ANALYSIS: Why has Sweden's digital response to Covid-19 been so slow?

In 2021, Sweden was ranked the third most advanced digital economy in the EU, behind only Denmark and Finland. But in many ways it has also fallen behind its European neighbours during the pandemic, with several tech solutions introduced much later or not at all.

It is, for example, one of only four countries in the EU never to have launched an official contact tracing app. The others are Bulgaria, Romania and Slovakia.

So why is tech-savvy Sweden lagging behind?

A lot of the problems have been political rather than technological.

Sweden’s Civil Contingencies Agency (MSB) spent six million kronor (approximately $662,000) developing a contact tracing app in April 2020, but failed to clear it with the Public Health Agency, which then vetoed it the following month. And so, the app was never launched.

At the time, state epidemiologist Anders Tegnell argued Sweden had “too much infection”, so a contact tracing app would overwhelm health services and force too many necessary workers to stay home. MSB said that “uncertainties around data storage and users’ anonymity and privacy” had also been an issue.

A source who was involved in the early stages of the aborted contact tracing app argues that the resistance to digital solutions follows a pattern seen throughout the pandemic.

“They were very sceptical of how efficient contact tracing apps were, and I think it’s in line with a lot of other perspectives during the crisis,” he tells The Local. “It’s the same with the masks: ‘without a systematic scientific evaluation, we cannot recommend anything’.”

What about vaccine passes?

The slow response also extends to Covid vaccine passes, with thousands of fully vaccinated foreigners still unable to get their vaccinations validated in Sweden.

When Sweden first launched its version of the EU Digital Covid Certificate, Covidbevis, it came as a simple PDF (online or print) with no accompanying app, and it was only available on July 1st, the absolute deadline and long after many other EU countries.

At first the Swedish version of the Covid pass could only show vaccination status. It wasn’t until the start of August, when most people’s holidays were over, that Swedes could get an EU Digital Covid Certificate on the back of a negative test or proof of recovery. Again, this was right on deadline and months after most other EU countries.

The Public Health Agency was initially sceptical of the value of vaccine passes, and at the time the certificates were only used for travelling to Sweden from abroad without restrictions. When countries like France, Germany and Denmark started to also require them to enter restaurants and events, Tegnell argued this was ethically problematic as many people had not had a chance to get the jab.

Sweden eventually rolled out vaccine passes to large public events on December 1st, and the government is now preparing to possibly extend them to venues such as restaurants and long-distance public transport. It also tasked the Agency for Digital Development (DIGG) with developing a new vaccine app that event organisers can use to verify their attendees’ vaccinations.

“It’s not like we were late with developing something,” protests Mats Snäll, who led the work on the app, which was ready on November 30th.

His 20-person team did the job in two and a half weeks, he adds. “We developed this app when the government told us to, and they thought it was a good idea now and not earlier. It is not the most beautiful app in the world. But I think it suits its purpose.”

In fact, his team also developed a system for verifying test status and recovery from Covid back in July, so the fact that the app lacks this capability reflects a decision from the Public Health Agency to focus on vaccine passes, not a technological limitation.

The decentralised digital approach

Blame for Sweden's slow digital response cannot solely be laid at the door of the Public Health Agency. Sweden’s decentralised approach, with every municipality, region and government agency responsible for their own digitisation, is arguably a big culprit.

Denmark's version of DIGG, the Agency for Digitisation, was launched in 2011 with some 300 staff and a powerful mandate. DIGG was launched in 2018, has only a third as many employees for a country with twice the population, and has no powers to impose its solutions on agencies or local governments.

“They’ve made the right decision,” Johan Magnusson, professor of applied information technology at Gothenburg University, says of the Danish approach.

“They’ve created somebody in charge and made sure that there’s enough funding to be able to create not 290 individual solutions out in the country, but just one. They utilise the logic of digital: massive economies of scale and zero margin cost,” he adds.

That Sweden hasn’t done this, he argues, reflects the “Swedish government model”, which leaves agencies and regions responsible for day-to-day decisions and frowns on ministerstyre, “ministerial rule”, when ministers micromanage government agencies.

It was this fragmentation that arguably led to the clash between MSB and the Public Health Agency over the contact tracing app. It is arguably the reason why DIGG could not take its own initiative and launch a vaccine pass app before it was asked to by the government. It also part explains the issues faced by those foreigners who are unable to get a valid vaccine certificate, despite being fully vaccinated.

As The Local has been reporting since summer, people who got both of their vaccine doses abroad or who don't have a personal identity number (personnummer) have faced obstacles or even been unable to get a Swedish vaccine pass. Although Sweden is hardly the only EU country where non-residents have encountered problems, it is a hurdle that was cleared in many other countries long ago.

The e-Health Agency, which has been in charge of issuing Covid certificates, told The Local in July that the problem faced by those who don't have a personnummer came down to difficulties connecting the population registry databases and vaccinations.

The situation was resolved for some of these people in autumn, but for people vaccinated with a temporary reserve number, it is more complex, as reserve numbers are only unique by each region, so vaccinations can’t be matched up to a person and their name on a national level. The Health Ministry told The Local in November that they plan to roll out a solution on January 1st, six months after the passes were launched.

• Which foreign vaccine passes are valid for public events in Sweden?

Swedish residents vaccinated abroad have also been unable to get their foreign vaccine certificate converted to a valid Swedish vaccine pass. This problem is due to the set-up of the National Vaccination Register (NVR), which is managed by the Public Health Agency.

“Denmark has had a national vaccination repository for several years [which] can also handle information about vaccinations done in other countries,” explains Jan Pettersson, a communications officer at the e-Health Agency.

“The Swedish national vaccination registry is a health data registry governed by a different type of legislation, which contains only certain vaccinations done in Sweden, and the information can only be used for statistics and research.”

It took a change in legislation to enable the registry even to be used for the Covid-19 passes, he adds. The registry can still not be accessed by regional health authorities for anything other than statistical purposes, which explains some of the administrative issues above.

It's not that Sweden isn't aware. The e-Health Agency and the Public Health Agency as early as June 2020 proposed a move to a Danish-style system, which would allow doctors employed with regional health agencies to manually add vaccination data. The next step now is for the Health Ministry to decide which government agency will be responsible for verifying vaccinations administered in third countries.

Constitutional changes?

Gothenburg University’s Magnusson argues that overcoming some of the barriers to digital government thrown into sharp relief by the pandemic will require carving out exceptions to Sweden’s decentralised system set up by Lord High Chancellor Axel Oxenstierna in the 17th century, something he says Finland, which has a similar system, is already working on.

“It’s a major problem that there’s no central authority, so you find everybody running in the wrong direction at once,” he explains. “But to change it, you need to change the constitution, and that’s something no government has been willing to do.”