Sweden’s Minister for Social Affairs and Public Health has been called to appear before Parliament amid growing concerns over the lack of medical competence of a senior specialist at the Public Health Agency. The agency’s Director General is also set to testify before a parliamentary committee on 11 September.
When Magnus Gisslén, an infectious diseases professor and a specialist, resigned last week as the nation’s state epidemiologist at the Swedish Public Health Agency, the country’s authority for infection control, he went public with his motives in an opinion piece in the daily Dagens Nyheter.
There, he expressed serious concerns about what he described as a lack of medical expertise in the agency’s management team, a weak scientific basis and ineffective leadership.
“For me, there was no alternative. It is so incredibly important for Sweden that we have an infectious disease control authority that functions on the day a pandemic strikes. I feel a responsibility to ensure that things improve,” he told Euractiv.
Top decisions, no doctors
The Public Health Agency was formed in 2014 through the merger of the National Institute of Public Health and the Swedish Institute for Communicable Disease Control. Since then, it has been in hot water many times, particularly during the pandemic.
“After two years as Sweden’s Chief Public Health Officer, I am leaving the Public Health Agency. I have put a lot of effort into trying to strengthen the agency’s scientific foundation and medical expertise. But there is a lack of insight and willingness to change,” Gisslén mentioned in his article.
He disclosed that for the past year, there has not been a single qualified medical doctor in the management team.
Gisslén’s criticism quickly prompted a Swedish parliamentarian from the Centre Party to request that the Social Welfare Committee of the Swedish Parliament should summon Jakob Forssmed, the Minister for Social Affairs and Public Health, to the Committee to explain whether the Public Health Agency actually could cope with a new pandemic without medical experts at the top. He will appear alongside Olivia Wigzell, Director General of the agency.
Wigzell, also a board member of the European Centre for Disease Prevention and Control, ECDC, has, since the disclosure, been called twice to meetings with Forssmed. She has defended the management, saying it could always co-opt medical expertise when making decisions.
However, after the second meeting on 25 August, the Minister promised that medical doctors’ competence would be added to the agency’s leadership.
He also launched an internal review of the agency’s work. An independent internal audit function will be established to analyse risks and efficiency in the agency’s infection control work.
A National CDC
There is now an intensifying debate in Sweden, where some medical professors are advocating for the re-establishment of a Swedish Institute for Communicable Disease Control.
According to Karl Ekdahl, an infectious disease specialist and former vice state epidemiologist at the agency, the infection control and pandemic perspective at the agency has been shrunk to a more general public health perspective.
“In a crisis, the country’s leading infectious disease control authority needs to have a person in a leading position with broad expertise in epidemiology, microbiology and infectious diseases,” he said in an opinion piece.
“Having a doctor exam does not mean that you are competent. What is actually needed are infectious medical doctors and epidemiologists with long clinical and scientific experience with senior competence in areas as infectious diseases and infection control in the management,” he told Euractiv.
The iGAS dispute
The dispute between Gisslén and the agency’s management has centred on the leadership’s decision to retract a published recommendation for primary care doctors to generously test and treat Group A streptococcal (GAS) infections, such as tonsillitis. It was published in the summer of 2024 but was taken down in early spring 2025.
The reason for providing a more flexible recommendation was that Sweden was experiencing a historic increase in invasive GAS infections (iGAS) after the pandemic.
Streptococcus bacteria are generally not dangerous, but could occasionally become invasive and rapidly cause critical illnesses, particularly among children under ten and people over 70.
In 2023, there were 1,327 cases of iGAS registered, the highest number in Sweden since its reporting started in 2004.
Although the level appears to have decreased slightly, it remains at a historically high level, with 828 cases reported during the first 20 weeks of this year. A similar pattern of increases in iGAS has also been seen in France, the Netherlands and the UK.
According to Gisslén, the withdrawal followed lobbying efforts for strict guidelines by the Strama network, a Swedish collaboration against antibiotic resistance, which feared that the increased use of penicillin could fuel AMR levels in the country.
The move, in fact, meant that the medical experts at the agency were sidelined by their own management. “As we use penicillin to treat tonsillitis in Sweden, the effect on antibiotic resistance is marginal,” Gisslén argued to Euractiv.
In March 2025, several external infectious disease specialists in Sweden also protested against the withdrawal. As they wrote in an opinion piece, several patients who were denied testing and antibiotic treatment following the strict guidelines later developed iGAS with fatal consequences.
Among them was, for example, a nine-month pregnant woman who died of sepsis, along with her unborn baby, only ten days after being denied a GAS test in the spring of 2024.
According to Gisslén, his strong commitment to infectious disease matters made him a nuisance to management. By midsummer, the leadership wanted to replace him, he said.
From 2020 to 2022, the Public Health Agency had three medical doctors at the top. However, they acted in accordance with the pandemic plan in force at the time, which was based on influenza (and the Coronavirus was not an influenza virus).
Sweden’s policies towards the spread of the Coronavirus became widely debated at home and internationally, and the country failed to protect, especially older adults, the Swedish state coronavirus investigative commission reported.
(VA, BM)
