Intended for healthcare professionals

Letters Covid-19: Swedish strategy

Misleading media coverage of Sweden’s response to covid-19

BMJ 2020; 370 doi: (Published 03 August 2020) Cite this as: BMJ 2020;370:m3031
  1. Rachel E Irwin, researcher
  1. Department of Arts and Cultural Sciences, Lund University, Box 192, 221 Lund, Sweden
  1. rachel.irwin{at}

Sweden does not have a herd immunity strategy, and it is irresponsible for The BMJ to perpetuate this myth.1 Similarly, the decision not to “lockdown” is only “controversial” because the media have framed it as such. It is time for the word lockdown to be replaced with precise, non-sensational language that describes the measures taken.

Most of the media coverage has focused on country level data, which is misleading. Stockholm county has 91 deaths per 100 000, whereas Skåne county, including Malmö, has about 15; Blekinge has the lowest, with 4.4 deaths per 100 000. I am still waiting for an article on what we can learn from Blekinge’s approach to covid-19.

Sweden does not have a single approach to covid-19; its response is a mixture of policies at national, regional, and local levels and in sectors outside of the health system such as public transportation. Although a strategy might be set nationally, the responsibility for implementation can be regional or local. In Sweden social care, including care homes for the elderly, is run by municipalities, whereas healthcare is run by the county. Municipalities are also responsible for public health education campaigns and for enforcing physical distancing in public and commercial spaces. In practice, the balance of responsibilities is blurry and can differ depending on the county and municipality. Much of the “public” sector in Sweden is privatised, which raises further questions of responsibility (and blame).

Compulsory physical distancing measures exacerbate social and health inequalities to a greater extent than voluntary ones. With some exceptions, people in Sweden have continued to have access to regular and specialist care, and children have had access to education. The importance of a semi-normally functioning society cannot be overstated.

Sweden, and the Swedish approach, is much more multilayered than portrayed in the media, and this hinders serious policy evaluation.


  • Competing interests: None declared.

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