Europe / World | Coronavirus

Europe Versus Coronavirus - Switzerland and the Principle of Responsibility

ARTICLES - 19 May 2020

By Alexandre Robinet-Borgomano

Key Points

Switzerland, which had an especially detailed "pandemic plan" in place before the crisis began, nevertheless demonstrated that it was not better prepared to deal with the epidemic than other European states. Inadequate screening capacity and a low stock of masks at the start of the epidemic have shattered the myth of a country that was considered to be particularly well-equipped to deal with crises.

It is important to distinguish between a country’s initial crisis preparedness and its government’s ability to respond when in the thick of it. Despite the massive spread of the virus in some of the cantons that border Italy, the rapid response by Swiss institutions made it possible to avoid overwhelming the healthcare system. In addition, the quality of its public and private research laboratories enabled Switzerland to quickly reinforce its screening capacities, which has put it in a good position to develop the first serological tests and a possible vaccine.

With the easing of measures underway, Switzerland is banking on the principle of individual responsibility to allow for a faster return to normality than its European neighbors.

Timeline

February 25: First case of Covid-19 - a 70-year-old man is tested positive in the Ticino canton in the country’s south, on the border with Italy. Ticino bans all public events.
February 27: The Federal Office of Public Health launches a vast communication campaign advocating social distancing.
February 28: The government raises the alert level to "special situation", banning events of over 1,000 participants, among which the soccer and ice hockey championships, the carnivals of Basel and Lucerne, and the Baselworld Watch and Jewellery Show.
March 5: A 74-year-old woman in Lausanne dies. It is the first confirmed Covid-19-related death in Switzerland.
March 13: Ticino becomes the first Swiss canton to close its schools as an emergency measure. The federal government announces CHF 10 billion in aid and bans public gatherings of over 100 people.
March 16: The Swiss government declares an "exceptional situation", instituting the closure of restaurants, bars, shops and leisure facilities, with the exception of pharmacies and supermarkets. The army is mobilized to help the cantons fight the spread of the virus; it is the largest mobilization of the Swiss army since the Second World War.
March 19: The canton of Uri orders people aged 65 and over to remain in their homes. Two days later, the federal government reminds the canton that it does not have the ability to order such a measure.
March 20: The government announces a national ban on meetings of over five people in public spaces. Citizens are asked to stay at home, except for food purchases or medical visits. A number of public parks are closed.
March 21: The Federal Department of Foreign Affairs announces that flights will be chartered to repatriate the hundreds of Swiss citizens stranded in South America and Africa.
March 22: Ticino orders the closure of factories, despite the federal government’s warning to cantons not to go beyond the measures taken at the national level.
March 25: The Swiss government broadens entry restrictions and mobilizes the army to control its land borders.
March 27: The cantons obtain the ability to shut down industrial activities, if they demonstrate that it is necessary in order to slow down the spread of the virus.
March 31: The "Swiss National Covid-19 Science Task Force", composed of scientists, is set up to advise the government and to act as coordinator for the work undertaken by coronavirus research organizations.
April 16: The government presents a three-stage plan to ease the restrictions implemented to combat Covid-19.
April 27: The first phase of the easing of measures begins as certain businesses, such as hairdressers, DIY- and gardening shops, reopen.
May 4: Parliament begins a special session lasting several days - the first session since Parliament was suspended in mid-March.
May 8: The federal government announces that at-risk groups and people over the age of 65 can leave their homes so long as they respect the safety measures.
May 11: A new phase of eased measures begins, marked by the reopening of schools, bars and restaurants.

Analysis

"We want to act as quickly as possible and as slowly as necessary." This is the formula used by Federal Councilor Alain Berset to present the progressive easing of measures at a press conference on April 16, 2020. It is not only a challenge to time; it also perfectly sums up the Swiss government’s doctrine for its management of the crisis, which has been characterized by pragmatism and moderation.

63% of Swiss people strongly support the government’s policy to combat the epidemic.

The Federal Council is the Swiss Confederation’s executive organ, responsible for governing the country and leading the administration, as well as proposing and implementing laws. Currently presided over by Simonetta Sommaruga, it is made up of seven Federal Councilors who represent Parliament’s various political sensitivities. The Council operates on the principle of collegiality. It is a central component of Swiss federalism, which grants a large amount of sovereignty to the cantons and municipalities.

While the public health crisis has led to an unprecedented bolstering of its powers, the Federal Council acted effectively during the epidemic, which has strengthened the Swiss population’s trust in its institutions. According to a poll published on April 17, 2020, 63% of Swiss people strongly support the government’s policy to combat the epidemic. The government’s response has enabled Switzerland to make up for its lack of initial preparedness.

Alors que la confiance apparaît comme l’un des éléments clés des réponses apportées par les États à la crise du Covid-19, le succès de la stratégie suisse permet désormais au gouvernement de miser sur la responsabilité des citoyens pour aborder la phase du déconfinement.

Switzerland in the face of risk

Switzerland is undoubtedly the European country that has invested the most in risk prevention in general. During the Cold War, for example, Switzerland ordered the construction of over 360,000 atomic shelters; enough to protect its entire population in the event of a nuclear disaster. The case of public health disasters was not forgotten in the country’s apprehensive approach to risk. In 2018, the Federal Office of Public Health (FOPH) presented its new "Influenza Pandemic Plan", which lays out, in detail, the respective institutional powers and the measures to be taken in the event of an epidemic. In theory, then, Switzerland was well prepared to deal with the Covid-19 crisis.

Switzerland also recognized the threat posed by the virus early on. In an interview with the Neue Zürcher Zeitung on February 19, Daniel Koch, the inescapable director of the Communicable Diseases department of the FOPH, stated that "although the epidemic does not yet represent a threat to Switzerland, the situation could change in the coming weeks" and reminded people that Covid-19 was not comparable to a simple flu. Indeed, the direct proximity to Lombardy - the first Covid-19 epicenter in Europe - accelerated the spread of the virus on Swiss territory.

The first case of contamination was recorded in the canton of Ticino, north of the Italian lakes, on February 27, 2020. The threshold of 100 contaminated persons was crossed on March 5, the same day that Switzerland’s first Covid-19-related death was identified. In the ensuing weeks, the curve of contaminations followed a distinct upward slope, which put the healthcare systems in the most-affected regions - Geneva and Ticino - under pressure.

As of May 12, Switzerland had 30,000 contaminations and 1,500 deaths out of a total population of 8.5 million. By way of comparison, Austria, which has a population of around 8.9 million, had 16,000 cases and 623 deaths on the same date - half as many as the Swiss Confederation.

Switzerland is the European country that has invested the most in risk prevention.

The Covid-19 crisis has revealed the flaws in the Swiss plan that was supposed to prepare it for the risk of an epidemic. As noted in an article in Le Temps, this plan, which presumed the existence of a vaccine, did not take account of the need for stocks of masks or disinfectant gel. And, as early as 2018, a report by the former director of the Swiss public health agency emphasized the country’s strong dependence on foreign countries for its supply of medical goods. By revealing Switzerland’s lack of preparedness, the Covid-19 crisis has shattered the myth of a country viewed as particularly resilient.

The government’s response

According to Michael Schoenenberger, director of the Neue Zürcher Zeitung’s politics department in Zürich, it is important to distinguish between the preparation and response phases when it comes to Switzerland’s handling of the epidemic. The shortcomings in its preparation, in particular the paucity of masks, is at the root of certain inconsistencies in the strategy adopted by the Federal Council, but this strategy is largely characterized by a remarkable responsiveness.

Two days after the appearance of the first cases of contamination on national territory, the federal authorities launched a communication campaign calling for compliance with the rules of social distancing and ordered the cancelation of several major events, among which Baselworld, Basel’s prominent watchmaking exhibition. From mid-March, and when some cantons had already ordered the closure of their businesses and schools, the Federal Council declared a state of emergency under the Epidemics Act, which increased its decision-making power relative to that of the cantons and Parliament.

The declaration of the state of emergency was accompanied by a ban on public and private gatherings; the closure of schools, bars, restaurants and sports centers; the reinstatement of border controls; and an unprecedented mobilization of the army, as part of which 8,000 military personnel were deployed for logistics and public health support. As in many other European states, the government’s crisis response is based on an increased reliance on scientific expertise. As such, on March 31, the Federal Council announced the creation of a Covid-19 Task Force, headed by the President of the Research Council of the Swiss National Science Foundation (SNSF), Matthias Egger, and composed of researchers from leading universities.

Compared to the measures adopted by its European neighbors, the restrictions imposed on the Swiss population appear to be limited. This moderation can partly be explained by the expectation of individual responsibility, inherent in Switzerland’s democratic tradition, but also by the need to create a common framework that suits the different realities of the twenty-six cantons. Indeed, when certain cantons that were heavily impacted by the epidemic chose to tighten their containment measures, the Federal Council asked them to revert these decisions in order to comply with the national framework. On March 23, the canton of Uri was forced to lift the lockdown it had wanted to impose on persons over 65 years of age, and the cantons of Geneva and Ticino were invited to reconsider the closure imposed on their factories and construction sites.

The mild nature of the restrictions probably means that economically, Switzerland has not been penalized as much as other European states - but experts still expect the country’s GDP to decline by 6.7% in 2020.

As a way of facing the economic consequences of the epidemic, Switzerland has launched an extensive business support plan amounting to almost CHF 65 billion. It consists mainly of transitional loans for SMEs, financial support for partial unemployment and loss-of-earnings allowances for the self-employed. To facilitate the recovery of businesses, the government also plans to lift shopkeepers’ obligation to pay rent over a given period, thus placing the burden to minimize bankruptcies and job losses onto property owners. Lastly, Switzerland plans to bail out its airlines Swiss Air and Edelweiss to the tune of €1.9 billion.

Switzerland is one of the countries with the highest financial sum, in proportion to population, of measures taken against Covid-19, after Luxembourg and Japan.

According to SwissInfo, Switzerland is one of the countries with the highest financial sum, in proportion to population, of measures taken against Covid-19 (about CHF 7,500 per capita), after Luxembourg and Japan. Despite this powerful economic response, the crisis has also revealed Switzerland’s new faces of poverty. The scores of immigrant workers and young, self-employed people lining the streets of Geneva to receive food aid in early May appear as a harbinger of the coming recession.

Strengths and weaknesses of the Swiss healthcare system

The Swiss government’s ability to respond to the spread of the virus has undeniably benefited from a particularly well-equipped healthcare system. According to OECD figures, public health expenditure in Switzerland amounts to USD 7,317 per capita, which is the second-highest number among OECD countries after the United States (USD 10,586 per capita). Switzerland also has a notably high number of doctors per 1,000 inhabitants, on par with Germany (4.3) and higher than France (3.4).

The number of intensive care beds, on the other hand, brings Switzerland closer to the OECD average. At the start of the epidemic, the Swiss Society of Intensive Care Medicine (SSICM) reported that the country had 82 certified intensive care units and between 950 and 1,000 beds, most of which were equipped with ventilators. This places the number of intensive care beds per 1,000 inhabitants close to that of France, but well below the rates of Austria and Germany (3.56 in Switzerland compared to 3 in France, 5.4 in Austria and 6 in Germany). In early April, the FOPH announced that it had increased intensive care capacity by 60%, raising the number of beds to 1,600, although the number of patients under care at any given time at the peak of the crisis did not exceed 560.

Despite, the pressures placed on the healthcare systems of certain cantons, and concerns about the border closures - with international workers accounting for almost half of the healthcare staff in some cantons, the Swiss healthcare system is particularly dependent on foreign labor - the healthcare system’s capacity has not been saturated; in fact, it has been able to take in French patients.

On the other hand, at the end of March, Swiss hospitals faced a shortage of masks comparable to that observed in France, according to an article published in newspaper Le Temps.At this time, the military pharmacy, which is responsible for distributing the Confederation’s reserves, had already delivered 16,555,000 sanitary masks and 180,00 FFP2/3 masks to the cantons and still had 6 million sanitary masks and 403,000 protective masks available. In order to bridge the gap between the remaining stock and the anticipated needs of medical staff, Switzerland had to obtain supplies on a market that was under pressure and set up a consortium called ReMask to stimulate the national production of protective masks.

While Switzerland’s dependence on foreign supply sources has been one of the main weaknesses of its crisis management, its ability to rapidly increase its screening capacity is a real success. Although Switzerland faced a shortage of tests in early March, which forced it to temporarily limit testing to persons at risk, the Swiss Confederation remains one of the countries with the highest number of tests carried out in proportion to population size.

The two largest pharmaceutical companies in Europe, Novartis and Roche, are Swiss, which puts the country in a strong position in the race for vaccines.

In fact, according to an article in the Financial Times, Switzerland has tested most out of any country during the crisis, even though screening was not one of the government’s priorities in the epidemic’s early stages. As "contact tracing" gradually emerged as a crucial component of crisis management, Switzerland rapidly increased its stock of tests, thanks in particular to the involvement of the pharmaceutical industry, and especially pharmaceutical giant Roche. After a considerable build-up of its production of epidemiological tests, the Basel-based company is now developing a new serological test to detect Covid-19 antibodies.

The two largest pharmaceutical companies in Europe, Novartis and Roche, are Swiss, which puts the country in a strong position in the race for vaccines. The caution that characterizes Swiss political leaders is, however, also present in the industrial sector: the CEOs of both pharmaceutical giants have said that they do not believe a vaccine will be available before 2021.

An exit strategy based on a call for individual responsibility

On April 16, following a flattening of the contamination curve, the Federal Council presented its plan for a gradual resumption of activity. It was constructed around the symbolic date of May 11, which president Emmanuel Macron had chosen as the exit horizon for France’s lockdown a few days earlier.

Hairdressers, DIY- and gardening stores were allowed to reopen from April 27 onward, but May 11 represented the real start of a "new normal". Since May 11, the cantons can choose to reopen schools; museums, stores, bars and restaurants can reopen as long as they avoid groups of more than four people. Restrictions on entry into the country are gradually being lifted and, from June 8, all activities can resume as normal, with the exception of events involving more than 1,000 people, which remain banned until the end of August.

In contrast with its European neighbors, Switzerland seems to be approaching the end of the crisis with a remarkably laid-back posture.Normal life is resuming more quickly than elsewhere in Europe. It is also not compulsory to wear a mask, though it is recommended on public transportation during rush hours. In addition, a surprising debate rouses the Swiss Confederation since Daniel Koch, the country’s most respected epidemiologist, declared that grandparents can hug their grandchildren again, as the latter do not appear to contribute to the spread of the virus.

This gradual return to normalcy is accompanied by measures aimed at strengthening the authorities’ capacity to monitor the chain of contamination. A pilot of the Swiss application DP-3T, developed by the Federal Institutes of Technology of Lausanne and Zürich, is set to launch in mid-May. Its use is voluntary and anonymous, and is based on Bluetooth technology without geolocation. The user receives a notification if they have been in close contact (less than two meters away for at least fifteen minutes) with a person who has tested positive for Covid-19. The system is decentralized, meaning that data is not stored on a single server.

According to political scientist Marcus Freitag, a researcher at the University of Bern, the trust Swiss people have in their institutions, and the government in its population, are the two main components of the crisis exit strategy. But despite the government’s calls for individual responsibility, the easing of measures could jeopardize this harmony, as shown by the numerous demonstrations organized on May 9 in the main cities to denounce the measures imposed by the government as violations of fundamental rights.

Conclusion

"We want to act as quickly as possible and as slowly as necessary." This motto of the Swiss government is similar to the phrase "festina lente" ("make haste slowly"), which Suetonius attributed to Emperor Augustus as a principle of good government. It is an apt summary of the Swiss government’s demeanor in the face of the epidemic: far from the martial rhetoric and coercive measures advocated by various other European leaders, Switzerland approached the crisis with calm and moderation, thereby limiting the number of deaths and strengthening the trust the Swiss have in their institutions. It may not have been more prepared for this epidemic than any other European country, but Switzerland seems to be more accepting of the presence of risk within its society.

With the collaboration of Margaux Tellier