The GOVERNANCE of the health system with regard to COVID-19 relates to pandemic response plans and the steering of the health system to ensure its continued functioning. It includes emergency response mechanisms, as well as how information is being communicated, and the regulation of health service provision to patients affected by the virus.
Sweden has contingency plans for pandemic influenza at national, regional and local levels. The parliament have decided on a legislative amendment that will temporarily give the government increased powers to be able to quickly take measures to limit the spread of infection. The Public Health Agency is coordinating surveillance, communications and testing.
Pandemic response plan in place
Sweden has contingency plans for pandemic influenza at national, regional and local levels. These plans are also applicable to other major outbreaks of infectious diseases, such as COVID-19. Contingency planning for a pandemic aims to limit the spread of infection and reduce the negative consequences for those affected by the pandemic. The Public Health Agency coordinates pandemic preparedness at the national level and supports planning at regional and local levels, where the operational work is carried out. In each region there is an infection protection physician who develops a pandemic plan and cooperates with emergency responders within the region. International coordination takes place with the World Health Organization (WHO) and within the European Union and its infection control agency the ECDC.
The regions responsible for health care in Sweden are also responsible for the care of patients with suspected infection. Hence, routines for pandemics and contingency plans exists in the regions and national recommendations for handling suspected cases are drawn up by the Public Health Agency. Municipalities also have pandemic and crisis contingency plans as do hospitals.
The Public Health Agency has published three reports with the purpose of supporting in the planning for an influenza pandemic for the national authorities concerned, the regions’ medical doctors with specific responsibility for disease control, emergency managers and coordinators, as well as for other operational and planning officers in the regions and municipalities. The first report is on how to prepare for a pandemic, the second is on how the authorities communicate recommendations to the public, while the third report is on access to and use of pharmaceuticals.
These plans serve as the knowledge base for organization and operations and are currently being followed.
The parliament have decided on a legislative amendment that will temporarily give the government increased powers to be able to quickly take measures to limit the spread of infection.
On December 9th, the government sent out a draft proposal for a temporary pandemic law to undergo consultation. The proposal would complement the Communicable Diseases Act and the Code of Conduct and extend the scope of measures at the government’s disposal. It would enable the government to take more accurate and far reaching actions, targeting activities not affected by current binding rules. The law is proposed to enter into force on March 15th 2021.
On January 8th 2021, the parliament decided to adopt the pandemic law. See https://www.riksdagen.se/sv/dokument-lagar/arende/betankande/en-tillfallig-covid-19-lag_H801SoU23
Leading the response
The Government Offices (through the Ministry of Foreign Affairs and the Ministry of Social Affairs), the Public Health Agency, the National Board of Health and Welfare and Social Security are the authorities that work to a large extent with the new coronavirus. In summary:
• The Public Health Agency has primary responsibility for issues related to the spread of infection and protection.
• The Ministry of Foreign Affairs is responsible for travel advice and assisted home travel.
• The National Board of Health and Welfare is responsible for coordination of hospitals beds and other resources.
• The Swedish Civil Contingencies Agency (MSB) is responsible for providing information for the public, supporting other agencies with competence and resources, and informing the government about societal crisis issues that can occur due to the coronavirus.
• In addition, the regions are responsible for scaling up health care capacity.
The government has tasked the Public Health Agency with responsibility for coordinating the work on expanded sampling of COVID-19 in Sweden. The National Board of Health and Welfare has been assigned the task of identifying the groups that are most at risk of suffering from a particularly serious disease course. Those groups who may temporarily have to give up work and thus will need financial compensation. The MSB, together with the expert authorities, will produce information materials that will be distributed to all households. The regions are responsible for health care and the treatment of COVID-19 patients.
Fast-track procedures for the regulation and licensing of medical devices and aids
The Swedish Medical Products Agency is prepared to expedite the approval procedure for relevant medicines and vaccines. An emergency license has been issued for the use of remdesivir. A temporary approval can be given to use a drug already approved in Sweden with a non-Swedish labelling or package leaflet. From May 20 until the end of 2020, medical devices with information other languages than Swedish may be released on the market.
On March 18th, the Swedish Work Environment Agency issued a temporary exception from the rule that personal protective equipment used in health care must have a CE label, following the European Commission Recommendation (EU) 2020/403 March 13th on conformity assessment and market surveillance procedures within the context of the COVID-19 threat. This exception is valid until the end of 2020. From April 7th, the Swedish Work Environment Authority may evaluate and permit licenses for safety equipment intended for staff in health care and care for older people, the police and the emergency services.
Bodies that are coordinating surveillance, communications and international reporting
The Public Health Agency is coordinating surveillance and testing. The MSB is responsible for coordinating communication to the public.
COVID-19 is subject to mandatory reporting under the Communicable Diseases Act, therefore physicians and laboratories continuously supply data that are analysed by the Public Health Agency every day.