Learning from Sweden: A contextualised approach to deal with an unprecedented situation

The world is watching Sweden because of the initiatives they have taken to tackle Covid-19, and I am no exception to that. Sweden has drawn global attention with an unorthodox approach to avoid a strict lockdown, while its neighbours have imposed extensive restrictions. I got inspired to know more on the approach that Swedish government has taken to deal with Covid-19 due to my personal and professional interest, i.e. staying three weeks in Sweden two years ago, I got the scope to know this society and culture closely.

Let's get right to the detailed discussion. A few burning questions for today that needs to be addressed to understand the wider impact of Covid-19 in upcoming days is – is Covid-19 a wake-up call in history? Will this pandemic instil in all of us (e.g., policymakers, citizens, businesses) the sense of urgency to finally embrace and implement sustainable development practices? Or will we just see more "business as usual" development after the pandemic? 

It is a bit tough to predict. But I am sure some systematic changes will occur to deal with the "new normal" situation, and we all need a context specific solution to cope up with upcoming days. 

When a large part of the world was under lockdown forcibly, no official lockdown was declared in Sweden. Thereby, we may learn some important lessons from Sweden, as they did not follow the dominant "Lockdown" approach.  

It is worth remembering that as of June 05, 4,562 people in Sweden have died from Covid-19 out of 41,883 positive cases. The number of cases in Sweden is much higher than in neighbouring Denmark (it has reported 586 deaths out of 11,875 positive cases) and Finland (estimated with 6,941 cases and confirmed 322 deaths), that strictly imposed strict lockdown measures. 

It is evident that Sweden has higher infection and mortality rate of Covid-19 as compared to neighbouring countries. Yet, Sweden's government advocated a flexible approach by not imposing the lockdown method and Sweden's response to the pandemic has been guided by the Public Health Agency. 

Anders Tegnell, Sweden's chief state epidemiologist has led the country's coronavirus response. Therefore, it is important to know their perspective to tackle this unprecedented pandemic. Mr Tegnell said, "Our whole system for communicable disease control is based on voluntary action. The immunisation system is completely voluntary and there is 98 percent coverage". 

From his statement, it is deduced that Sweden's approach appeals to the public's self-restraint and sense of responsibility. He also added that "unfortunately the mortality rate is high due to the introduction (of the virus) in elderly care homes and we are investigating the cause of that. More than half of the people that have died lived in elderly care homes".

Now we have got concrete answers on two major aspects - why the mortality rate is higher compared to their immediate neighbouring countries and the approach Sweden follows in their health system. 

At this point of discussion, it is relevant to know another insight from someone who is not working at the government level but conducting research in the area of public health and is able to give us a view of the people of Sweden. 

Dr Mamunur Rashid has obtained his master's degree in Epidemiology and PhD in occupational health epidemiology from Sweden and has been living there for more than seven years. 

During a discussion he mentioned that "It seems people are discussing Swedish regulations on Covid-19 a lot. Whatever they're doing is based on their society's cultural norms and values and it may not be suitable for any other context. From the beginning of this pandemic, the Swedish authority and epidemiologists realised that this is going to be a marathon, not a 100-meter race. So, they decided on a long-term strategy."

The main goal of the government was to encourage people to protect themselves by taking self-responsibility and abiding by the rules imposed by the government, such as washing hands frequently, keeping a distance, and staying home if you feel sick. Most importantly, people are happy with the government's decision and they know how to deal with this crisis," he added. 

No policy is beyond question, especially if it is a little unusual. Sweden's offbeat policy has drawn has several views, but the vital question is what is our takeaway from their strategy.

In my observation, their approach represents values of the Swedish culture, how they conceptualise their health system, responsibility from both parties to response to the pandemic, the government's long-term plan to survive the pandemic with maximum economic benefit and to keep their people productiveand secure their mental well-being. 

We should not forget World Health Organization (WHO) warned earlier that "The coronavirus may never go away". It means WHO has already declared Covid-19 a prevailing disease. So, it indicates there is long-term effect of this crisis and lockdown is thus not a convenient approach. 

In this backdrop, we can learn how Sweden implemented their strategy and most importantly, we need to explore how to customise an effective strategy to deal with the Covid-19 pandemic situation, setting aside the strict lockdown approach considering our country's values and culture. 

Most importantly, it is clearly evident that the lockdown approach can never work for a long time, especially in developing and populous countries like Bangladesh or India, due to the failure of the government to ensure minimum livelihood and food security. 

Covid-19 has already changed much of the world and Bangladesh is no different. We have no choice but to embrace this new situation. Therefore, it is important to learn from others to explore what can be a better choice for us to contextualise further. So, it is of utmost important to change our approach and system in not only dealing with the current pandemic but also in any national issue where people need to be empowered. 

The major learning from the Swedish approach is that people and culture need to be prioritised to get long term benefits. I understand we cannot compare these two countries but we can certainly learn how policy can be contextualised following the culture of the community and society. 

If we do not start the process to educate and empower people to be self-dependent and self-responsible to deal with any situation, we can never emerge as a progressive country. 

We also need to remember that Cambodia, Vietnam and even Nepal have done a tremendous job in tackling Covid-19 situation so far, with the same socioeconomic status as Bangladesh. Moreover, the Japanese government did not declare the so-called lockdown as they cannot do that as per their rules of the constitution, they can only request people to maintain a responsible lifestyle and that worked out. Here people have played the main role while the government has taken the right policy and decision. 

It is thus a mutual responsibility, although the government needs to take the appropriate initiative where people follow in the same line. Most importantly, we all need to understand that in this critical time, "Business-as-usual" approach would be a certain blunder.

Last but not least, as I am writing this article, Anders Tegnell has stated their strategy - "If we would encounter the same disease, with exactly what we know about it today, I think we would land midway between what Sweden did and what the rest of the world did." He continued: "There is quite obviously a potential for improvement in what we have done in Sweden. It would be good to know exactly what to close down to better prevent the spread of the virus." 

In my opinion, there is important learning for our policymakers from his open statement - how to confess to the limitation of any strategy if it does not work in an optimum way and work towards further approaches to follow. 

However, coming back to the point, personally, I think, it is too early to say whether Sweden's people-driven Covid-19 strategy has succeeded or failed, but as countries across the globe count the deaths caused by Covid-19 and wonder whether they could have done something different to halt the spread of the virus, the world will be watching this welfare state. 

The author is a public health anthropologist. He is currently working for WaterAid Bangladesh, an international reputed entity and member of Public Health Foundation of Bangladesh.