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“Detailed narrative accounts are essential for learning lessons from the global tragedy of COVID-19. Sweden’s approach – which became famous for all the wrong reasons – is meticulously documented here. It should be essential reading for those involved in planning for future public health emergencies.” – Professor Trisha Greenhalgh, GP and Public Health academic, University of Oxford, UK “For many reasons this book is a unique and special contribution to public health coming at a unique time. There are many reasons why ‘herd immunity’ is not applicable in a pandemic. This book will tell why. There are more reasons why government as medical scientific leader is also not applicable. The COVID-19 pandemic proved that, and this book tells why. Which government should we follow (many differed one from another)? Why should we limit expertise where we know it is limited or even lacking?” – Robert Gallo, MD, Gudelsky Professor of Medicine and Microbiology/Immunology and Founding Director, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Md., and Co-Founder and Chair of the International Scientific Committee of the Global Virus Network “From the earliest months of the coronavirus pandemic, international observers have been taken aback by Sweden’s policy choices in responding to COVID-19. Countering its long history of leadership in public health, the Swedish state has advanced a laissez-faire approach in which the population is allowed to be exposed to the virus in a manner that experts believed would remain controlled. To date, it has remained difficult for outsiders to understand Sweden’s permissive attitude towards the pandemic, the unwillingness of national leaders to revisit counterproductive policies, the state’s controversial trafficking in misinformation, and ultimately a lack of reflection on highly disparate rates of infection and death. Sweden’s Pandemic Experiment resolves these puzzles by offering a rich account of the context informing Sweden’s COVID-19 response. Its interdisciplinary contributors illuminate a wide array of inputs – sociological, historical, cultural, and political – to the so-called ‘Swedish way.’ As they show, Sweden’s pandemic failures have drawn on a constellation of institutional failures: in media, in crisis management, in health care, in public health, and in national scientific research institutes. Presented without fear or favor, Sweden’s Pandemic Experiment should prompt a reckoning in Swedish society. This meticulously documented account will also be a model for researchers elsewhere, inspiring comparative analysis of pandemic strategies that have underperformed in other global settings.” – Martha Lincoln, Assistant Professor of Anthropology at San Francisco State University and author of Epidemic Politics in Vietnam: Public Health and the State (Bloomsbury Academic, 2021) “This volume is one of the first to provide an interdisciplinary critical assessment of the Swedish response to the pandemic of COVID-19. This is a timely and welcome contribution to study the interplay of scientific, political, and public discussion about a ‘Swedish puzzle’ that has triggered essential moral questions while deeply affecting the social compact.” – Yohann Aucante, Associate Professor at the School of Advanced Studies in the Social Sciences (EHESS), Paris; author of The Swedish Experiment. The COVID-19 Response and Its Controversies (Bristol University Press, 2022) “Different national states launched different medical-political strategies to combat the Covid pandemic. If nations are willing to learn from each other how to cope with such an unusual situation that, however, may repeat with another infectious disease, such strategies must be comprehensibly assessed and evaluated according to ethical standards. Bergmann and Lindström present such critical assessment for the specific Swedish case. I see this interdisciplinary volume as paradigm case for a holistic survey which is of interest far beyond the Swedish case as such. It is a ‘must read’ for all persons and organizations worldwide even if it may remind doubtful whether there are final ‘lessons learned.’ ” – Konrad Ott, Professor of Philosophy and Ethics of the Environment at Kiel University SWEDEN’S PANDEMIC EXPERIMENT This book considers Sweden’s pandemic management which differed so significantly from much of the rest of the world: it provoked intense and wide-r eaching interest, curiosity and criticism. Transdisciplinary Swedish authors from the humanities, life sciences, social sciences and cultural studies use a variety of tools to mine deeper into some of the central elements and dimensions in their country’s pandemic management such as understandings of freedom, the execution of power, denialism, exceptionalism, patriotism, the role of expertise and trust in the national state to give a deeper understanding of Sweden’s decisions, failures, successes and the lessons to be learned. Aimed at readers with interest in global health and politics, it will also be of interest in disciplines such as virology, epidemiology, history, cultural studies, ethics, media studies, medicine and economics. Sigurd Bergmann is Emeritus Professor of Religious Studies at the Norwegian University of Science and Technology, Trondheim; Visiting Researcher at the Faculty of Theology, Uppsala University; and Fellow at the Rachel Carson Center at Munich University. His research covers religion and the environment, and religion, arts and architecture, and among his multiple books and articles are Weather, Religion and Climate Change (2020), Religion, Space and the Environment (2014), In the Beginning Is the Icon (2009) and God in Context (2003). Martin Lindström is Professor of Social Medicine at the Medical Faculty, Lund University, Sweden. He holds a PhD in Social Medicine (2000) and a second PhD in Economic History (Historical Demography) (2015). Lindström is a Fellow of the Center for Economic Demography (CED) and EpiHealth, both at Lund University. His research covers social capital and health, socioeconomic differences in health, life course epidemiology and historical demography (including epidemics in the 18th and 19th centuries). Lindström has authored many international research articles and chapter contributions in edited books. The Politics of Pandemics Understanding the Politics of Pandemic Emergencies in the time of COVID-19 An Introduction to Global Politosomatics Mika Aaltola Pandemic Response and the Cost of Lockdowns Global Debates from Humanities and Social Sciences Edited by Peter Sutoris, Sinéad Murphy, Aleida Mendes Borges and Yossi Nehushtan The COVID-19 Pandemic in the Middle East and North Africa Public Policy Responses Edited by Anis Ben Brik Sweden’s Pandemic Experiment Edited by Sigurd Bergmann and Martin Lindström For more information see www.routledge.com/The-Politics-of-Pandemics/book- series/TPOP SWEDEN’S PANDEMIC EXPERIMENT Edited by Sigurd Bergmann and Martin Lindström First published 2023 by Routledge 4 Park Square, Milton Park, Abingdon, Oxon OX14 4RN and by Routledge 605 Third Avenue, New York, NY 10158 Routledge is an imprint of the Taylor & Francis Group, an informa business © 2023 selection and editorial matter, Sigurd Bergmann and Martin Lindström; individual chapters, the contributors The right of Sigurd Bergmann and Martin Lindström to be identified as the authors of the editorial material, and of the authors for their individual chapters, has been asserted in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. The Open Access version of this book, available at www.taylorfrancis.com, has been made available under a Creative Commons Attribution-Non Commercial-No Derivatives 4.0 license. Trademark notice: Product or corporate names may be trademarks or registered trademarks and are used only for identification and explanation without intent to infringe. British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library ISBN: 978-1-032-26670-1 (hbk) ISBN: 978-1-032-26671-8 (pbk) ISBN: 978-1-003-28936-4 (ebk) DOI: 10.4324/9781003289364 Typeset in Bembo by Apex CoVantage, LLC CONTENTS List of figures ix List of tables x List of contributors xi Acknowledgements xiv Sweden stumbles along the Third Way 1 Peter Baldwin 1 In the rupture between this and another world to come: introductory remarks on pandemic emergency and Sweden’s response 8 Sigurd Bergmann and Martin Lindström 2 A timeline of events: December 2019 to February 2022 43 Sigurd Bergmann 3 On the virology of SARS-CoV-2 and an expert authority without real experts: was there a deliberate disinformation from the Public Health Agency of Sweden on the SARS-CoV-2 infection’s spread in the population? 75 Anders Vahlne 4 The Covid-19 pandemic and the Swedish strategy: central aspects of the strategy in relation to evidence and evidence-based medicine criteria 90 Martin Lindström viii Contents 5 The Swedish Covid-19 response: from poorly judged utilitarianism to history revisionism and the tragedy of the commons 106 Emil J. Bergholtz 6 Learning from failure: mastering a pandemic in the triad of science, politics and trust 127 Sigurd Bergmann 7 Epidemiology and Covid-19: why numbers are important and can be misleading 169 Nele Brusselaers 8 The political economy of estimating immunity levels 191 Rodney Edvinsson 9 Children at the front line of the Covid-19 pandemic 212 Johanna Höög 10 The biopolitics of herd immunity 235 Lapo Lappin 11 Collaborators, supporters, and science judges: how trust in the Public Health Agency’s messaging was achieved 256 Kajsa Klein 12 Sweden unmasked: reading state and society through the pandemic 276 Jens Stilhoff Sörensen 13 A drastic end to a long story of success in Swedish preventive medicine 294 Gunnar Steineck Index 306 FIGURES 1.1 Ingela Bergmann, M/S Strategia Suedecia 11 2.1 a) Daily new confirmed Covid-19 cases, b) Daily new confirmed Covid-19 deaths, c) Number of Covid-19 patients in hospital per million people, Sweden, Norway, February 2020–February 2022 44 7.1 Covid-19 as cause of death in Sweden: discrepancies between the different official databases 172 7.2 Number of deaths per day as reported by FHM with the different colours representing the retrospectively updated daily numbers 174 7.3 Timeline of incubation, infectiousness, and recovery for Covid-19 176 7.4 How to interpret epidemiological studies on potential associations 177 7.5 The proportion of Covid-19 tests with a positive result on January 8th, 2021 (globally) and between July 2020 and January 2022 (Sweden) 181 8.1 The stringency index in Sweden, Europe (weighed by population) and New Zealand in 2020–2021 200 9.1 Children in Sweden during the pandemic 213 9.2 Health and mortality of Swedish children during the Covid-19 pandemic February 2020 to June 2021 216 9.3 The number of hospitalizations in small children (age 0–9), children and adolescents (10–19) compared to the average of all other age categories 227