Policy responses for Sweden - HSRM


Policy responses for Sweden

3. Providing health services effectively

The section on PROVIDING HEALTH SERVICES EFFECTIVELY describes approaches for service delivery planning and patient pathways for suspected COVID-19 cases. It also considers efforts by countries to maintain other essential services during periods of excessive demand for health services.

3.1 Planning services

On December 4th, the Swedish Public Health Agency presented a national vaccination plan including a more detailed priority list for vaccination. People in retirement homes will be given first priority, followed by care and nursing staff working with particularly vulnerable people in elderly care as well as other healthcare workers. The priority list concerns 600 000 people in total.

The government also decided that Sweden will conclude the joint EU contract with the pharmaceutical firm Moderna. So far, Sweden has signed deals to secure enough vaccine doses for its entire population.

The government allocated SEK 300 million for regional vaccination preparations. Vaccination will be free of charge for individuals.
On December 8th, the government signed a deal with the Swedish Association of Local Authorities and Regions (SKR). The agreement stipulates that the Swedish state undertakes the full funding for vaccine purchases and vaccination activities and the regions will be responsible for carrying out the vaccinations. The plan is to offer vaccinations to everyone over 18 years old during the first six months of 2021, under the condition that current vaccines are approved and supplied according to plan.

On December 9th, Sweden has undertaken, as a part of Nordic cooperation, to resell the vaccine developed by Pfizer/BioNTechs to Norway and Iceland on behalf of the EU.

On December 18th, vaccination began. The Swedish Public Health Agency, the Medical Products Agency, and the Swedish Civil Contingencies Agency are tasked with securing accessible and updated information related to vaccination. This is to ensure an effective vaccinations process, reach groups where vaccination coverage is lower, and to counteract the spread of misinformation.

On December 25th, the Swedish Public Health Agency published a recommendation of which groups should get vaccinated in the next phase beginning in February 2021. This group consist of all adults over 70 years old, adults with personal assistance, and health and social care workers. The recommendation is non-binding and up to the regions to decide whether to implement.

December 30th, Sweden has, as a part of the Nordic cooperation, undertaken to resell the vaccine developed by Moderna Switzerland GmbH to Norway and Iceland on behalf of the EU.

On the January 5th, the Public Health Agency announced that local adjustments may be made to the priority list for vaccination. This came after several regions expressed that health care workers should be vaccinated in phase 1. Great concern has been raised over the high care burden and severe disruptions in case of health care workers falling ill. Some prioritized health care workers, such as staff working in intensive care and emergency care may be prioritized for vaccination as part of the ongoing phase 1. This adjustment has to be well balanced with the other groups in priority group 1, while waiting for larger volumes of vaccine supply.

On January 15th, changes in the Pfizer delivery schedule means that Sweden receives 15% fewer doses over a four-week period.

On January 22th, the vaccination process is slowed down by vaccine shortages, the bigger regions report having the capacity to vaccinate at a higher rate but are waiting for more supply.

On February 2th, 6 out of 21 regions report that the reduced inflow of vaccine doses has affected their plan for vaccination.  In some of these regions, vaccination of prioritized health care workers in phase 1 and groups of people over 70 years old in phase 2 may be delayed.

On February 5th, the Public Health Agency is tasked with weekly reporting and following up on the process of vaccination. This includes reporting on the amount of vaccine doses supplied and doses administered by the regions. Statistics of doses administered, and a preliminary forecast (until June 2021) is published on the following sites:
Statistics available at (in Swedish): https://www.folkhalsomyndigheten.se/nyheter-och-press/nyhetsarkiv/2021/januari/uppdaterad-statistik-om-vaccinationer-mot-covid-19/ 
Preliminary forecast available at (in Swedish): https://www.folkhalsomyndigheten.se/smittskydd-beredskap/utbrott/aktuella-utbrott/covid-19/vaccination-mot-covid-19/statistik/prognos-av-vaccinleveranser/ 

Vaccines sources:

On aggregate the Swedish health care system’s capacity for intensive care has doubled during the COVID-19 outbreak. Hospitals have made organizational adjustments to meet the required needs and have allocated both material and personnel resources to the intensive care units (ICUs). Different regions and hospitals have taken somewhat different measures. The number of surgeries almost halved in April compared with the average for April in the previous three years. In particular, many surgeries were cancelled in orthopaedics, general surgery and eye care. The number of physical visits to primary care fell by about 800,000 during the spring. Visits to specialized care also fell sharply. However, digital care visits increased. People with a background in care or health care have offered their services to hospitals who have been hiring on demand. The private sector and military have provided support with material resources. A selection of primary care providers work with sentinel surveillance, reports the incidence of infection, and sends samples to labs. In general, there is no designation of specific hospitals and/or departments that are meant to deal exclusively with COVID-19 patients.
Organizational adjustments and re-allocation of resources in the health care system
• March 13th. In order to take pressure off the health care system, the requirement for presenting a medical certificate for sick leave from the eighth day of sickness has been temporarily removed.
• March 14th. The National Board of Health and Welfare has been assigned to be national purchasing centre for medical supplies, protective equipment and certain medical technical equipment. The Swedish Work Environment Authority has been assigned to ensure that there is a procedure for providing non-CE-marked personal protective equipment (PPE) for socially important occupational groups.
• March18th. The government assigns the National Board of Health and Welfare to set up a coordination function for ICUs. The purpose is to support the regions in the coordination and expansion of intensive care centres in the country.
• March 23rd .The National Board of Health and Welfare develops national principles for prioritization, in case of intensive care shortages, to support health care personal.
• April 14th. On aggregate the capacity for intensive care has doubled and is now able to take care of 1046 intensive care patients.
• April 15th. ICU beds rises to 1064

The role of the National Board of Health and Welfare in securing material resources
• Signed an agreement for SEK 1 billion. For example, for 800 respirators, 12 million face masks; has also secured large deliveries of hand sanitizers and surface disinfectants.
• Close collaboration with the Swedish Defence Materiel Administration, which supports contractual agreements and quality contracts with suppliers.
• Deliveries are made on a continuous basis and distributed after quality control to the health care system.
• Few regions have an urgent needs for protective equipment, but several will need more in the next few days (from April 16th). The authority makes daily decisions on material support for regions and municipalities.

Role of the Swedish Armed Forces

The Swedish Armed Forces have contributed with equipment, e.g. ambulances and about 50 000 military masks and 150 respirators. They are also contributing with a field hospital with capacity for 40 patients and 30 intensive care patients in Stockholm. In Gothenburg, a similar module has been raised with capacity for 50 patients and 20 intensive care patients. They are also contributing with personnel in different functions. Hospital tents and beds have been installed in several other regions.
• 27th March. The Swedish Armed Forces hands over the responsibility for the ICU at the field hospital in Gothenburg to the region of Västra Götaland
• April 6th. Älvsjö Hospital in Stockholm is operational

Role of the private sector

Upon the initiative of the Government and private actors themselves, several Swedish companies have started to change their production to ensure domestic production of PPE for health care, including masks and disinfectant. The state research institute, Rise, is responsible for quality control.

Role of Primary care – Sentinel Surveillance and general guidelines

The Regions have developed different guidelines on how the primary care units should operate when meeting patients with respiratory symptoms. The guidelines concerns both more general hygiene guidelines and practical procedural guidelines concerning distancing and isolation of patients.

A selection of primary care units works with sentinel sampling in order to determine how many patients with flu-like symptoms actually have the flu or COVID-19. In connection with the spread of COVID-19 in Europe, the Public Health Agency has decided to include analysis for COVID-19 in the sentinel samples. This is to get a better idea of the spread of influenza and COVID-19 as well as the risk groups and age groups affected. The units participating in sentinel sampling each week take samples from patients with flu-like illness and submit them to the Public Health Agency for analysis.

Improving access to COVID-19 services for vulnerable populations

Children who are undocumented migrants or seeking asylum have the same right to health care as Swedish citizens. Adult asylum seekers or undocumented migrants have the right to care that cannot wait, which means that they are entitled to health care in case of serious illness caused by COVID-19.

Sweden’s 290 municipalities have the ultimate responsibility for ensuring that people living or staying in the municipality receive the support and assistance they need. On April 24th Amnesty International encouraged the National Board of Health and Welfare to publish national guidelines which clarify the municipalities’ responsibilities for homeless people during the COVID-19 crisis.

The Prison and Probation Service have prohibited visits to prisons and remand prisons. The restrictions do not concern lawyers, prosecutors and police officers.

Guidance for long-term care providers

The National Board of Health and Welfare have produced guidelines, online training courses and support documents to long-term care facilities regarding COVID-19. Long-term care is a municipal responsibility and supply of both physical and personnel resources and contingency plans and routines differ between municipalities and care providers, the National Board of Health and Welfare are producing follow-up reports on this matter.

May 12th.  The Government presents measures with the aim of strengthening the human capital in the sector of care for older people. The government allocates SEK 2.2 billion to give employers in the sector paid education during working hours. The aim and hope is that this will increase the number of permanent employees.