Magnus Gisslén, Professor and Chief Physician at Sahlgrenska Academy, University of Gothenburg, says in his videos that the authority lacks scientific foundation and in-depth medical expertise. As State Epidemiologist his role was advisory and not a management position, he describes further. In one of the videos Gisslén states that no one in the Swedish Public Health Agency’s management currently has in-depth medical expertise, and he emphasizes the danger of this, for example in the event of a new pandemic.

The Public Health Agency of Sweden told Swedish Television (SVT) in an email that Gisslén recently received notice that his assignment as State Epidemiologist would be terminated. This was due to different perceptions of what the role entailed and what was expected. “However, we wanted to keep him and his expertise within the authority and he was offered to remain, albeit in another role, but he chose to resign,” stated Ellen Jones, head of unit at the Public Health Agency, to SVT.

Erik Sturegård is currently the deputy state epidemiologist. He will take over as acting state epidemiologist until a new permanent one has been appointed by the authority, it states.

Group A streptococcus

In one of his videos, Gisslén also gives a concrete example of the frustration he has felt at the agency. It concerns recommendations that he helped to develop and which, through more generous sampling, aimed to prevent the spread of group A streptococcus. In severe cases, group A streptococci can cause what are called invasive disease states, iGAS, such as sepsis and deep soft-tissue infections with severe muscle pain. The latter is called necrotizing fasciitis, as it leads to the breakdown of muscle tissue. In recent years, the spread of variants of group A streptococci associated with an increased incidence of cases with iGAS has become more common in Europe and Sweden.

Despite the fact that our recommendations were well-founded in science, the new management at the Public Health Agency chose to depublish/remove them this spring.

The recommendations from Gisslén and other experts were that healthcare providers should test for group A streptococci more than before and also prescribe penicillin if the result is positive. “Despite the fact that our recommendations were well-founded in science, the new management at the Public Health Agency chose to depublish/remove them this spring,” he says in the video.

The recommendations created tensions with the Medical Products Agency and the Swedish strategic program against antibiotic resistance (Strama) network, Gisslén says in the video. The agency’s Director General, Olivia Wigzell, has rejected the criticism and said that competence is always present when decisions are made and that the new recommendations were withdrawn because they lacked sufficient scientific evidence and caused confusion for caregivers.

Suggested measures

Wigzell has also responded to Gisslén’s videos by admitting that there are issues that need to be addressed, and she has proposed different measures to fix this, including closer scientific collaboration and overseeing the medical expertise at the agency. In his last video on LinkedIn, Gisslén addresses these measures. He is skeptical that the agency fully understands what medical expertise means, and he is very surprised about their move to intensify collaboration with academia.

“Scientific collaboration with academia is something I have worked intensively on from day one. Several collaborative research programs have been initiated. As early as in spring 2024, the then Director General Karin Tegmark Wisell and I developed a basis for establishing an external medical scientific council. This issue has since been grinding in the bureaucratic mills and after a year and a half, it has still not been realized. That says a lot about the inefficiency that characterizes the authority. How difficult can it be?” he writes on LinkedIn.

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Wigzell was summoned to the Ministry of Health and Social Affairs. After the meeting the Minister of Health and Social Affairs, Jakob Forssmed, announced that the measures that have been taken are good and necessary, but that more is needed.

This assignment also requires integrity, courage, and the ability to stand up for medical and scientific expertise, even when it is inconvenient.

“To be honest, I am not hopeful that there will be any real changes. Unfortunately, I do not believe that the current leadership of the agency has the ability. But let’s hope that I am wrong and that we get real change that means something in practice, not just on paper. It is necessary,” writes Gisslén on LinkedIn.

He writes that the right selection of the new state epidemiologist is crucial. “In addition to extensive infectious disease and scientific experience, this assignment also requires integrity, courage, and the ability to stand up for medical and scientific expertise, even when it is inconvenient,” he writes.

Comment: Statens Serum Institute in Denmark

In one video, Gisslén also compares the agency to its Danish equivalent, Statens Serum Institute (SSI), where the management consists of leading medical experts and where important research is conducted according to him.

Having leading medical experts involved in decision-making is important, but so is ensuring that we have experience in managing large, complex organizations. We see the best results when these perspectives are combined.

“First of all, it is important to point out that in Denmark the tasks corresponding to those of the Swedish Public Health Agency is shared between different organizations underneath the Ministry of Health. However, most of these organizations have medical doctors as CEOs,” states Tyra Grove Krause, Executive Vice President at SSI to NLS.

Tyra Grove Krause, EVP, SSI. Photo: SSI

“At SSI, we place strong emphazis on combining medical expertise with broad leadership competencies in our management. Having leading medical experts involved in decision-making is important, but so is ensuring that we have experience in managing large, complex organizations. We see the best results when these perspectives are combined.”

NLS also asked her what she believes are key factors for gaining public trust for an institute like SSI. “Public trust depends on transparency, scientific integrity, and clear communication. We believe it is important to provide accurate information, even when it is complex, and to explain both what we know and what remains uncertain,” says Krause.

This partnership reflects the importance we place on bridging basic research and applied public health.

Key factors for preventing and combating infectious and congenital diseases include strong surveillance systems, close collaborations with healthcare providers and academia, and the ability to rapidly translate research into practice, she adds. “It is also essential to maintain international collaborations, as diseases do not respect borders.”

An example of SSI’s collaboration with academia is its recent strategic partnership with the University of Copenhagen under the Novo Nordisk Foundation Initiative for Vaccines and Immunity (NIVI), NIVI Research Center.

“This partnership reflects the importance we place on bridging basic research and applied public health. By working closely with academic partners, we aim to strengthen Denmark’s preparedness against future infectious threats and support the development of new vaccines,” explains Krause.