Intended for healthcare professionals


Covid-19: Comparing Sweden’s response with the UK’s is “misleading,” experts argue

BMJ 2020; 370 doi: (Published 28 September 2020) Cite this as: BMJ 2020;370:m3765

Read our latest coverage of the coronavirus outbreak

  1. Gareth Iacobucci
  1. The BMJ

Sweden’s response to covid-19 should not be used to argue the case for a population immunity strategy in the UK, the Independent Scientific Advisory Group for Emergencies (Independent SAGE) has argued.

In a briefing paper published on 25 September, Independent SAGE noted that Sweden is often used as an example of a country where a population immunity strategy is working, without lockdowns.

But the paper argues, firstly, that it is a misconception that Sweden has no restrictions or lockdown and, secondly, that assertions that the country’s strategy is successful are “far from clear.”

The report noted the differing social conditions between the UK and Nordic countries, which have a high standard of living, less labour market insecurity, and higher levels of trust. “It seems misleading to draw direct comparisons between Sweden and the UK. Rather, it is appropriate to compare Sweden with its Nordic neighbours. Nor is it justifiable to imagine that policies adopted there can be applied seamlessly in the UK.”

In a media briefing on 25 September, Gabriel Scally, visiting professor of public health at the University of Bristol and a member of Independent SAGE, said Sweden’s model was being praised too readily in some sections of the UK media.

He said, “We are extremely concerned that the Swedish model may be given some credence,” he said. “We believe it is ineffective. Sweden has had an enormous amount of deaths per head of population, 5880 deaths representing 581 deaths per million population. Compared with its neighbours it has been unsuccessful in preventing deaths—Finland, for example, has had 343 deaths, which equals 62 deaths per million population.”

Scally said the report also sought to tackle the “myths” that Sweden had not imposed any restrictions to curb the spread of covid-19.

The report highlighted that on 17 March, Sweden moved to online learning only for all children 16 and over and university students, and did not return to face-to-face teaching until the middle of June. Schools for children under 16 stayed open, but have had small class sizes, social distancing, and hygiene measures put in place.

It also noted that Sweden has had other restrictions such as a ban on travel from outside the European Union (in place until November 2020), a ban on visiting retirement homes until October 2020, and a continuing ban on gatherings of more than 50 people.

The report said that in September Denmark has seen a surge in covid-19 cases and Norway saw a sharp increase that has since levelled off. Sweden’s cases appeared relatively flat in early September, which has been taken by some as proof that Sweden’s strategy is working. But it points out that Sweden’s cases are now rising again, and both Finland’s and Norway’s cases per population remain lower than Sweden’s. Nordic countries are currently functioning under similar levels of restrictions, it added.

The report also draws attention to the economic comparisons, noting that the latest data from the European Commission shows that Sweden’s likely gross domestic product this year and next is similar to that of Denmark, Finland, and Norway.

“We see no merit in Sweden being held up as an example,” Scally said.

Based on the available data, the briefing paper says, “There is little to suggest that Sweden’s strategy is better than its Nordic neighbours (particularly Norway and Finland) and a lot to suggest that it is worse, with a much larger burden of disease over spring and summer.

“While it is certainly possible that the winter will evolve differently for Sweden compared with other countries, it is far too early to know.”

In the meantime, the report advises the UK to learn from Sweden’s effective public messaging, its high levels of public trust, and its policy to keep schools for younger pupils open throughout, but to also look at what has worked in Finland and Norway.

“Finally, we need to recognise that the UK is not Sweden—and what works there might not work here,” it adds.