The COVID-19 pandemic has cast a spotlight on public health officials around the world. But few are facing the intense scrutiny that’s been aimed at Sweden’s State Epidemiologist Anders Tegnell.
Dr. Tegnell has attracted international attention for his hands off approach to the pandemic and his resolute defence of the Swedish model. There’s no lockdown in the country and most schools, pubs, restaurants and stores remain open. The few measures that have been introduced – social distancing in eateries, no gatherings of more than 50 people and a request that everyone work from home – are largely voluntarily and there are no fines or police checks to ensure compliance.
The strategy has made Dr. Tegnell a target of praise and ridicule. Critics accuse him of gambling with people’s lives and pursuing a dangerous “herd immunity” strategy that has resulted in a soaring mortality rate. Others see him as a hero who has pursued a sensible policy and spared Sweden from economic catastrophe. The 64-year old bureaucrat has become such a polarizing figure that while 2,000 Swedish scientists have signed a petition denouncing his strategy, more than 100,000 people have joined Anders Tegnell fan clubs. He’s even had his face plastered on T-shirts and inked on tattoos across Stockholm.
“It’s all absurd I must say,” Dr. Tegnell said in a recent interview, using the matter-of-fact tone that has become a hallmark of his daily news conferences. “The media attention is something completely different, that’s for sure. I have not been called by Canadian newspapers very often over the years in spite of working with a lot more dangerous things than this.”
The blunt-talking physician who favours brightly-coloured pullovers has spent nearly 30 years in public health, working mainly on vaccine programs and pandemic preparedness before becoming state epidemiologist in 2013. He’s also worked with the World Health Organization in Asia and Africa where he spent time in Zaire during the Ebola outbreak in 1995.
Dr. Tegnell insisted that his go-slow approach to the coronavirus pandemic is working. His objective has always been to pursue measures that were sustainable and that would keep hospitals from becoming overwhelmed. It didn’t hurt that the Swedes have an inherent trust in government agencies and a willingness to take direction. “There is a big part of trust in the population that this is the right thing to do,” he said.
He pointed out that although the number of new cases has been growing, and is now above 20,000, one third of the country’s intensive care beds remain empty. “There is quite a lot of excess capacity at this stage,” he said. “Our health care service is still functioning.” If anything, he’s feeling vindicated as he watches officials in other countries, including Canada, grapple with how to ease restrictive lockdowns. “To me it looks like a lot of the exit strategies that are being discussed look very much like what Sweden is already doing,” he said.
Dr. Tegnell got a boost this week from Michael Ryan, the WHO’s executive director, who praised the Swedish method of voluntary compliance and said the country was an example for a way out of lockdowns. “I think there may be lessons to be learned from our colleagues in Sweden,” Dr. Ryan told a news conference.
The strategy has not been entirely successful and there have been some serious failings which Dr. Tegnell acknowledged. Sweden’s death toll has topped 2,500 or roughly 22 for every 100,000 inhabitants. That’s higher than neighbouring Norway, Finland and Denmark which have imposed strict lockdowns. Norway and Finland have less than four deaths per 100,000, while in Denmark it is 7.3, according to Johns Hopkins University.
Dr. Tegnell said the difference is largely due to seniors’ homes where Sweden has not contained the outbreak. “Something like 50 per cent of our death toll comes from the rather small population living in care homes,” he said. “We know that we have had a problem with the elderly homes, this has been a discussion for years.”
Sweden has no tradition of multi-generational households and seniors typically live in state subsidized nursing homes. Years of budget cuts and privatization have raised questions about the standard of care in many homes. “We hope that [the COVID-19 outbreak] can trigger a discussion on resources and competence and how those institutions can deliver better quality of care than they do today,” Dr. Tegnell said.
Critics say there’s something else going on and that Sweden’s high mortality rate is tied to what they believe was Dr. Tegnell’s disastrous pursuit of herd immunity. That immunity occurs when a sufficient number of people have been infected with a virus and become resistant, which slows or stops the spread of the disease. In order to achieve herd immunity, health officials have to let the outbreak essentially run its course. It’s a strategy the British government considered but quickly dropped in March after researchers at London’s Imperial College said up to 250,000 people could die. Dr. Tegnell said that while he didn’t set out with a herd immunity strategy, the number of people infected by COVID-19 in Stockholm is approaching levels that will have the same effect. “We do believe that we have a certain affect of [herd immunity] already,” he said.
That infuriates researchers like Dr. Stefan Hanson, a Swedish infectious disease expert who was one of 22 scientists who recently wrote an article in a Swedish newspaper criticizing "officials without talent” who were in charge of the COVID-19 strategy. “I think it’s a risky business and we don’t know anything about herd immunity,” Dr. Hanson said from a Stockholm suburb where he was leading an antibody testing program. “The only thing we know is that a lot of people have died. These are human beings, not just figures. And if we would have chosen another approach, this number would have been much smaller.”
Dr. Hanson believes Dr. Tegnell deliberately pushed herd immunity and he should have followed the Norwegian, Danish and Finnish approach and introduced a lockdown. “You cannot take risks with people’s lives if you don’t know what risks you are taking," he said.
There are other challenges, too. Dr. Tegnell and the government have insisted that by not shutting down the country, the economy will revive faster once the pandemic is over. But Finance Minister Magdalena Andersson recently estimated that even with the looser measures, Sweden’s economy could shrink by as much as 10 per cent this year and unemployment could jump to 13.5 per cent. That’s comparable to estimates for Norway.
Dr. Tegnell has faced criticism over a pandemic strategy before. During the 2009 swine flu outbreak, he advocated widespread use of a vaccine from GlaxoSmithKline called Pandemrix even though it had been rushed into service. Eventually more than 400 Swedish children who had been inoculated developed narcolepsy, a rare sleep disorder, and the drug was taken off the market. Several other European countries also used Pandemrix and reported cases of narcolepsy, but Sweden was among the largest users of the drug. The government later apologized and provided compensation to those affected. Dr. Tegnell has defended its use and said at the time that it was hard to balance “400 children with narcolepsy against about 100 deaths.”
Those who know Dr. Tegnell dismiss the critics and say he has shown nothing but integrity and commitment during the COVID-19 crisis. “He has done admirably well,” said Johan Giesecke the former chief scientist at the European Centre for Disease Control who hired Dr. Tegnell as the state epidemiologist. “Sweden is doing it right. Everyone else is wrong.”
Paul Franks, an epidemiologist at Lund University in Malmo, said it’s too early to judge Dr. Tegnell. “I think you can question strategically why care homes and hospitals weren’t more closely protected from coronavirus,” he said. “I think that’s a strategic failure and has cost lives. But other than that, nobody knows if it’s the right strategy.” Dr. Franks gives Dr. Tegnell high marks for being straight with Swedes. “He’s been quite honest that they’ve clearly chosen a path and they are sticking to it.”
Polls show that the vast majority of Swedes back Dr. Tegnell and believe in what he’s doing. “We are kind of a science-trusting people here in Sweden,” said Christine Tidasen a university lecturer in Stockholm who started one of the Anders Tegnell fan clubs. “We are letting him know that there are people who believe in making decisions that are really thought about very carefully,” she added. “The virus will not go away and we have to learn how to live with it."
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