Assessing the impact of forced and voluntary behavioral changes on economic-epidemiological co-dynamics: A comparative case study between Belgium and Sweden during the 2020 COVID-19 pandemic

During the COVID-19 pandemic, governments faced the challenge of managing population behavior to prevent their healthcare systems from collapsing. Sweden adopted a strategy centered on voluntary sanitary recommendations while Belgium resorted to mandatory measures. Their consequences on pandemic progression and associated economic impacts remain insufficiently understood. This study leverages the divergent policies of Belgium and Sweden during the COVID-19 pandemic to relax the unrealistic -- but persistently used -- assumption that social contacts are not influenced by an epidemic's dynamics. We develop an epidemiological-economic co-simulation model where pandemic-induced behavioral changes are a superposition of voluntary actions driven by fear, prosocial behavior or social pressure, and compulsory compliance with government directives. Our findings emphasize the importance of early responses, which reduce the stringency of measures necessary to safeguard healthcare systems and minimize ensuing economic damage. Voluntary behavioral changes lead to a pattern of recurring epidemics, which should be regarded as the natural long-term course of pandemics. Governments should carefully consider prolonging lockdown longer than necessary because this leads to higher economic damage and a potentially higher second surge when measures are released. Our model can aid policymakers in the selection of an appropriate long-term strategy that minimizes economic damage.