperate internationally during the pandemic?

We have a couple of established networks that became even more active during the pandemic. The IHR network, with the WHO at its center, played a very important role in sharing international information and data. In Europe, we have the EU networks, including ECDC and the Health Security Committee. While these large networks facilitated data sharing, they didn’t allow much opportunity for dialogue. But in the Nordic countries, where we have a long history of collaboration, we held weekly meetings between agencies. These proved to be very useful. Even though we handled the pandemic differently, we could keep each other informed about what was happening and why we did certain things and why we didn’t do other things. Overall, the international collaboration was incredibly valuable.

 

«When talking with colleagues, we’re all fascinated by how easily these measures were implemented, yet how incredibly difficult is proved to stop them.»

 

How could it be improved?

We could improve how we analyze the shared data. While we exchanged large amounts of information, no one had the time or resources to properly understand what the data was actually telling us. Additionally, at the international level, we need a better system for sharing resources effectively. Though there have been ongoing discussions about a pandemic treaty, the outlook isn’t particularly promising.

 

Why not?

It seems to be very difficult to arrive at some kind of agreement on what a pandemic treaty will actually include.

 

Overall, do you think a pandemic treaty is a good idea?

Definitely. We urgently need a system to share resources fairly during a pandemic. Putting resources where they’ll have the greatest impact benefits everyone. It would be neither ethically sound nor practical to exclude poor countries from resource distribution.

 

Some people worry about concentrating too much power internationally and fear that the WHO could become a kind of health dictatorship. Are these legitimate concerns?

No, I don’t think so. The WHO will never get that kind of power. They only have the authority that member countries choose to give them, nothing less. I’m not worried about that.

 

What were the reactions to Sweden’s strategy during the pandemic?

The reactions were quite mixed, though this diversity isn’t always recognized. Media responses varied enormously between very positive and very negative, while public reactions remained more consistent. Though there were various reactions on social media, the Swedish population showed strong support for our approach. Our monthly surveys consistently showed 75 to 80 percent of the population was behind us. In fact, during these five years, although I meet people on the streets all the time, not a single person has approached me to say we did something wrong.

 

There was significant criticism in the media and on social media. Abroad, the media often portrayed you as a symbol of an irresponsible policy. How did you experience that?

It wasn’t dominating for me. When I spoke with colleagues in other countries, they generally understood what we were trying to do in Sweden. They didn’t see it as irresponsible. We managed to keep the pandemic at a reasonable level through extensive collaboration across society, without implementing strict legal measures. Through my many media interactions over the years, I came to realize that media is just media – it’s not the population. Our role is to serve the population and help everyone get through the pandemic in a good way. The media isn’t the most important thing. What really matters is the population.

 

Why did the media’s assessment differ so dramatically from the public’s view?

That’s a good question. I don’t have a clear answer, but I think the media has a fondness for fights. They feel they need to present a collision with opposing voices on every issue to create tension between them. I think that’s what was driving things.

 

Looking back, which criticisms do you think were justified?

Several points were valid. Our elderly homes did not handle the situation well. While our options were limited once the pandemic began, we should have planned better beforehand as a country, working with different partners. The criticism about our failure to protect newcomers to Sweden is also valid.

 

What would you have done differently?

We would have needed better supplies, so medical staff wouldn’t have to scramble looking for essential items every morning. We also would have needed better preparedness in our elderly homes for these kinds of events.

 

How important was vaccination for handling the pandemic?

I think vaccinations saved our health system. During the third wave in spring 2021, most vulnerable people in Sweden were vaccinated, which dramatically reduced pressure on the healthcare system. Without vaccines at that time, it would have been extremely difficult for hospitals to manage patient care. However, the vaccines did not do much to stop the pandemic, even though we were hoping that we could reach levels of immunity in the population that would really slow down the spread considerably. That did not happen, unfortunately.

 

Why is that?

The vaccines were not very good at that. While they prevented severe illness and ICU admissions, they didn’t stop people from getting infected, and they only partially reduced disease transmission to others.

 

Do you view the vaccine differently than you did at first? Did your views change on that?

Not really. The early studies from Israel showed quite clearly that the vaccine would not affect the spread of the disease.

 

When exactly did those studies come out?

Early population-level vaccine testing in Israel showed that vaccinated people could still get infected, though they rarely became seriously ill. These studies provided early indications that vaccination wouldn’t significantly slow the spread of disease, but it would prevent severe illness and ICU admissions.

 

However, the official communication led people to expect that the vaccines would stop the virus completely. While you say the evidence clearly showed otherwise early on, this wasn’t the message that reached the general public.

In Sweden, we communicated early on that the vaccines’ main purpose was to prevent vulnerable populations from getting sick and requiring hospitalization. That was our main message and our primary goal.

 

Were vaccine side effects underestimated?

No, the side effects were remarkably few. There were common mild reactions like fever and feeling unwell after vaccination, but serious side effects were extremely rare. We found a few concerning effects with one particular vaccine, which led us to quickly discontinue its use. Through large studies in the Nordic countries – where we have high-quality data and good registries –, we could clearly track and confirm that while this specific vaccine had some serious side effects in certain age groups, the vaccines proved to be very safe overall.

 

What are the key lessons we should learn for the next pandemic?

The main lesson is that we must preserve and learn from all our experiences, both good and bad. Many companies implemented innovative changes during this time. People often tell me it was a interesting period because they discovered new ways of working, which many continue to use. We need to remember these experiences for the next pandemic. Additionally, we must address the weak spots in our society that became apparent – in Sweden’s case, this means improving elderly care homes, better integrating newcomers, and maintaining adequate healthcare supplies. Of course, these specific challenges will vary from country to country.

 

Do you see a danger that after the severe restrictions that were taken in the COVID pandemic, that when the next virus comes, people will say «Well, it wasn’t that bad last time» and just ignore the recommendations or orders of the government?

Yes, I’ve heard from many countries that public trust in institutions has significantly declined. This poses a real danger for the next pandemic. People may not heed official guidance sufficiently.

 

And what about trust levels in Sweden?

The trust increased.

 

«Public trust in institutions has significantly declined. This poses a real danger for the next pandemic.»

 

That’s another downside of overly strict measures – it erodes public trust.

Trust is key. Harsh measures can be effective if people are convinced of their usefulness and relevance. It’s not about the severity of interventions – it’s about how well you can explain and justify them.