Acting under uncertainty: a cross-country comparative qualitative study of France and Sweden during the COVID-19 pandemic Lessons learned and preparedness for future pandemics

Abstract

Introduction: In 2020, the COVID-19 pandemic had a global impact, exposing gaps in pandemic preparedness of many countries. In Europe, both France and Sweden adopted very different strategies in response to the crisis. The high probability of facing a new pandemic highlights the importance of understanding how countries interpret and incorporate lessons learned from the COVID-19 pandemic. Objective: The study aims to investigate how national health system strategies of Sweden and France have been influenced by the COVID-19 pandemic, what lessons have been learned and how they prepare for next pandemics. Methods: This qualitative study used a case study approach. The data was collected through 10 semi structured interviews with public health experts from France and Sweden, and analyzed with a thematic analysis. Results: Several themes were identified. The overarching theme was: handling uncertainty during a pandemic. And the five subthemes were: structural, operational, social and cultural handling of uncertainty, as well as learning and adapting under uncertainty. Conclusions and Implications: The findings suggest that under conditions of uncertainty, Sweden and France largely relied on their pre-existing institutional traditions when shaping their pandemic response. In addition, several lessons from the COVID-19 have been learned, and both countries are particularly focusing on strengthening collaborations nationally and at the European level.