Costly Gambles and Effective Execution: Pandemic Lessons from Sweden and Singapore.
By Joe Fletcher
When considering the different responses to the coronavirus pandemic around the world, it is hard to ignore the unconventional position adopted by Sweden. As its European neighbours took strict measures to try to stop the spread of the virus, the citizens of Sweden continued to go about their business almost without any restrictions (1). Scientific consensus and the advice of bodies, such as the World Health Organisations (WHO), appear to have been disregarded by the architects of Sweden’s pandemic response. As the pandemic has progressed this unconventional approach has resulted in Sweden paying a significant price for a risky gamble (2). In contrast, Singapore is a shining example of how a swift and strict response can be effective in the face of an uncertain threat.
In the early stages of the pandemic, Sweden viewed implementing sweeping restrictions as completely unnecessary. Anders Tegnell, the chief epidemiologist, and head of Sweden’s response described lockdowns as ‘like killing flies with a hammer’ (1). The message to the Swedish people emphasised the shared responsibility of every citizen in the absence of clear restrictions on civil liberties. The use of guidelines rather than enforceable restrictions relied heavily on assumptions about the Swedish population, most prominently, likely social compliance with government recommendations. However, this contrary attitude towards the virus has resulted in mortality figures as high as 10 times that of other countries in the region (1), and as such it is difficult to see how this could be deemed a success.
Source: Our World in Data
In contrast to Sweden, Singapore had a different response to the threat of the pandemic. Singapore dealt with a crisis relatively recently with the experience of SARS in 2003 and had made significant improvements to the health system, bolstering its pandemic response capabilities (4). Singapore correctly identified coronavirus as a potentially devasting threat and acted quickly and decisively. Opting for ‘covid-zero’ policy, Singapore has used large scale testing, aggressive contract tracing, closed borders, and lockdowns to control the spread of the virus. This is in stark contrast to the situation in Sweden where restrictions have only slowly come into effect and testing has been conducted at a lower level. Singapore has been ranked either first or second throughout the pandemic according to Bloomberg’s COVID-19 resilience ranking (5). Modelling has been used to investigate what would have happened had Singapore opted for mitigation rather than containment. The modelling demonstrates a likely 65% increase in infections as well as a steep increase in resulting deaths (6).
Both countries were deemed to be pandemic prepared prior to the emergence of coronavirus. Singapore’s SARS experience was fresh in the minds of health officials and Sweden was ranked number 7 in the GHS index measuring a countries preparedness for a pandemic (7). Both countries also have well-functioning health care systems which are reflected in very high life expectancies (8). The different performance of the two countries isn’t a factor of resources or preparedness but rather fundamental attitudes and assumptions about the virus.
The administrative model of the Swedish Government and civil service means that a large degree of autonomy was granted to the Ministry of Health regarding navigating the pandemic (9). Furthermore, the decentralised nature of the health care system, with its numerous autonomous regions has contributed to a disjointed response. In addition, there is clear evidence the Swedish government lacked a formal plan to tackle the pandemic (10). Arguably there were fundamental failures in the delegations of power and the ability for the health system to function as a unified entity in the response to an issue as large as a global pandemic.
Mask wearing, synonymous with measures aimed at tackling the virus, has become emblematic of Sweden’s unconventional approach to the pandemic. Mask wearing has not been implemented in Sweden as the chief epidemiologist has denied its effectiveness. This is despite The Royal Swedish Academy of Sciences conducting an independent review which agreed with the WHO’s recommendations regarding masks (11).
Vaccination policy is another key element of the pandemic response, Sweden’s policy in this sphere is much more in line with the rest of the world. As of the end of July, 77% of the population had received a single dose and 50% were fully vaccinated which is above the European average (12). A similar proportion of Singaporeans have received a single dose, while 60% of the population were fully vaccinated at the end of July (13).
The ripples of pandemic repercussions will be felt for years and even decades into the future, especially from an economic perspective. Singapore has been hit very hard economically, as a trade and travel hub the decision to close the borders has triggered the countries deepest recession in its history (14). Singapore’s effective health care policy did have a detrimental effect in other areas.
Sweden’s economy has been affected less severely, with GDP falling by 8.6% which is below the European average of 11.9%. Those European nations that implemented strict restrictions have suffered economic blows above the European average which seems to illustrate the positive economic effect of the Swedish policy (15). However, this positive economic effect came with a significant human cost.
Singapore and Sweden are both still grappling with the pandemic and, like the rest of the world, must find a way to live with the virus. It is a huge change for Singapore to open back up and live with coronavirus, less so for Sweden. It is unclear just how each country will fare as vaccination rates rise and the world tries to adapt to living with coronavirus. However, when judging the success of a country’s pandemic response, the primary measure should be how effectively limited resources were deployed to save lives. Given this criteria, Sweden’s response does not score favourably. Singapore’s pandemic plan may not have been perfect, but it demonstrated a genuine attempt to use all available resources to save lives.
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