Keith Rankin Analysis – Sweden and Covid19: Three Years after the World’s Attention

Analysis by Keith Rankin.

Over Easter I relistened to Jim Mora’s RNZ interview (17 May 2020) of Johan Giesecke, “world leading epidemiologist” and Professor Emeritus at the Karolinska Institute in Stockholm, Sweden. In the period April to June 2020, Sweden gained notoriety for its divergent public health policies with respect to the management of the Covid19 pandemic. People – including me – widely pointed to Swedish authorities then as being more concerned about retaining a pretence of their economic normality rather than caring about people’s lives.

Swedish exceptionalism became a thing, again; this time seemingly for all the wrong reasons. Hitherto ‘progressive’ New Zealanders had regarded Sweden as an exceptional policy exemplar; now it seemed to be an outlier of classical liberalism.

Here are two summary measures of pandemic and post-pandemic mortality; comparing Sweden with Finland, Germany, New Zealand and Japan:

We note that all these countries have rising populations of older people, so some increase in deaths was to be expected in all of them. Sweden had covid vaccination rates comparable with these other four representatives of ‘the rest of the civilised world’, so differences in vaccination uptake cannot explain its mortality difference.

It’s worth relistening to this Giesecke interview, now with the perspective of hindsight. The context is that, in the contest (as it was then framed) of Sweden versus the rest of the civilised world (with the World Health Organisation settling on the counter-Swedish majority view), Sweden has come out a clear winner. The scandal is the failure of ‘the rest of the civilised world’ to acknowledge the statistical reality.

(Note that I use ‘civilised world’ with mock irony. In New Zealand at least, few politicians or high-profile commentators believed that there could be anything New Zealand authorities could learn from the experiences of West Europe, South America, or Africa; instead, the policy elite contemptuously assumed such countries to be ‘basket cases’. See the use of this phrase in 1980s: Days of greed and glamour, NZ Herald, while noting that we are still waiting for a balanced history of the ‘Muldoon Years’ referred to.)

Highlights from the 2020 Interview, and the interview itself can be heard here, and read in synopsis form: Johan Giesecke: Why lockdowns are the wrong approach, Radio New Zealand, 17 May 2020.

Relating to points not covered in RNZ’s synopsis, Giesecke draws a direct comparison with Finland, which was pursuing a public health policy very close to New Zealand’s. His concern – shared by Finland’s state epidemiologist – was that the authorities’ actions were creating a significantly vulnerable population in Finland.

Giesecke, from that May 2020 perspective, mentions that if a good vaccine would come quite soon then New Zealand’s outcome might be better than Sweden’s. The irony is that, while a good vaccine did indeed come quickly, New Zealand’s authorities were slow to embrace the vaccine as the answer; having already decided that New Zealand had eliminated the virus as per the China policy. Then, after New Zealand’s people were vaccinated, the government doubled down on the lockdowns, not at all trusting the vaccine to work as a substitute for lockdowns. (Indeed, New Zealand only abandoned its border-quarantine policy in 2022 because that policy failed on its own terms. Had the border policy been implemented without error, New Zealand presumably would have followed a set of draconian restrictions through 2022, with a timeline similar to that of China. New Zealand’s border mishaps proved to be a blessing in disguise.)

In mid-2020, Johan Giesecke’s main expectation was that the mortality experience of all countries in the OECD (essentially the rich western plus the rich eastern countries) would all be about the same; and that Sweden’s major benefit would be in its substantially lesser disruption to normal life.

Where Giesecke was wrong was that the OECD ‘WHO countries’ (a label for the ‘civilised world other than Sweden’) ended up with substantially higher increases in deaths than did Sweden; he was wrong in a way that favoured Sweden rather more than he had expected.

The pandemic has nevertheless had an adverse impact on Sweden’s mortality. Sweden did experience the West European surge in deaths from respiratory illnesses late last year. Its people no more live in a bubble than do New Zealand’s. Overall though, Sweden got the win-win outcome: fewer deaths, and less social and economic dislocation. (David prevailed over Goliath.)

A very basic summary of the difference between the Swedish and the Goliath approaches is that Sweden focussed on its people whereas the prevalent strategy focused too much on the virus; the world by-and-large pursued a strategy of covid exceptionalism. (One consequence of covid exceptionalism was that a death clinically ascribed to Covid19 became a more noteworthy death than most other deaths.) Sweden focussed on having people with good levels of immunity, whereas in 2021 much of the rest of the world went down the unhelpful path of obsessing over the various mutant variants of the novel coronavirus.

Giesecke clearly had a better understanding the history of human coronaviruses than most other epidemiologists; these are viruses for which specific immunity is short-lived, from which we top-up immunity naturally through living our daily lives in a normal manner, and for which vaccine-conferred immunity would also be short-lived.

Sweden understood the science better; indeed, the interview tells us that there was a substantial scientific contest of interpretations of the evidence in Sweden, a good sign that actual science was taking place. Not only did a number of Sweden’s scientists prove to be among the better predictors of the future, people such as Johan Giesecke were also much more prepared to offer humility to their own people and to the world if they had got it wrong.

I am still waiting for our authorities – including the scientists – to do a proper retrospective comparison of New Zealand (and other countries, as in my table above) and Sweden. I am still waiting for a little gracious humility from our authorities in Aotearoa New Zealand. Humility is an important characteristic of civilised behaviour.

In the middle of the interview, Jim Mora noted: “Our readers are quite fascinated with Sweden; I think the world is”. When and why did that fascination stop? Or is it just that Goliath’s information mediators stopped being fascinated when the ‘contest’ moved in David’s favour?

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Keith Rankin (keith at rankin dot nz), trained as an economic historian, is a retired lecturer in Economics and Statistics. He lives in Auckland, New Zealand.