Sweden is not strange. Sweden is just very Swedish.

Marco Morner PA-chef/Senior Rådgivare
Illustration: Fredrik Edén

I receive questions from all over Europe: Why are the Swedes so different? Who is this Anders Tegnell everyone in Sweden listen to? Is it him or the Government making the decisions? The truth is that Tegnell is “just” a civil servant for a one-council authority. Let me explain.

It is difficult to explain for international clients how everything functions in the largest country in Scandinavia. That we have 290 municipalities and 21 regions with their own taxing power and a constitutional right of self-determination. That we have authorities with a high degree of independence and a transparent decision-making process. Not to mention the complexity of welfare policies – or currently, the Swedish public health policies with a mix of ideology and science.

In addition to this, the last couple of years we have had an extraordinary political situation with a weak government, an annoyed and moody opposition and a political map which no longer follows what one learnt in school.

And now the pandemic.

Healthcare in Sweden is essentially a regional responsibility, which means it can differ between regions and the responsible Minister does not decide much in practice. No matter how medial they are, they will always have great challenges and modest successes.

This does not prevent national politicians from engaging with healthcare, which is an area of the Swedish welfare state that is in need of reform – and which is always highly ranked when voters list their most important issues. Consequently, attempts at major national reforms are becoming normal. Even though the implementation remains a regional responsibility.

However messy this sounds; the healthcare system works well in “peacetime”. Of course, there are always ongoing arguments between the right and left wing, trade unions and employers, professionals and political leadership, and no one is ever satisfied. The patients, whose increased influence all politicians have championed for decades, in practice still have little to say. But they are usually quite satisfied with the care they receive – though the waiting period can be incomprehensibly long.

But the system is not well suited for a pandemic. It quickly reminds us that mandates and roles are unclear, that government agencies often are just consultative and that different regions have different prerequisites.

The media image that has been portrayed of the pandemic management has provided the Public Health Authority a great deal of room in relation to the political leadership. The authority has had to shoulder unrealistic expectations of national coordination and strategic governance when they have been at the centre of daily press conferences with others, both authorities and government representatives, who have not always contributed with much substance. One example is the extreme attention the media have had on Anders Tegnell. Despite the title of “State epidemiologist”, in more prosaic terms, he is the head of department and deputy director-general of a so-called one-council authority that is governed by a director-general who is solely responsible to the Government. Thus, everything Anders Tegnell does falls under the responsibility of his manager, Johan Carlson. And everything Johan Carlson does, in turn, falls under the responsibility of his manager, Minister of Social Affairs Lena Hallengren. To make it tougher: if Anders Tegnell stumbles, Lena Hallengren defeats. At the same time, we do not have a so-called ministerial rule, which gives the authorities comparatively great operational freedom.

Most would probably agree that the Swedish crisis management does not measure up. The crux of the matter is that the demanded responsibility is the result of a long chain of decisions and recommendations at different levels, where the Minister and the authority are important, but where the implementation of decisions fall on the regional management. In principle, everyone is involved in something that no one is happy with, making constructive solutions difficult.

It is against this backdrop, among other things, one should understand the debate on the number of dead and Sweden’s strategic choices, which at present, although individual regions have done well, do not appear to have been successful. It is reasonable to assume that the Government’s weak parliamentary support played a role in this. But a strong majority Government would probably have faced great challenges too.

Nonetheless, it did not take many days of falling death rates before truce waned, and we can now already see how the pandemic will be used in the election campaigns in 2022. For instance, the high mortality rate of elderly residents will not fall into oblivion. If a second wave, a new pandemic, or other tragedies occur, it is very likely Sweden will behave more like its neighbouring countries. But – my guess is, that whatever Sweden does, we will have to do it our own way.

Marco Morner, Head of Public Affairs, GK Stockholm