Imagine this … A new pandemic hits the US. There’s a lack of knowledge about the virus that causes the illness, about the disease’s epidemiology, clinical symptoms, and treatment, and about the effective preventative measures that could be introduced in a modern, liberal society. In five small adjoining US states, the authorities decide to invest huge sums of money in research into the disease, and to do so quickly. Each of the states organizes its own research calls, finances its own researchers, and establishes its own research groups and projects. No attempt is made to work together on the calls or to co-ordinate efforts across state borders.
Although this is an imagined scenario, it’s roughly how things went in the Nordic countries when the COVID-19 pandemic reached our shores in March 2020. All the Nordic countries reacted quickly and released large sums of money for national research on COVID-19.
In the spring of 2021, NordForsk conducted a survey among public and private research financiers in the Nordic Region. This resulted in the report Funding for COVID-19 related research in the Nordic countries 2020-2021. We contacted the financiers directly and asked how much money they had allocated to COVID-19-related calls and what type of research they had financed. The financiers reported that, within a year of the start of the outbreak, they had invested roughly NOK 3.3 billion in research related to COVID-19 and combating the disease. Of this, around NOK 1.9 billion went to research in medicine and health. Just shy of NOK 600 million went to research in the social sciences, and a little more than NOK 300 million was allocated to innovation, primarily to areas specializing in health. The grants were national and, as far as we know, the calls were announced without any attempt to collaborate or co-ordinate efforts across national borders in the Nordics. There was also little attempt to co-ordinate research efforts between different financiers within the same country.
NordForsk also announced a small Nordic-Baltic COVID call in May 2020. A total of NOK 57 million was granted across five projects. Each project had partners from at least three Nordic countries, or from two Nordic countries and one Baltic country. The projects have, so far, published very interesting results about COVID and mental health, the risk to pregnant women and unborn babies following vaccination, and the risk of COVID in smokers and users of snuff. Common to all the projects is that they have used national health data across national borders. In a short space of time, they have been able to study COVID in large populations and thereby obtain more reliable results than had they only used one country’s data. In reality, it wouldn’t have been possible to conduct these studies individually in any of the Nordic countries in such a short time frame and with such reliable results.
“The purpose of Nordic Commons is to make it simpler to share and use health data for research and innovation across national borders in the Nordic Region.”
Although the Nordic countries’ health data gives us incredible opportunities to conduct good health research in the Nordic Region, there are legal, technical, and practical obstacles between countries and registers that make data sharing difficult and time-consuming. The Nordic Council of Ministers took note of this and established the Nordic Commons project under the auspices of NordForsk. The purpose of Nordic Commons is to make it simpler to share and use health data for research and innovation across national borders in the Nordic Region.
Back in the autumn of 2019, we didn’t know which agent would cause the next pandemic or when the next pandemic would come, but a health crisis was already looming. A pandemic was high on the emergency preparedness authorities’ list of crises that could affect Nordic society. And yet despite this, we were unprepared when it actually happened. We had inadequate plans for what to do in the event of a pandemic, and we had pandemic plans that were unusable because they’d been developed to fight the flu virus and not the coronavirus. The pandemic plans that existed were national and did not take into account the usefulness of regional co-operation and interaction. Consequently, control plans and measures had to be developed on the fly, and national authorities were put to the test.
“The COVID-19 pandemic demonstrated that we have a long way to go before we become particularly integrated in this area. The nations ended up going it alone instead of integrating and interacting with each other.”
Just six months before the start of the pandemic, the Nordic prime ministers adopted the vision for the Nordic Region to be the most sustainable and integrated region in the world by 2030. The COVID-19 pandemic demonstrated that we have a long way to go before we become particularly integrated in this area. The nations ended up going it alone instead of integrating and interacting with each other. With the exception of Sweden, it became almost a competition to have the strictest measures. Borders were closed, and the trust we often boast of having in the Nordics was broken.
The next health crisis, whatever it is, must be fought with the help of international interaction and co-operation. We know that there will be a health crisis caused by microbes that are resistant to treatment with antimicrobial agents. It’s a crisis that’s already emerging. All the Nordic countries are engaged in efforts to limit the use of antimicrobial agents and prevent the occurrence of antimicrobial resistance (AMR) nationally. The Nordic countries’ use of antimicrobial agents is among the lowest in Europe. The Nordic countries, and Sweden in particular, have been a driving force internationally in efforts to limit the use of antimicrobial agents and prevent the development and spread of AMR. Sweden, which currently holds the EU presidency, is also pioneering research into AMR both nationally and internationally and has convened a high-level meeting on antimicrobial resistance in Stockholm in March 2023. Good on you, Sweden!
Nordic parliamentarians have prioritized the fight against AMR within their work in the Nordic Council for a number of years. It has also been a priority issue within the Nordic Council of Ministers and several policy documents have been developed with the aim of stepping up joint Nordic efforts against AMR. Although Nordic co-operation has limited funds, in the last year money has been granted to two small research projects on the detection and tracking of AMR in the environment. In addition, a project will start in 2023 that gives medical and veterinary medical authorities and expert environments in the Nordic and Baltic countries the opportunity to work together on building up institutional and technical capacity to promote antimicrobial management in a one-health perspective.
“As COVID-19 has shown, it’s not enough to tackle such crises with national measures alone. More co-operation across national borders is needed. If the Nordic Region is to become as integrated as our prime ministers have decided by 2030, we must have the courage to blur our national borders in our search for knowledge and in order to develop combative measures.”
Essentially, both COVID-19 and AMR are international health crises. When crises of such magnitude arise, society as a whole is affected. As COVID-19 has shown, it’s not enough to tackle such crises with national measures alone. More co-operation across national borders is needed. If the Nordic Region is to become as integrated as our prime ministers have decided by 2030, we must have the courage to blur our national borders in our search for knowledge and in order to develop combative measures. It is critical that we obtain research-based knowledge quickly on which we can build our planning and combative measures. The most effective way to do this is for like-minded countries, as we are here in the Nordics, to co-operate more closely.
“In the event of major health crises such as pandemics and AMR, it should be possible to organize pan-Nordic research calls quickly and to finance these directly from the contingency fund.”
I have advocated that the Nordic countries should work together to establish and contribute to a research fund to finance Nordic research projects in the field of social security and emergency preparedness. These funds can be released during crises or when there is a need to acquire new knowledge about the prevention and limitation of the consequences of supranational crises. In the event of major health crises such as pandemics and AMR, it should be possible to organize pan-Nordic research calls quickly and to finance these directly from the contingency fund. In this way, we can ensure a rapid, robust, and co-ordinated research response across the Nordic countries.
Column by Arne Flåøyen, Director, NordForsk (originally published in NLS magazine No 01 2023, March 2023)
Featured image: Covid in the Nordic region (Photo: Ricky John Molloy, norden.org) and Arne Flåøyen, Director, NordForsk (Photo: Kurt Gaasø)