Sweden’s Pandemic Paradigm: Does Trust in Citizenry Save Lives

Transcript, Hubwonk, September 5, 2023

This is Hubwonk. I’m Joe Selvaggi. Welcome to Hubwonk, a podcast of Pioneer Institute, a think tank in Boston. With the benefit of hindsight, what should the nations of the world have done to minimize the deadly impact of COVID-19? While there is no opportunity to rerun history, the policy choices of other countries and their respective public health outcomes closely approximates a natural experiment that should provide some evidence. While most European nations followed China and Italy’s lead of imposing comprehensive, extended lockdowns, Sweden, by contrast, chose a different path. Faced with the responsibility of optimizing public safety, Sweden chose to employ a pandemic plan developed over decades by the World Health Organization, which emphasized protecting the most vulnerable while keeping society as a whole up and running. While social distancing was encouraged and large gatherings limited, the choice to live as one pleased was left to its citizens. This resistance to mandates and faith in individuals earned Sweden’s global scorn from international leadership voices that characterized it as a pariah state, one which should serve as the world’s cautionary tale and which would likely result in a human disaster. But now in late 2023, with the benefit of more than three and a half years of pandemic data, policymakers can examine whether their predictions and policy choices resulted in the real-world outcomes they predicted. How did Sweden’s COVID-19 mortality rate compare with their peer nations and the US? And what should policymakers learn from this global experiment to better prepare the countries of the world for future pandemics? My guest today is Johan Norberg, a senior fellow at the Cato Institute and a writer who focuses on globalization, human progress, and intellectual history. He’s the author and editor of more than 20 books, his two most recent being named by the Economist newspaper as Book of the Year in 2016 and 2020. Mr. Norberg has written a policy analysis for Cato entitled Sweden During the Pandemic, Pariah or Paragon, in which he compares the COVID-19 policies employed by his native Sweden with those of other Western countries, examining the relative outcomes for both COVID and overall excess deaths during the pandemic. He will share with us why and how Sweden chose a different policy path, what outcomes were observed relative to its global peers, and what lessons future political leaders can learn from this deadly and difficult global experience. When I return, I’ll be joined by senior fellow and writer, Johan Norberg. Okay, we’re back. This is Hubwonk. I’m Joe Selvaggi and I’m now pleased to be joined by author and editor of more than 30 books and also the recent policy analysis piece entitled Sweden During the Pandemic, Pariah or Paragon, Johan Norberg. Thank you for joining me and Hubwonk, Johan. Thanks for the invitation. Well, before we dive into your fascinating piece talking about Sweden’s success or lack of success during the pandemic with its policies, we all had a life before COVID. What were you doing just before, let’s say, February, March 2020? Tell us about yourself. Well, actually, I was professionally doing quite similar things to what I’m doing now, writing my books, doing my lectures, and doing documentary films for American public television.

But of course, that entailed lots of traveling around the world, lots of travel. And that suddenly ended. I remember I must have been one of the last Europeans to enter America before the lockdowns, because the first thing that happened was I came to my hotel room, watched Donald Trump, president at the time on CNN, saying that we don’t want any more Europeans here. So we’re now shutting down all air traffic to Europe. So it took me some time to get back, actually.

Well, yeah, so you experienced the excitement, if you will, firsthand. So now we’re more than three and a half years past that faithful time. And what puzzles me about COVID and our policies is that with the wisdom of hindsight, we tell ourselves that should be 2020. But I think there are a lot of people who explain policies in two ways. One is we had to do it in real time. We had to make policies in real time without knowing what was coming and knowing how bad the virus is. So we have that sort of analysis. But then we also have the analysis of saying with the wisdom of hindsight, what should we have done better in the past? So I want to separate those two things, saying, okay, we didn’t know everything at the time, but we certainly know more now. But let’s start at the beginning. Sweden had to you mentioned Donald Trump and imposing restrictions here in the United States. What was Sweden’s culture? What institutions did Sweden have to help mitigate or reduce the effect of COVID? Yeah, Sweden was an outlier when it came to the response. Because Sweden tried to mitigate, tried to flatten the curve, tried to make sure that people socially distanced, but tried to do it in a voluntary way based mostly on recommendations while keeping society at large open, as open as possible. So workplaces, public transportation, schools, restaurants, hairdressers and so on, was open in Sweden. At the same time, authorities said that if it’s possible for you to work from home, if it’s possible for you to avoid public transportation, if it’s possible to avoid meeting elder relatives, do it because now’s the time to worry. So there was social distancing going on, but it left some room for local knowledge, individual needs, and especially then the economy and education was left open. Well, so the rest of the world characterized Sweden as being sort of, as you say, an outlier, but characterized it more as being somewhat reckless or irresponsible and essentially letting COVID have its way. You mentioned in your paper that it wasn’t so much that you saw Sweden as an outlier as far as radical, taking a radically different approach, but rather one that was more recommended prior to the pandemic by organizations such as the World Health Organization.

Share with our listeners, did Sweden see itself as rebels or sort of conforming to the sort of the recommendations of the past? Yeah, that’s a good question because in Sweden, when we listen to the public health authorities and international ones like the World Health Organization, they say that in times of a pandemic, we’ll try to keep normal life as normal as possible so that we don’t wreck more things. We try to make sure that we get as little transmission of the disease of the virus as possible, but we shouldn’t unnecessarily hurt the economy, schools, and things like that. So in Sweden, we had the sense that the rest of the world was engaging in a kind of a reckless experiment and an unprecedented experiment at the time because no one had ever tried to shut down societies to the extent that happened during the pandemic.

So Sweden and its policymakers said we’re following the prudential course that has been recommended by the World Health Organization. Everybody else is taking a somewhat more radical approach. You mentioned several times in your piece that Sweden’s state epidemiologist Anders Tegnell, his quotation, and you mentioned borders being closed down, his quotation you cite is closed down, lockdown, closing borders, nothing has a historical scientific basis in my view. We have looked at a number of European Union countries to see whether they have published any analysis of the efforts of these measures before they were started and we saw almost none. In other words, they looked for evidence that say border closings were effective and saw no evidence whatsoever and therefore didn’t do it. Yes, quite right. And when researchers looked at what other places did and the lockdowns that took place after first China and then Italy started lockdown societies was and tried to find a correlation. Did they do that because of the state of transmission in their society or the capacity of the health care system or anything like that? They couldn’t find a correlation with anything except one thing. What did the neighbors do? What did neighboring countries do? So it seemed like this was a panic reaction. It seemed like countries just climbed onto the pan wagon and did what the others did. And I think this is for very sort of natural human psychological reasons because if you do what everybody else does and you end up in a disaster, you can say that, yeah, we did what everybody did. There was no alternative. While if you are the odd man out like Sweden was and it were to have resulted in a disaster, then everybody will point their fingers at you and said that you made this happen. And that’s why even though in Sweden, we thought that we were the one country that didn’t throw out the manual and began to experiment with the response, it was difficult because the rest of the world were looking at us and saying that this is crazy. This is reckless. This is the way of sacrificing human lives. And it’s difficult for a person like Anders Tegnell to stand up to that and keep on arguing for the traditional way of responding. Well, I think you point to an important point.

You mentioned two things. One is essentially follow the crowd is better to follow the crowd than be an outlier. Again, you can always point to your neighbor and say, I did what they did. And what our mothers used to say, if everyone jumped off a bridge, would you do it too?

Essentially, countries effectively did that. Again, you’re the expert in sort of Swedish policy. If you’re de-generalized, the political pressure or the sort of risk aversion, is that what motivated other countries as you see to go by a completely different playbook? I think so because many countries were resistant or public health authorities were resistant or some politicians were resistant to lockdowns originally. But then when this pressure built up and country after country entered a lockdown, it was incredibly difficult to keep on arguing that, look, we need a scientific basis to do things like this.

One reason why Sweden was different was that we have traditionally government authorities and agencies that are fairly independent. I mean, they are their director general, their bosses, they’re appointed by governments, but then they have a set mandate and they’re not replaced the moment the government is replaced, which means that they have traditionally had some sort of independent role. Of course, they can be sacked, but that rarely happens. And this independent role meant that, and if I’m now trying to psychologize as well, why Sweden could stick to its guns.

When the Swedish public health authority said that, look, border closures, lockdowns, shutting down schools, that’s crazy. That’ll hurt us in the long run. Well, then politicians could feel safe and think that, yeah, we’ll do what we traditionally do. We’ll listen to the advice from the experts and the expert agencies. And because if that would have turned out to be a disaster, they could have blamed them rather than thinking that, than being blamed themselves. So perhaps there was some of that in Sweden too. Well, I applaud the courage. I’m going to now quote another person from your prime minister, is it Luffin, Stefan Luffin. He sounds like he’s channeling James Madison here, a hero of our show. I’ll quote, we will never be able to legislate about everything. We will never be able to ban all harmful behavior. Now it is actually more a matter of common sense. There’s an individual responsibility, and every individual has to take responsibility for themselves, for their fellow people and their country. That is pretty courageous and something that position I admire. But before we get too carried away, there were some restrictions imposed. Share with our listeners what actually was mandated, if anything.

Oh yeah, for sure. Let me just say, you didn’t hear things like that, what Luffin said at the time in many other places. And one interesting thing is that he’s a social democratic. He was a social democratic government in Sweden at the time. And that tells you something about how Sweden is kind of different. And Swedish social democrats are different from other kinds of socialists. So yes, there were some restrictions in Sweden. It banned the private visits to elderly care homes to try to reduce the transmission in nursing homes. Bars and restaurants were open, but they were ordered to offer table service only. And the space between tables had to be increased, so you couldn’t be standing and drinking in a pub like you used to. The most restrictive regulation in Sweden was that public events were limited to no more than 50 participants in March 2020. So this includes public events, theaters, cinemas, lectures, concerts, sporting events and things like that. Not workplaces, shopping centers and private gatherings, but yet it’s still a very restrictive one. And in November 2020, this limit was reduced to eight people. So life wasn’t normal in Sweden. But apart from this, workplaces, offices, factories, schools, public transportation, restaurants, bars were still open in Sweden. So it looked different from what it did in other places. So our podcast has acknowledged that some restrictions are of course appropriate. And we discuss often the risk stratification, that is COVID was a very special disease in so far as it was virtually harmless to young people and very, very deadly to much older people. Did Sweden use that sort of knowledge to target and protect or isolate elderly homes and those people who are statistically much more vulnerable than the general population? Yes, this seems to be one lesson that they learned quickly, that try to keep society open, but protect the old and those who have various forms of conditions that made  them particularly vulnerable. And this includes then elderly care homes, nursing homes and trying to protect them. But it also means that children weren’t very susceptible to the disease and they didn’t seem to, with the data at the time, spread the disease much. So let’s not try to stop their events. Let’s make sure that they keep on going to school as usual. And now afterwards, when we look at what’s happened, I think everyone in Sweden and around the world are quite happy about this decision to keep schools open. On the other hand, it seems like we didn’t succeed to protect elderly care homes as much as we would have wanted. And one reason is that we got the transmission, we got the virus so early that we didn’t really know what was going on even before any country started to think about limiting visits to nursing homes or much less lockdowns.

Indeed, you got it. I think those students who traveled to Italy early had the unfortunate result of bringing COVID back to Sweden very early in the pandemic. I’m imagining a parallel universe where someone like me or someone like you or someone like who leads Sweden, was leading the US or Massachusetts and saying, look, let’s leave it to the people to decide how they impose their own restrictions. You must have had critics. I imagine in that parallel universe, I would have had critics and said, are you indifferent to the suffering or indifferent to the death? Certainly in Sweden, somebody was saying, let’s lock the place down. Did that happen? Oh, yes, we had a very fierce debate and lots of people and newspapers argued for more lockdowns in Sweden as well. Because it is a difficult argument to make always when there is a crisis. You always have this tendency to say, let’s focus all, devote all our resources and everything we can at this one problem. But then cooler minds prevailed when they said, yeah, but if we do that, there’s always a cost-benefit analysis that has to be made. If we do that, we’ll wreck other things in other places and we’ll hurt workers, we’ll hurt families, we will hurt school children and so on. So perhaps we can make sure that we have this social distancing voluntary. So there was a debate about this, but you can see in polls that this Swedish strategy was quite popular throughout. So somewhere between 50 and 60 percent supported the policy throughout, while no more than around 20 percent said that they wanted more lockdowns at Sweden society. And you could also see that when it comes to the politicians, to the political parties. No one saw a possibility of gaining votes by being of the pro lockdown party. We had a right-wing populist party in Sweden who argued for school closures and for Sacking Anders Tegnell who was sort of the bigger head of the policy. But even they began to sort of climb down when they saw that Swedes in general were in favor of this openness. It’s again this parallel universe where the right seemed to embrace lockdowns and the left improved, you know, embraced a more libertarian approach to the whole thing. So I don’t want to bury the lead. I’m sure our listeners are, if they’re not already apprised of the results, let’s not linger on it. You mentioned early on Sweden had some difficulty in spikes in deaths and in a sense could have been perceived as an indictment of its more liberal strategy to lockdowns. But let’s talk about how the deaths in Sweden measure against those, let’s say system brother countries that did lockdown. What happened in Sweden? Yeah. Well, it’s always a question of what’s the peer group? How do you compare yourself to? And Sweden did much better, no matter how you count COVID deaths did better than Southern Europe and Britain and the United States. But people keep on saying you should compare it to Norway, Denmark, Finland, countries that are close by and similar to your culturally and otherwise.

And in that case, what you see is that they did better. You should though keep in mind that those Nordic countries had shorter lockdowns and more moderate ones than most European and American countries. But yes, when you count COVID deaths as such, it’s, we had some 40% higher COVID death rates than the Norway, Denmark and Finland. However, it’s important to realize that sometimes countries measure and define COVID deaths in different ways. Some countries, like Norway, for example, very similar country, the doctor in charge has to make the decision that yes, COVID killed this patient and then call it in. As such in Sweden, on the other hand, you just check the population register and if someone died who had a COVID diagnosed, that’s counted as a COVID death. So some people were then added to the column because they died with COVID rather than of COVID. And that’s a reason why it’s important to also then look at total excess deaths. The number of deaths over the pandemic years compared to a previous period or a previous trend or according to projections. And then what you see is quite extraordinary. When you look at crude death rates, just the number of people dying over the three COVID years compared to the three previous years, Sweden had the lowest excess death rates of all European countries, lower than Norway, Denmark and Finland as well and less than half of America’s.

Yeah, I was going to get to that. So I do want to talk about excess deaths, but again, because on this podcast, we’ve addressed that, that there are trade-offs. There’s no good choice. There’s just trade-offs. And you mentioned excess deaths from mitigation strategies.

But let’s just stick on the how many people died from COVID as a measure, a percentage of population relative to the United States. Again, a country that had fairly substantial and protracted lockdowns. How did Sweden’s number with its liberal policies compare with the United States?

Yeah, well, even if you just look at COVID-19 deaths and the death rate or per million people or so, no matter how you define it, Sweden had a total of some 2,300 COVID deaths.

And that’s a thousand fewer per million than the United States. So did much better. And this is extraordinary because, you know, New York Times at the time said that Sweden was the world’s cautionary example, the pariah state. Donald Trump said that Sweden is suffering greatly because of its decision not to lockdown. And now it ends up with Sweden having even COVID-19 deaths around a third, a fewer than the United States.

So you alluded to your peers and I assume Nordic countries, we all have our sort of image of Sweden as being, you know, Vikings and healthy and driving Volvo’s and going shopping at Ikea.

Is there something that scientists have pointed to within Sweden that makes it that would, you know, explain why would it have half the death rate that the United States? Is there something unique about Sweden and its health?

Yes. And when it comes to excess death rates over the three pandemic years, Sweden had less than half of the excess death rate in the United States. And well, I think there are some things to be said for that. Sweets are generally a bit healthier. We have less obesity, diabetes and some conditions like that, which is actually one reason why Sweden, it would have been silly perhaps for Sweden to to lockdown with all the effects that entails as well. On the other hand, Sweden does not have a, Swedes do not have a much better health than, no, the Dutch, the Belgians and the Swiss and other Europeans. And so it’s not the only thing that’s important in this comparison. So we’ve, I didn’t want to postpone the concept of death, excess deaths. And, you know, for our listeners who aren’t familiar with these concepts, the measure of excess death is sort of saying all death, all reasons for death, it could be, you know, falling out of window, but you measure, let’s say expected statistical expected deaths based on a set of years, three years, perhaps, and you say, given all other things keeping them the same, this is how many deaths we’d expect in the next three years. When you compare the deaths of during COVID and you subtract out those deaths attributed to COVID, you subtract them out, you still see substantial numbers of excess deaths in the United States. We’ve talked about this on the show. You didn’t see that in Sweden. So say more about why you speculate, let’s say, not having lockdowns would cause fewer excess deaths. Yeah, no, it is extraordinary, less than half of America’s and the average European excess death rate in Sweden. And let me just be clear, you can adjust these numbers in different ways, according to age structure, depending on which years you compare them to. And according to some of these methods, Denmark beats Sweden to first place in some Norway beats Sweden as well. But we’re far below Finland and far below the European average and the American death excess death rate. So something is definitely going on. And that suggests to me that Swedes did adapt to the pandemic, try to reduce social and try to increase social distancing and try to avoid spreading the virus. But in a voluntary way, which always left everybody with this exit door, you have the possibility of meeting people you have to meet, go to the job you have to do. And in a bizarre ironic twist, perhaps that made it possible for us to be careful in a longer, over a longer period than others who faced this very harsh lockdown, which you couldn’t be sustained for a very long time. And then you just sort of go crazy and go out and party instead. But there are other reasons, of course, that could explain why Sweden has a lower total excess death rates. And this will keep researchers busy for a long time. There’s lots of data to look for. But it seems like Sweden has been doing much better than other countries when you look at things like suicide, mental illness, domestic abuse, violence, different problems that might be related to living under a much more stress being forced into house arrest with someone you have problems living with. And with all the loneliness or the harsh conditions that people went through during lockdowns, that takes a heavy toll on people. Now, the world called you a pariah state. Sweden is reckless pariah state. Now the dust has settled and it seems that at the very least your middle or lower of the pack of COVID deaths and certainly all excess deaths, much further down on the less you did actually extraordinarily well. Has the, let’s say, global press or a global public policy universe come back and said, you know what, Sweden may be on to something. Maybe we should follow their lead next to a pandemic. Has anybody come out and effectively apologize for their critique of Sweden’s policy? That would be something, wouldn’t it? It’s very peculiar because, you know, according to media analysts, the world’s media has never before reported as much about Sweden as it did in 2020. And there was almost a consensus that Sweden was heading for disaster.

And then suddenly they all went quiet. There’s been remarkably little follow up on what really happened in Sweden afterwards. And that, to me, says that people have a sort of, they have a dog in the fight. They don’t want to revisit their predictions. But that is very concerning to me because, I mean, it’s okay to make mistakes. We all make mistakes. And that’s how we make progress in the future if we learn from those mistakes. If we look at the data and we try to realize why we made the wrong turn, then we’ll go somewhere else in the future. But when things have been so politicized as this whole response to the pandemic has been, few people want to revisit it and look at why they were wrong. And I think that’s deeply, deeply problematic. But because it suggests that if you’re that intellectually arrogant, you will keep on making mistakes. Indeed, doom to repeat the future. So we’re getting close to the end of our time together. I want to read from nearly the last paragraph of your piece and encourage others to read it. It’s Kato Institute’s policy analysis, Sweden during the pandemic, Pariah or Paragon. This final or next to final paragraph really stood out for me. I’ll quote you. I’ll say, it seems likely that Sweden did much better than other countries in terms of the economy, education, mental health, and domestic abuse, and still came away from the pandemic with fewer excess deaths than in almost any other European country, and less than half that of the United States. The country where both the president and majority newspapers repeatedly used Sweden as a cautionary tale. The conclusion is uncomfortable for other governments. It was not Sweden that engaged in a reckless, unprecedented pandemic experiment, but the rest of the world. This experiment did not turn out well compared to the one country that did not throw out the manual. Millions of people were deprived of their freedoms without a discernible benefit to public health. Wow. I hope that makes everyone, the hair on everyone’s back of their head stand up, because you are essentially a natural experiment for what would have happened if we trusted individuals to exercise caution in the way they saw fit. I’ll give you the last word. I’d like to say, well, if you were king for a day or if you had the podium and you could give some advice to the world about how we might encounter the next and deal with the next pandemic, what would you say? Well, I think in that case it follows great from what you just quoted. I think I wouldn’t underestimate people next time around. I wouldn’t treat them like children who had to be bossed around or even in some countries sort of surveilled with drones to make sure that they follow the rules. Because when you do, you turn people into your enemies and you politicize issues and people will be angry and frustrated and they won’t pay much attention to what you’re saying in the future. If you’re honest with people, give them the data and tell them, recommend that they behave in a way that will reduce transmissions of viruses or any kind of microorganism. I think we can trust people to make the right decisions more often than not because they want to protect themselves and their loved ones and society and at least that’s what the Swedish model suggests.

And again, as you say, the reward for politicians who have that courage in the long run was that they are rewarded the ballot box. Their confidence is enhanced. I think one of the casualties of this pandemic was the loss of trust in public institutions from political leaders, of course, but also our public health institutions. They’re still recommending suggested lockdowns. Now going into another wave into the winter, do you see the death of faith in public institutions in Sweden or going forward, do you see that this has enhanced their confidence in trusting people?

Well, I think this is really an argument for the Swedish way. Sweden is one of few countries where the public health authorities actually came out of the pandemic with greater trust than they had before the pandemic. And I think it’s, I mean, this is almost a rhetorical question, but where do you think, in which country will people listen when they get the information, when they get the recommendations the next time around on how to behave to protect themselves and their loved ones? I think Swedes will are going to listen because they were treated more like adults by the authorities and by the government. While in places like America, they were not, I think there’s so much hostility. It has been politicized to such a drastic extent that it might just be that they’ve cut off the branch, the tree that they depend on themselves.

Well, I appreciate you coming in and speaking truth to history, to power, to everything. You can believe what you want, but I think ultimately Sweden demonstrated with its policies a different way. And ultimately, with the wisdom of hindsight, now that we have three and a half years of hindsight, Sweden got it about right. So thank you very much, Johan, for joining me on the podcast today. You’re a great asset for how I want. I really appreciate your time and the work you do in your analysis. Thank you. Thank you very much. My pleasure. This has been another episode of Hubwonk. If you enjoyed today’s show, there are several ways to support Hubwonk and Pioneer Institute.

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