Risk Wise

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] 72

Infectious disease control

and emergency management:

the Swedish approach

Dr Johan Carlson & Dr Anders Tegnell, National Board of Health and Welfare, Sweden

weden is a country of some nine million inhabitants in the

north of Europe. It is administratively organized into 21

counties, which are responsible mainly for the health care,

and 290 municipalities, which are responsible for most other

services to the inhabitants.

The Swedish system for communicable disease control is decentral-

ized to a very high degree. The major operational role lies within the

21 counties, varying in size from less than 100,000 inhabitants to

more than two million. In some of the counties with small popula-

tions, the geographical area might be very large, with a dispersed

population. Each county has a medical officer in charge of commu-

nicable disease control, who has a coordinating function regarding

the operational activities in the area.

At national level the National Board of Health and

Welfare (NBHW) fills the national coordinating func-

tion, but also develops guidelines and directives and

supervises activities in the counties. The Swedish Centre

for Communicable Disease Control (SMI) is the national

node for the surveillance system, and is tasked with

developing the knowledge that forms part of the basis for

the normative activities of the NBWH.

The general principle for the responsibilities for

preparedness and the management of a crisis is that it

should be in the hands of the same actor as the one who

is in charge of them in peacetime. This means that

responsibility for planning for healthcare and commu-

nicable disease control during a pandemic lies with the

healthcare authorities, and in practice pandemic plan-

ning for healthcare is often an integral part of the

hospitals’ emergency plans. For emergency planning in

other sectors the municipalities have a central respon-

sibility, while coordination for a bigger geographical area

lies with the county administrative boards.

Planning assumptions

Pandemic planning needs to be based on a concept of

the effects that the pandemic will have on people and on

the society. Several sources can be used to develop this

concept, but the main source is the knowledge of previ-

ous pandemics and, to a certain extent, the yearly

epidemics of seasonal influenza. However, these give only

a possible scenario, and the likely variations are big. This

is accepted in the Swedish planning process, and the

solution is an adaptable planning were many details in

the plan will have to be left for rather late adjustments.

Things that might be adjusted are, for example, needs

for hospital beds, risk groups that need special resources

and others. However, some assumptions need to be made

in case no better data becomes available. Swedish

assumptions are that the pandemic will start somewhere

outside Sweden and that it will resemble the Hong Kong

or Asian pandemic rather than the Spanish influenza.

One assumption that has increasingly become a focus

of the planning is that the pandemic will affect major parts

of society. Many people will be ill at one time and there

will be a lack of manpower in many of the functions of

National stockpiles of antivirals and antibiotics have been purchased to ensure that

a variety of drugs is available whenever possible to deal with future changes in

resistance among viruses and bacteria

Image: Matton