Comparative report of the COVID-19 Pandemic Responses in Norway, Sweden, Germany, Switzerland and the United Kingdom

Abstract

The purpose of this report is to compare the risk communication strategies and public health mitigation measures implemented by Germany, Norway, Sweden, Switzerland, and the United Kingdom (UK) in 2020 in response to the COVID-19 pandemic based on publicly available documents. The report compares the country responses both in relation to one another and to the recommendations and guidance of the World Health Organization where available. The comparative report is an output of Work Package 1 from the research project PAN-FIGHT (Fighting pandemics with enhanced risk communication: Messages, compliance and vulnerability during the COVID-19 outbreak), which is financially supported by the Norwegian Research Council's extraordinary programme for corona research. PAN-FIGHT adopts a comparative approach which follows a “most different systems” variation as a logic of comparison guiding the research (Przeworski & Teune, 1970). The countries in this study include two EU member States (Sweden, Germany), one which was engaged in an exit process from the EU membership (the UK), and two non-European Union states, but both members of the European Free Trade Association (EFTA): Norway and Switzerland. Furthermore, Germany and Switzerland govern by the Continental European Federal administrative model, with a relatively weak central bureaucracy and strong subnational, decentralised institutions. Norway and Sweden adhere to the Scandinavian model—a unitary but fairly decentralised system with power bestowed to the local authorities. The United Kingdom applies the Anglo-Saxon model, characterized by New Public Management (NPM) and decentralised managerial practices (Einhorn & Logue, 2003; Kuhlmann & Wollmann, 2014; Petridou et al., 2019). In total, PAN-FIGHT is comprised of 5 Work Packages (WPs), which are research-, recommendation-, and practice-oriented. The WPs seek to respond to the following research questions and accomplish the following: WP1: What are the characteristics of governmental and public health authorities’ risk communication strategies in five European countries, both in comparison to each other and in relation to the official strategies proposed by WHO? WP2: To what extent and how does the general public’s understanding, induced by national risk communication, vary across five countries, in relation to factors such as social capital, age, gender, socio-economic status and household composition? WP3: Based on data generated in WP1 and WP2, what is the significance of being male or female in terms of individual susceptibility to risk communication and subsequent vulnerability during the COVID-19 outbreak? WP4: Based on insight and knowledge generated in WPs 1 and 2, what recommendations can we offer national and local governments and health institutions on enhancing their risk communication strategies to curb pandemic outbreaks? WP5: Enhance health risk communication strategies across five European countries based upon the knowledge and recommendations generated by WPs 1-4. Pre-pandemic preparedness characteristics All five countries had pandemic plans developed prior to 2020, which generally were specific to influenza pandemics but not to coronaviruses. All plans had been updated following the H1N1 pandemic (2009-2010). During the SARS (2003) and MERS (2012) outbreaks, both of which are coronaviruses, all five countries experienced few cases, with notably smaller impacts than the H1N1 epidemic (2009-2010). The UK had conducted several exercises (Exercise Cygnet in 2016, Exercise Cygnus in 2016, and Exercise Iris in 2018) to check their preparedness plans; the reports from these exercises concluded that there were gaps in preparedness for epidemic outbreaks. Germany also simulated an influenza pandemic exercise in 2007 called LÜKEX 07, to train cross-state and cross-department crisis management (Bundesanstalt Technisches Hilfswerk, 2007). In 2017 within the context of the G20, Germany ran a health emergency simulation exercise with WHO and World Bank representatives to prepare for potential future pandemics (Federal Ministry of Health et al., 2017). Prior to COVID-19, only the UK had expert groups, notably the Scientific Advisory Group for Emergencies (SAGE), that was tasked with providing advice during emergencies. It had been used in previous emergency events (not exclusively limited to health). In contrast, none of the other countries had a similar expert advisory group in place prior to the pandemic. COVID-19 waves in 2020 All five countries experienced two waves of infection in 2020. The first wave occurred during the first half of the year and peaked after March 2020. The second wave arrived during the final quarter. Norway consistently had the lowest number of SARS-CoV-2 infections per million. Germany’s counts were neither the lowest nor the highest. Sweden, Switzerland and the UK alternated in having the highest numbers per million throughout 2020. Implementation of measures to control the spread of infection In Germany, Switzerland and the UK, health policy is the responsibility of regional states, (Länders, cantons and nations, respectively). However, there was a strong initial centralized response in all five countries to mitigate the spread of infection. Later on, country responses varied in the degree to which they were centralized or decentralized. Risk communication In all countries, a large variety of communication channels were used (press briefings, websites, social media, interviews). Digital communication channels were used extensively. Artificial intelligence was used, for example chatbots and decision support systems. Dashboards were used to provide access to and communicate data.

The Legacy of the Pandemic Preparedness Regime: An Integrative Review

“…In 2017 during the time of the G20 meeting, Germany ran a health emergency simulation exercise with WHO and World Bank representatives to prepare for potential future pandemics. Meanwhile, Switzerland referred to SARS and H1N1 outbreaks in updating its legislation guiding its response to epidemics [ 12 ].…”

“…For example, let’s consider the countries involved in the PAN-FIGHT study: Germany, Norway, Sweden, Switzerland, and the UK. Despite current health expenditures (% of GDP) 11.43% (2018) in Germany, 10.05% (2018) in Norway, 10.90% (2018) in Sweden, 11.88% (2018) in Switzerland, and 10.00% (2018) in the UK—mong the highest expenditures in the world -, all five countries experienced ruthless surprises and struggled with their COVID-19 responses [ 12 ]. In early 2020, masks, PPE, and functioning lines of coordination across countries, regions, and sectors were lacking.…”

“…Our text is also informed not only by the current contribution both authors make to Norwegian-based project PAN-FIGHT [6], but also by earlier work on vaccine hesitancy [7][8][9][10] and on the global management of pandemic responses prior to COVID-19, namely H1N1 and Ebola [11]. PAN-FIGHT is a 5-country research consortium that compares the risk communication strategies and public health mitigation measures implemented in Germany, Norway, Sweden, Switzerland, and the United Kingdom in 2020 in response to the COVID-19 pandemic [12].…”