Ambassador: Dolly Lin
Which aspects of Pandemic Preparedness is most pertinent to your country and why? In preparing for pandemics, Sweden is concerned with 1) vaccine and drug provision to its citizens and 2) contributing to global pandemic control measures.
1) Vaccine and Drug provision
Sweden does not have a domestic vaccine manufacturer for influenza, and is completely dependent on imports for vaccine provision. Specific storage conditions required for vaccines make storage and transport also difficult. H1N1 influenza preparations in Sweden also shed light on the challenges present with stocking therapeutics, such as antivirals and antibiotics in preparation for a pandemic. Given the low profile of most annual annual influenza epidemics and Sweden and most of Europe, antivirals are currently stored in very limited quantities. It is estimated that antivirals such as oseltamivir would need to be stocked in amounts equivalent to 5 year’s normal influenza supply to be able to cope with pandemic demands. Antibiotic stocks are currently managed, without anticipated problems, by the Swedish National Board of Health and Welfare (Swedish National Board of Health and Welfare, 2005).
2) Global Pandemic Control Measures
Sweden is concerned with global pandemic control measures as a generous provider of international aid, as a leader of global development initiatives, and as a country who experiences pandemic effects due to immigration and its citizens’ travels abroad. [The first two points are elaborated in the caption next to Figure 1, page 2]
Recent global pandemics such as the H1N1 and SARS have had minimal impact on Sweden in comparison with the world. Over 2000 cases of H1N1 was reported in Sweden, but with the high recovery rate that resulted in a total of 3 mortalities. Similarly for SARS in 2003, Sweden reported 3 cases of infection with 2 recoveries.
Pandemics which affected Sweden include the 1918 Influenza, where Sweden experienced 74% excess mortality compared to pre-pandemic rates. In this scenario, influenza entered the country through travel between Europe by infected individuals. Currently, Sweden also cares for its chronic HIV citizens. HIV rates in Sweden are low compared to elsewhere in the world. However, the incidence of HIV does not occur primarily within Sweden. A third of HIV infected Swedes report having contracted the disease abroad. Another significant portion entered Sweden with pre-existing infection.
Given that most migration in and out of Sweden occurs through refugee claimants and inter-European immigration, respectively, it makes sense that Sweden is recently decreasing the breadth of its aid but focusing efforts on bilateral relationships with select economically developped countries with less corruption and more central governance capabilities, as well as strengthening relationships with the European Union nations (Landes, 2010).
How would you as the WHO Ambassador of your country address this issue? How has your country addressed Pandemics in the past? What would you have done differently?
I agree with the measures Sweden is currently taken to address the above issues, including initiatives to target its foreign aid in a sustainable way which fosters beneficiary countries’ own capacity building, and health system development (Government of Sweden, 2002).
In light of problems with vaccine provision during the H1N1 pandemic preparations in Sweden, I would focus the country’s resources towards 1) fostering domestic capabilities to manufacture vaccines and necessary pharmaceuticals, and 2) building relationships with corporations/organizations that could provide Sweden with reliable pharmaceutical supplies in times of need. In the meantime, the Swedish government has identified the need for vaccine delivery prioritization for when pharmaceutical supplies are insufficient to serve all Swedes. Priority should be given to groups identified at being greatest risk, and groups with vital social functions including healthcare staff, rescue and police services, and central authorities.
I would enact policies to ensure equitable health outcomes for Swedes across the socioeconomic status spectrum during a pandemic. Such strategies may be needed in light of the tax and welfare benefit cuts that took place in Sweden since the electino of New Moderate leader Reinfeldt as president in 2006 (Economist, 2007).
Which countries do you see yourself becoming allies or rivals with? Why? Sweden would potentially disagree with countries that have different priorities in terms of 1) provision of foreign aid, 2) and means of legally deterring infectious disease transmission.
1) Foreign Aid
Figure 1. Net ODA in 2008 as percent of GNI
Sweden provides generous proportions of its gross national income to foreign aid (OECD, 2009).
Sweden’s policy for global development, outlined in the government bill 2002/03:122, works towards equitable and sustainable global development. Sweden has a history of leading global development efforts through hosting international conferences, and supporting UN and international law. It pushes for global cooperation as a means to effectively fight against HIV/AIDs and other diseases. Under the social welfare and public health policy goals outlined in the bill, Sweden highlights the need to prevent and limit the spread of HIV/AIDS and alleviate the consequences. It supports the development of equitable basic healthcare systems (Sweden, 2002).
Sweden may have special incentive to focus foreign aid on limiting infectious disease spread given that most cases of communicable diseases (eg. HIV) in Sweden were either contracted abroad, or immigrants to Sweden were infected before entry into the country (Celsing, 2007).
Because of its strong commitment to foreign aid, Sweden may disagree with the foreign policies of less generous countries such as the U.S.A., Japan, Italy and Greece.
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Source: OECD, 2006
2) Legalities relating to Communicable Diseases
Potential points of contention involve a) criminalization of HIV-positive individuals for exposing others to HIV, b) legal issues surrounding prostitution
1. HIV transmission and the law
While the use of injection drugs is illegal in most European countries, laws relating to the criminalization of HIV-positive individuals who engage in sexual activities with others without disclosure of their status are less uniform. Sweden, and countries such as Slovakia, Russia, Poland, Norway, Germany, France and Denmark treat HIV transmission more harshly. The exposure of others to HIV risk itself can be charged as homicide, if fault is assigned to the HIV positive person on the basis of their intentions, reckless behaviour, or evidence of negligence. Other countries includeing Belgium, Switzerland, U.K. and Finland only criminalize individuals who cause their partners to contract HIV. Furthermore, Sweden’s Communicable Diseases Act is committed to tracing HIV transmission routes, and requires HIV-positive individuals to undergo regular medical checks (Gaines & Nyambe, 2005).
2. Prostitution
Sex trade is linked to organized crime, and STD transmission. Changing the legal milieu of sex trade then, has been used as a means to decrease organized crime and the transmission of HIV and other sexually transmitted diseases.
Since 1999, Sweden began to penalize prostitutes’ patrons, with the result of decreasing streetwalking prostitute prevalence by 40%. However, there is contention over whether this legal policy alleviates STD risk and organized crime. In stark contrast, the Netherlands legalized brothels in 2000, with similarly ambiguous results.
Sweden, England and Wales uniformly adopt increased punitive measures as a means to drive down sex trade and its associated disease risks, whereas jurisdictions such as the Netherlands, Rhode Island, Nevada, and New Zealand pursue the legalization of sex trade as the means to decreased disease transmission and organized crime (Economist, 2008).
RESOURCES
Gaines, H & Nyambe, M. (2005). Criminalisation of HIV transmission in Europe: A rapid scan of the laws and rates of prosecutino for HIV transmission within signatory States of the European convention of Human Rights. Global Network of People Living with HIV and the Terrence Higgins Trust. Retrieved February 25, 2010 from http://www.gnpplus.net/criminalisation/index.shtml
Government of Sweden (2002). Government Bill 2002/03:122 Shared Responsibility: Sweden’s Policy for Global Development. Retrieved February 25, 2010 from http://www.sweden.gov.se/content/1/c6/02/45/20/c4527821.pdf
Landes, D. (2010). Sweden in major embassy shake-up. The Local. Retrieved February 25, 2010 from http://www.thelocal.se/24512/20100121/
Organisation for Economic Co-operation an Devleopment (2006). Official Devleopment Assitance increases further but 2006 targets still a challenge. Retrieved February 25, 2010 from http://www.oecd.org/document/3/0,2340,en_2649_201185_34700611_1_1_1_1,00.html
Swedish National Board of health and Welfare (2005). Contingency Planning for an Influenza Pandemic: National Measures. Social Styrelsen, Article No. 2005-130-7. Retrieved February 25, 2010 from http://www.socialstyrelsen.se/publikationer2005/2005-130-7
The Economist (2007). Sweden, one year on: Moderate revolution: The centre-right government is proving highly cautious over reform. September 13, 2007. Retrieved February 25, 2010 from http://www.economist.com/displayStory.cfm?Story_ID=E1_JRDPRSG
The Economist (2008). Policing prostitution: The oldest conundrum, the red lights are going out all over europe- but not elsewhere. October 30, 2008. Retrieved February 25, 2010 from http://www.economist.com/displayStory.cfm?Story_ID=E1_JRDPRSG