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The ever-evolving nature of the COVID-19 situation has seen nations around the world grapple
with finding the “correct” plan of attack, inevitably giving way to strategy missteps and
miscalculations. However, when strategies and outcomes are compared, the cautious
preparedness of the Republic of Korea has minimized the overall damage of these missteps better
than the confident trailblazing of the Swedish strategy has. Particularly the novelty of the virus
has rewarded Korean humility in observing, adjusting, and acting, when Swedes, on the other
hand, have faced the consequences of an uncontrolled killer.

From the early days of the pandemic, Korea has excelled in being intentionally cautious by
learning from previous failures and taking on board international advice to achieve a balanced
approach. This strategy created a buffer to prevent devastation in the face of future error. Not
only did they experience the 2003 SARS and 2009 H1N1 outbreaks, the more recent 2015
MERS outbreak showcased the devastating and humbling failure of the Korean government and
healthcare system (1,2). When the first case of COVID-19 was then detected in the country on
January 20, 2020, the failures of the MERS response were corrected with quick and coordinated
action by the Ministry of Health and Welfare. The centralised government force acted with
the intention to protect citizens from a rapidly expanding unknown, almost eliminating the virus in two
short months. They initiated extensive free testing protocols throughout the country and made
use of MERS-induced legislation modification—unique to Korea, public health authorities now
had the legal right to trace and manage infected citizens during an outbreak (2). These measures and
the rapid initial lockdown provided Korean officials precious time to gather themselves. Yet
when the rest of the world was watching East Asia successfully battle these early outbreaks,
where were the Swedish politicians and public health professionals?

Before COVID-19 erupted, Sweden was ranked as the world’s most prepared for dealing with
future pandemics (3). Their advanced eHealth technology, equitable care access, and established
funding patterns were showing all the right signs, and yet when the pandemic materialised, it
wreaked havoc in the population (4). Unlike many welfare states, Sweden does not function under a
highly centralised and controlling government authority, but rather relies on the decentralisation
of power and shared autonomy. Not only do municipalities play a large role in decision-making,
but autonomy and freedom of choice are extended to the individual, creating a deep sense of trust
between the individual and the state. This extends to their Communicable Disease Act, shifting responsibility for disease spread to the lowly citizen and off the government’s shoulders (5). While
this is praised and even mimicked in normal, non-crisis circumstances, the Swedish model was
ill-equipped to govern when the individual’s choice had serious consequences. Their prized
system was not to be replaced or even informed by the example of the experienced East
Asians (5,6).

From the initial outbreak onwards, Sweden has held firmly to their strategy, refusing to humbly
take on external advice, despite the urging of experts abroad and at home (3). The same day
Swedish public health authorities made their first restrictive measure in mid-March, limiting
gatherings to 500 people, the WHO was declaring a global state of emergency—a pandemic
(5). Others were already experiencing skyrocketing cases and lockdown measures. Swedish
epidemiologist Anders Tegnell, the face of the COVID-19 strategy, equated these lockdowns to
“using a hammer to kill a fly,” as the responsible government agency confirmed they did not
need to lockdown or restrict freedoms to address a minor threat. This was in the early stages of
COVID-19 research, before scientists had confirmed the nature and spread of the disease, yet
Tegnell assured Swedes everywhere that they knew better (3). In doing so, Swedes threw Korea’s
exemplary caution to the wind.

The contrasting strategies in Korea and Sweden proceeded to give vastly different outcomes,
with soaring infections and deaths in Sweden gaining global attention while Korean numbers
remained among the world’s lowest (7). Their early attitudes and responses set them off on
different COVID-19 paths, but a significant point of convergence was their lack of extended
lockdown and promotion of economic activities. While Sweden completely avoided lockdowns,
the short snap lockdown in Korea to squash the initial outbreak transitioned into a state of
“everyday life quarantine,” with mask and distancing regulations, but freedom of movement
(2). Both countries recognised the crucial role of the economy amidst a global crisis, yet GDP growth
in Sweden was -2.8% and only -1% in Korea, suggesting the latter to yet again come out on
top (8).

Where Korea has failed in its caution, is in the vaccine rollout, reaching only 82 doses per 100
people while countries like Sweden have already reached 122 doses per 100 (7). They were slow to
purchase vaccines and have faced numerous delays in acquiring adequate numbers, but they had
also created for themselves a relatively safe and sustainable situation that buffered the effect of
vaccine delays (9). As of August 29, 2021, they have seen only 0.5% of the population infected. In
Sweden, on the other hand, WHO statistics suggest one in 10 people have been infected,
resulting in a significantly higher number of deaths as well (7). Initial negligence and costly
mistakes have forced Swedes into the arms of vaccination as quickly as possible. While they can
be applauded for their current vaccination levels, the decentralised healthcare system has
struggled to pull together a unified jab strategy, and ultimately future protection does not make
up for the damage done through the failed “herd immunity” experiment (5).

At the end of the day, humility allows for the wisdom of others and active caution almost always
saves lives. Korea learnt this lesson first from the MERS epidemic and again in their exemplary
but not perfect handling of COVID-19. The Swedes would have done well to look beyond their
“superior” system to the Koreans from the get-go. However, the pandemic is far from over.
There is still time for Swedes to learn their lessons, correct their failures and avoid adding to
their massive COVID-19 damages.


References

  1. Mallah SI, Ghorab OK, Al-Salmi S, Abdellatif OS, Tharmaratnam T, Iskandar MA, et al..
    COVID-19: breaking down a global health crisis. Annals of Clinical Microbiology and
    Antimicrobials; 2021;20(1).
  2. Lim B, Kyoungseo Hong E, Mou J, Cheong I. COVID-19 in Korea: Success Based on
    Past Failure. Asian Economic Papers; 2021;20(2):41–62.
  3. Bendix A. A year and a half after Sweden decided not to lock down, its COVID-19 death
    rate is up to 10 times higher than its neighbors. Business Insider Australia [Internet].
    2021 Aug 21 [cited 2021 Sept 3]. Available from:
    https://www.businessinsider.com.au/sweden-covid-no-lockdown-strategy-failed-higherdeath-rate-2021-8?r=US&IR=T
  4. Glenngård AH. International Health Care System Profiles: Sweden [Internet]. The
    Commonwealth Fund; 2020 June 5 [cited 2021 Sept 3]. Available from:
    https://www.commonwealthfund.org/international-health-policy-center/countries/sweden
  5. Becker T, Roine J, Stromberg S. The “Swedish model” in the COVID-19 pandemic.
    Centrum Balticum Foundation; 2021. Available from:
    https://www.centrumbalticum.org/files/5078/BSR_Policy_Briefing_9_2021.pdf
  6. Lindström M. The COVID-19 pandemic and the Swedish strategy: Epidemiology and
    postmodernism. SSM – Population Health; 2020;11:100643.
  7. World Health Organisation. WHO Coronavirus (COVID-19) Dashboard [Internet].
    WHO; 2021 Sept 3 [cited 2021 Sept 3]. Available from: https://covid19.who.int/
  8. World Bank Group. Data: GDP growth (annual %) [Internet]. The World Bank Group;
    2021 [cited 2021 Sept 3]. Available from:
    https://data.worldbank.org/indicator/NY.GDP.MKTP.KD.ZG
  9. Arin, K. Moderna delays once again threaten Korea’s vaccine rollout. The Korea Herald
    [Internet]. 2021 Sept 1 [cited 2021 Sept 3]. Available from:
    http://www.koreaherald.com/view.php?ud=20210901000873&np=6&mp=1
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