Brutal choices: Anders Tegnell and Sweden’s herd immunity goal

If the title of epidemiological czar were to be created, its first occupant would have to be Sweden's Anders Tegnell. He has held sway in the face of sceptics and concern that his "herd immunity" approach to COVID-19 is a dangerous, and breathtakingly cavalier approach, to public health. Tegnell T-shirts featuring him as a medieval liberator are available for purchase; fan pages can be found on Facebook abuzz with encouragement. Tegnell's point, throughout, is that his approach is less than radical given the global lockdown formula that has perpetrated, almost overnight, the worst economic crisis in generations.

This is not to say that such herd immunity is being encouraged by a lax approach to public health regulations. As the World Health Organisation's Mike Ryan has noted, a false narrative had been perpetrated about an absence of control measures in Sweden to halt the transmission of COVID-19. The focus in Sweden, rather, is on sensible, voluntary restraint, making sure that large gatherings are avoided, and, where people do gather (those of less than 50 are permitted), physical distancing is observed. But such a gamble is dependent on developing a critical, resistant core against re-infection, thereby protecting the vulnerable population. Viral transmission, it follows, will eventually be halted if a majority – say 60 percent of the population – have contracted it while the vulnerable are sheltered.

Karin Ulrika Olofsdotter, the country's ambassador to the United Nations, has been tasked with promoting the Tegnell model to the world. On National Public Radio, her words had the authority of a proclamation. "About 30 percent of people in Stockholm have reached a level of immunity." Daringly, she suggested that, "We could reach herd immunity in the capital as early as next month."

The merits of such a position soon became matters of culture and ideology. The science becomes part of the context within which it is pursued – Sweden as unique; Sweden as peerless – or at least just that bit more peerless than its Nordic neighbours. Within the country, trust for the myndigheterna (the agencies) is unflappable, and if herd immunity be the policy, then so be it.

Attempts to deprive Tegnell of primacy and his sheen of confidence have not succeeded. In March, 2,300 academics signed an open letter to the Swedish government calling for stricter measures to contain the pandemic. As one of the signatories, Cecelia Söderberg-Nauclér of the Karolinska Institute wondered, "No one has tried this route, so why should we test it first in Sweden, without informed consent?"

An attempted scientific putsch by 22 researchers in April, launched in Dagens Nyheter, failed. In the open letter, the group took issue with the Public Health Agency's approach, urging government intervention with "swift and radical measures" along the lines undertaken by the country's neighbours. "In Sweden, there are now ten times more people dying than in neighbouring Finland where coffee shops and restaurants are closed." Other comparisons were also cited, with a focus on the last three days before the Easter vacation. Between April 7-9, "10.2 people per million inhabitants died of COVID-19 each day in Sweden." For the same number in Italy, it was 9.7; in Denmark, 2.9; Norway, 2.0 and Finland 0.9.

The authors also threw in a quote from an interview in the same newspaper with Finnish President Sauli Niinistö. It was a pointed remark on the failed credo of voluntary restraint. "You cannot ask people not to go out if the restaurants are allowed to stay open."

Tegnell's response was curt, claiming that the figures cited by his critics were marred by "a number of fundamental errors". As is his wont, he drew upon technical qualifications to debunk the data, noting the line that country comparisons were always risky and deceptive propositions. "The death figures they quote are incorrect, they do not match the Swedish death figures." Italy's figures, for instance, only covered deaths in hospitals.

There is a certain brutal emphasis in the Swedish approach, an acceptance that a degree of suffering must be endured to reach sustainable levels of safety. The Swedish death toll from COVID-19 stands at over 2,600. Sweden's National Board of Health and Welfare has also published its own set of figures suggesting that those of the PHA might be 10 percent lower than they should be.

All methods employed so far have been devastating to limb, life and economy; what makes Tegnell's different here is the long run, one which will keep the financiers and market watchers happy. Finland's Osmo Soininvaara, a former minister and member of the Helsinki City Council, sees more merit in it than his current colleagues. In his view, "once the coronavirus crisis is over, the number of deaths in Sweden and Finland is the same. The difference is that in Sweden the death toll has been reached faster. And our economy is in ruins, but the Swedish one will be the strongest in Europe".

Praise and support for Tegnell can also be found among the Scandinavian neighbours. In Norway, epidemiologist Eiliv Lund has accused his counterparts of simply "pushing the problem out in front of us". The Swedish approach had the merits of ensuring a higher infection rate "and thus a higher immunity." Danish epidemiologist Christian Wejse lauds Tegnell's infection formula, suggesting that the number of immune Swedes might be triple those of Danes. This would mean that Sweden "will be in a better situation if there's a new wave."

The Swedish model is being saluted from the stands of the corporate friendly New York Times, with the consistently shallow Thomas L. Friedman touting its virtues. He does, however, concede that responding to pandemics presents us with only "different hellish ways".

Whatever Tegnell and his trusted underlings in the Swedish Public Health Agency claim, the herd immunity presumption has its fair share of dangers. Questioning the relative figures of other countries and their various measures has intellectual merit; embracing the herd immunity model, however, may not. As the authors of an article recently published by The Lancet warn, "There is no certainty as to the immunological correlates of antiviral protection or the proportion of the population who must attain them, making it impossible to identify a point when this level of immunity has been reached."

There is also uncertainty over whether, on being cleared of the virus, reinfection can take place. Last month, over 260 COVID-19 patients in South Korea were reported to have tested positive, suggesting that grim possibility. The explanation offered since is that the method of detecting the coronavirus – polymerase chain reaction (PCR) – fails to distinguish between genetic material (RNA or DNA) from the infectious virus proper and lingering fragments present in the body after recovery. The herd immunity advocates, it seems, still have stilts to stand on, even if they find support among a good number of corpses.