The National Audit Office's report on national infectious disease control

Jesper Skalberg Karlsson (M)

Madam Speaker! In 2020, the covid-19 pandemic came to Sweden, the deadliest epidemic to hit Sweden since the Spanish flu in 1918. Over 18,000 deaths were recorded from the time the first wave of infection reached us in February/March 2020 until the fourth wave of infection subsided during the winter of 2022.

The pandemic was a harsh teacher, but nevertheless a teacher. We learned that swift and powerful measures were a real strategy in terms of crisis management for monetary and fiscal policy. We learned that there was a lack of a plan to protect the elderly and other risk groups. We learned that crisis management should be managed nationally and be subject to the government, rather than outsourcing it to an agency. And we were reminded that vaccines work.

Today, much of what was deficient in the pandemic management has been addressed. That is good. We Moderates and the government and its coalition partners want to continue to be a constructive force that vaccinates our society against becoming naive again.

Madam Speaker! The National Audit Office has reviewed the national infectious disease control and asked whether it is adapted for a large-scale spread of infection. In this context, it should be mentioned that the national infectious disease control works well in a normal situation but needs to be strengthened to increase the capacity to handle future pandemics. We do not know how or when the next pandemic will strike, but we can assume that the last pandemic is not behind us.

It is important here to establish that what is an effective way to manage an outbreak of an infectious disease in one situation can be ineffective in another situation. Therefore, an actor is needed who clearly takes on the leadership role but who safeguards the principle of responsibility and enables well-functioning cooperation between the parties involved at national, regional, and local levels. It is crucial that society moves in step when common challenges are to be overcome.

Communication is critical in that context. I remember my own role during the pandemic; as acting chairman of the regional council on Gotland, I received information from the Public Health Agency that the infection would be eradicated, while the advice they gave to the population was only about, as it was called, flattening the curve.

Such an arrangement, where authorities say one thing but do another, is unsustainable. Locally, we therefore chose to take drastic measures to protect our population. Other regions and municipalities did things in other ways.

Madam Speaker! The National Audit Office, just as the National Board of Health and Welfare, makes an assessment and says that the coordination in the area of healthcare hygiene needs to be developed and become more equitable across the entire country. That is also what the Left Party has taken hold of in its follow-up motion, the only one in the report.

The government, however, is not of a different opinion. Already last year, the Inquiry on strengthened future infection control was appointed, which is to submit its final report in February 2025. The inquiry deals, among other things, with the question of a national strategy for managing pandemics and whether the Communicable Diseases Act needs to be adapted for situations with extensive spread of infectious diseases. I want to emphasize above all that Statskontoret has already been commissioned to conduct an agency analysis of the Public Health Agency.

In the assignment of the expert-heavy investigation, there are organizational issues concerning infection control as well as analyzing and proposing how a national coordination responsibility for healthcare hygiene issues should be designed. To grant the Left Party's motion will therefore be nothing more than a powerful blow in the air, completely without practical significance. The work has already been underway for half a year.

Madam Speaker! In another part, the following motioner would like to point out that the access to healthcare data is too poor. It is high time to wake up to that issue. All parties already stand behind the fact that we need to develop and improve access to healthcare data and have done so for many years. There is no political battle regarding this. We agree that the situation is not satisfactory, and the work on the issue could very well have started many years ago.

I will only mention a few initiatives regarding this that have been taken in the recent past. In November 2023, the Inquiry on the secondary use of health data submitted its final report. It is now being prepared in the Government Offices.

In the same month, the Inquiry on Infrastructure for Health Data also submitted a partial report on its assignment as a national interest. It primarily concerned a uniform interpretation of the law in the area, which has been requested. This is also being handled in the Government Offices.

In December 2023, a national coordinator for digital infrastructure in healthcare, Tomas Werngren, was appointed. He is to work on the issue of making health data available throughout the entire care chain for all care, both municipal and regional, as well as for dental care, regardless of the principal.

Furthermore, work is ongoing to review the regulatory framework for health data registers and possibilities to collect data from primary care, which is to be reported on June 30 this year. I and many with me look forward to seeing what product Ingela Alverfors will deliver so that we can achieve a better overview in the area.

The eHealth Agency reported in the middle of April its assignment to prepare proposals for a roadmap for a national digital infrastructure for healthcare based on a dialogue with regions, municipalities, healthcare providers and IT suppliers.

Overall, it is not possible to reach any other conclusion than that extensive work is already underway in the area regarding the issue raised in motion number 2 in the follow-up motion.

Madam Speaker! The Covid pandemic was a harsh teacher, and many can be described as having hindsight. But surely it is better to have hindsight and do one's homework than to be foolish and draw the wrong conclusions.

Madam Speaker! Extensive work is underway to strengthen Sweden's preparedness against crisis and war, but also against widespread spread of infection. It is a Swedish interest to strengthen national infectious disease control, which the government and the coalition parties are already working intensively on. The Left Party's follow-up motion therefore appears a bit premature.

I vote in favor of the committee's proposal for a decision.

(Applause)

The speech at riksdagen.se, in Swedish (opens in a new tab)

Karin Rågsjö (V)

Madam Speaker! The pandemic – how quickly we forgot what we need to do. That is my view as I stand here today.

I worked with the pandemic in the Committee on Health and Welfare from March 2020 until the Corona Commission submitted the final report on its major work in February 2022. I see major flaws in society right now when it comes to being able to meet pandemics, major crises and so on. We are simply not prepared. We should be.

The National Audit Office has looked at this and concludes that the national infectious disease control functions well in normal mode - one could say that - but it needs to be strengthened and the capacity to handle future pandemics increased. That sounds a bit alarming. I think, therefore, that we stand at roughly the same point as when the pandemic arrived. We do not have, for example, a stronger healthcare system, rather the opposite. There is so much we need to do.

The government has not done enough to improve the effectiveness of infection control, I believe. It is necessary to address deficiencies regarding regulations, insufficient systems and data for national surveillance, and a divided responsibility for healthcare hygiene. Quite a few more changes are required.

I noted that the previous speaker, Jesper Skalberg Karlsson, said something about how we did not come out of this pandemic particularly well. If one looks at all the investigations that exist regarding the pandemic and how the world managed it, one sees that Sweden managed it relatively well, Madam Speaker. There were problems, for example, that there was no protective equipment. We had no national stockpile. There were also no stockpiles in the three largest regions. I will return to that. We want to legislate on that, in fact.

In the communication, the government argues that several of the recommendations provided by the Swedish National Audit Office are already included in various investigations. That may be the case, but we think that the directives given are a bit vague. There is a reason why the government should take the Swedish National Audit Office's report significantly more seriously, and other parties should also look at it. When the pandemic arrived, it was like a crash, and I believe none of us want to experience that again.

Vänsterpartiet has, before, during, and after the corona pandemic, highlighted the deficiencies in Sweden's preparedness against pandemics. Despite the fact that Sweden and the rest of the world have undergone a terrifying pandemic with a public health hazard, a societal hazard disease, the Swedish government has done nothing more than perhaps minor changes.

We must strengthen the infection control to increase the ability to handle future outbreaks. I am very worried about this. If there is a pandemic again, are we really strong? Do we have a healthcare system that can handle it? Do we have a crisis preparedness that can handle it or if there is war? Unfortunately, I am not convinced of that.

Vänsterpartiet argues that it is high time to lay out a new course for infectious disease control, to accelerate and increase the preparedness for pandemics. Quite substantial reinforcements of the welfare system, the common sector, and healthcare are needed. We have discussed that so much! If one has a healthcare system that wavers, as we have today, everyone must realize that if there is a pandemic, we are in a rather precarious position. Now I expressed myself in a popular way, Madam Speaker.

Healthcare hygiene is fundamental. This was seen in the preventive work against infection. Today, the national responsibility for healthcare hygiene issues is shared between Socialstyrelsen and Folkhälsomyndigheten. We believe that the responsibility for healthcare hygiene issues should instead be gathered at one agency, so that it does not become as fragmented. We have, among other things, highlighted this in our reservation.

Vänsterpartiet agrees with what is said in the Swedish National Audit Office's review regarding the collection and management of healthcare data. Much is likely underway, but I think we in all parties must accept that we have not been particularly fast. It is very important that some speed is gained in the whole matter. There must also be legal prerequisites for data collection for the authorities. Vänsterpartiet wants the government to appoint an inquiry with a mandate to produce proposals on what legal prerequisites the Public Health Agency and the National Board of Health and Welfare should have to collect and manage healthcare data. We think that would be good.

Something that was very striking when the pandemic started was the total lack of infection control. It was fundamental. At Södersjukhuset, a person was interviewed in a news broadcast wearing diving gear because there was no infection control equipment available in Stockholm. There wasn't any in the other regions either. It is still a magnificent problem, I believe.

The three largest regions lack stocks to last for three months. I believe that this must be legislated. It cannot be voluntary; it must be obvious that one purchases protective equipment and other necessities. Doing it during a raging pandemic, as was done all over the world, becomes very complicated, inefficient, and expensive. We had to devote a lot of time to that.

As we have said, we want the regions to have a legal requirement to maintain stocks that last for at least three months during pandemics. We will return to that in a completely different debate than today's.

I move for approval of the reservation we have submitted.

The Swedish National Audit Office's report on national infectious disease control

The deliberation was hereby concluded.

(A decision was to be taken on 15 May.)

The speech at riksdagen.se, in Swedish (opens in a new tab)