Sunday September 13, 2020
By Richard Milne
State epidemiologist Anders Tegnell says herd immunity has played a part in recent sharp drop in Swedish cases
A sign with a portrait of Anders Tegnell, the face of the country’s response to the novel coronavirus Covid-19 pandemic, is hanged at an entrance to a restaurant to instruct people to wash their hands in Sodermalm, Stockholm. Photograph: Jonathan Nackstrand/AFP
At the start of this year, Anders Tegnell was just a low-profile bureaucrat in a country of 10 million people, heading a department that collects and analyses data on public health. Today, he has become one of the best known – and most controversial – figures of the global coronavirus crisis.
The 64-year-old Swedish doctor was meant to spend 2020 helping Somalia set up a public health agency as well as sending questionnaires out to Swedes to gauge different aspects of their wellbeing. Instead, his approach to coronavirus – to keep schools, restaurants, fitness centres and borders open while refusing to follow China in imposing a formal lockdown – has seen him become an unlikely polarising figure for a polarised age.
For many Swedes, their state epidemiologist has embodied a rational approach as other countries have appeared to sacrifice science to emotion. “I wish I were coming with you to see him,” one of Sweden’s leading chief executives confided to me just before I went to see Tegnell. “The way he has stood for what he believes in while the rest of the world does something else is admirable.”
Public support for Tegnell has remained high over a period in which life, while very different to before, has been more normal than in many other countries. Such is his stock in Sweden that there are stories of people having his bespectacled face tattooed on their bodies, while some on the American and British right have seized on Tegnell as a champion of freedoms they feel they have lost during lockdown.
But for a minority domestically, and many internationally, he is a far more problematic figure. The populist Sweden Democrats have called for him to resign after thousands of elderly in care homes died. That has given Sweden the fifth-highest death rate per capita in Europe, five times higher than neighbouring Denmark and about 10 times more than Norway and Finland.
For some local experts, Tegnell’s standing alone as the world locked down inspires none of the CEO’s veneration. “Tegnell is known for his stubbornness. You wonder what this would have looked like with a different person in charge,” says a Swedish epidemiologist who has been a critic of Tegnell. International media have been harsher still: The New York Times has called Sweden a “pariah state” and “the world’s cautionary tale”.
The man so venerated and so decried works in a drab backstreet building in a northern Stockholm suburb close to the capital’s largest hospital. Tegnell emerges out of the public health agency’s canteen smiling and looking both rested and tanned in a short-sleeve blue polo shirt. It is a warm late August day and we sit in the midday sunshine at a wonky picnic table, him nursing a mug of black coffee, me a bowl of deer and wild mushroom stew.
I start by asking him to give himself a report card – and his answer is classic Tegnell, defending Sweden’s approach resolutely and casting gentle aspersions on others.
“At the outset, we talked very much about sustainability, and I think that’s something we managed to keep to. And also be a bit resistant to quick fixes, to realise that this is not going to be easy, it is not going to be a short-term kind of thing, it’s not going to be fixed by one kind of measure. We see a disease that we’re going to have to handle for a long time into the future and we need to build up systems for doing that,” he says, with his arms crossed tightly to his chest as they are for nearly the entire hour-long interview.
Our meeting comes as things appear to be going his way. As coronavirus cases rise in pretty much all other European countries, leading to fears of a second wave including in the UK, they have been sinking all summer in Sweden. On a per capita basis, they are now 90 per cent below their peak in late June and under Norway’s and Denmark’s for the first time in five months. Tegnell had told me the first time we spoke in the spring that it would be in the autumn when it became more apparent how successful each country had been.
Today, the architect of Sweden’s lighter-touch approach says the country will have “a low level of spread” with occasional local outbreaks. “What it will be in other countries, I think that is going to be more critical. They are likely to be more vulnerable to these kind of spikes. Those kind of things will most likely be bigger when you don’t have a level of immunity that can sort of put the brake on it,” he adds.
Herd immunity is one of the most controversial concepts of the Covid-19 crisis. Tegnell is adamant that it was not Sweden’s goal to allow the virus to run its course until enough of the population had been exposed and the infection rate slowed. But he argues immunity is at least in part responsible for the sharp recent drop in Swedish cases and questions how its neighbours will fare without it. “What is protecting Copenhagen today? We will see,” he adds.
Sweden’s approach to the pandemic is unusual in large part because its governance is unusual. Unlike in pretty much every other country, it is not politicians who take the big decisions but Sweden’s public health agency, due to its constitution giving big powers to independent authorities. In practice, this means Tegnell. “This whole approach is Tegnell’s. The government has accepted it without questions,” says the critical epidemiologist.
That makes his ability to stand alone as the rest of the world locked down seem all the more remarkable. I ask him about it, suggesting it must be easier just to go with the flow. “Yes, of course it is. But I am not alone,” he says, dutifully listing the backing of the 500 staff in the public health agency as well as Sweden’s government and population.
The only other country not to lock down in Europe was authoritarian Belarus, I say. He erupts in a burst of nervous laughter: “That’s no comparison.” He looks awkward as I mention strong support for Sweden’s strategy from some US libertarians and UK supporters of a hard Brexit. “Odd bedfellows,” is his sole comment.
His dislike of national lockdowns is obvious. “It’s really using a hammer to kill a fly,” he insists. Instead, his approach has been about having a strategy that can work for years if needs be, rather than the constant chopping and changing seen in the rest of Europe. “We don’t see it as viable to have this kind of drastic closing down, opening and closing. You can’t open and close schools. That is going to be a disaster. And you probably can’t open and close restaurants and stuff like that either too many times. Once or twice, yes, but then people will get very tired and businesses will probably suffer more than if you close them down completely,” he says.
Sweden’s approach was predicated on trying to keep its healthcare system working but also looking at public health in the broadest sense, rather than narrowly trying to minimise Covid-19 deaths. So children’s sports carried on, as did primary school lessons, yoga sessions, drinking and eating out with friends, and shopping.
This trip is my first time in Stockholm for six months – I am based in Oslo and had been to Sweden once during the pandemic, to Gothenburg in June – and I soon settle into my usual rhythm. I go record shopping at several of my favourite spots, picking up several bargains, have coffee with a contact nearby, and take the metro to meetings and my hotel. Throughout, I barely see a single person with a mask.
I suggest to Tegnell that an alien landing in Sweden would have difficulty knowing there is a pandemic whereas in England or France, with face masks prevalent, they would realise immediately. He argues that while that might be true on the surface, especially with masks – which Sweden is one of the few countries not to recommend wearing in public – the differences elsewhere are exaggerated. Swedes have stopped travelling just as much as neighbours; hotels and restaurants may not have closed but have been severely affected.
He points to the markings in supermarkets showing people where to stand and detailed restrictions on restaurants in terms of how many people they can have and how they serve them.
“These types of restrictions don’t exist almost anywhere else than in Sweden. We have really tried to focus on places that we have known are going to be really dangerous, while going into a record shop and buying a record will not cause hundreds of people to get infected,” he says, adding: “It is there, but I think, as an alien, you need to be here a bit longer to see it.”
Suddenly, a young blonde woman rushes up behind him, plants a big kiss on his cheek, and says in Swedish: “I knew I’d find you here.” I must look slightly perplexed as Tegnell introduces her as his daughter, Emily. “I’m another fan, attacking him. Should I call someone?” she says jocularly.
‘A real doctor’
Emily is an intensive care doctor who normally lives in Gothenburg but is currently in Stockholm for a course. A dark-haired friend accompanying her comes up to Tegnell and simply says: “Good job.”
I suggest Emily must be more relaxed than she has been in previous months when coronavirus stretched Swedish healthcare. “She worked for the MSF [Médecins Sans Frontières] in Congo with Ebola, so I think she’s not that upset about this,” he says, matter-of-factly.
Has the fact Emily and Annemiek, another of his daughters, who is a nurse, work in healthcare helped him appreciate better the pressures in the system? “It’s good to talk to them because they can give me a different kind of view,” he says. He laughs that they say he’s no longer “a real doctor” but merely a bureaucrat. They also tease him about articles that have, for instance, called him a fashion icon despite his rather casual style and love of polo shirts in various shades.
Tegnell, in a few short months, has become the most famous Swede, both at home and abroad. “It’s hype,” he says. “And it’s completely surreal.” He tells of a woman and her son turning up at his home with a portrait of him made from plastic beads. He tries to argue that epidemiologists elsewhere have become well known, before conceding “people wouldn’t tattoo their face on their arms”.
He says that his fame is a “problem” and was never his ambition. He is all for free speech but comments comparing him to Hitler or Stalin “are not okay”, and he has spoken to police over death threats. Does the combination of his sudden fame and him appearing to stand alone make him defend his positions even more stubbornly?
“Not really, no. But, of course, it means I have to be very cautious about what I’m saying,” he says.
Is there a danger that he becomes too detached, too much at the level of general statistics rather than the tragedy of 5,800 deaths and rising? “That’s, of course, a danger but I think, then, it’s good to have the kind of experience that I have. I’ve worked in hospitals. I’ve seen the flu epidemics and people coming in and overflooding the hospitals. I worked with Ebola in Africa. I do realise what diseases can do to a society and a system.”
Tegnell had a normal Swedish childhood until he was 12 and his family moved to Ethiopia. He says the change of scenery affected him deeply. He met his Dutch wife at university in the US before travelling extensively.
Rather than his fight against Ebola in what was then Zaire in 1995, he says his time just before that working on vaccination programmes in Laos for the World Health Organisation was the most formative. “I really learned about the importance of broad thinking in public health. I think that’s also partly behind our strategy and also what the agency is doing. We are not just working with communicable diseases, we are working with public health as a whole,” he says.
So he looks at not just as a place where the virus might spread but also the most important part of health for a young person. “If you succeed there, your life will be good. If you fail, your life is going to be much worse. You’re going to live shorter. You’re going to be poorer. That, of course, is in the back of your head when you start talking about closing schools,” he adds.
In June, Tegnell described the rush to lock down in the rest of Europe and the US as “it was as if the world had gone mad”. He appears more emollient today, but he still displays signs of disbelief at the approaches of others. Adopting face masks is “more of a statement than actually a measure”.
He adds: “Face masks are an easy solution, and I’m deeply distrustful of easy solutions to complex problems.” I ask him about another previous comment: hadn’t he said that Sweden, in the local vernacular, had “ice in its stomach” whereas other nations had acted emotionally?
“That comes back to sustainability. Sustainability, to a certain extent, is to have ice in your stomach because you need to believe in the long-term effects of what you’re doing and not starting to doubt them too early,” he says.
Tegnell seems to have few doubts. He caused a stir in June by suggesting that Sweden would have been tougher if it knew at the start of the pandemic what it knew then. But when I ask him today if he would have done anything differently, he answers that while it would have been good to know how Covid-19 would develop “I’m not sure it would have changed very much”.
Our conversation ends with Tegnell again swimming against the tide, and warning that a vaccine – if and when it comes – will not be the “silver bullet”.
He adds: “Once again, I’m not very fond of easy solutions to complex problems and to believe that once the vaccine is here, we can go back and live as we always have done. I think that’s a dangerous message to send because it’s not going to be that easy.”