Bhutan went from no jabs to being a world leader in COVID-19 vaccine rollout in three weeks. Here’s how they did it

May 6, 2021
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When the tiny Himalayan nation of Bhutan was gifted 150,000 doses of the AstraZeneca coronavirus vaccine in January, they decided to consult the stars before rolling them out.

Buddhist monks informed the government that the most auspicious time to begin the inoculation drive was late March, and a woman born in the Year of the Monkey was an ideal candidate.

Thirty-year-old Ninda Dema was the chosen one — given her first dose at the perfect astrological time of 9:30am on March 27.

She received the shot from a nurse who was also born in the Year of the Monkey, at a vaccination centre in the capital Thimphu, amid chanting of Buddhist prayers.

“Let this small step of mine today help us all prevail through this illness,” she was quoted by the country’s Kuensel newspaper as saying.

The Prime Minister was next in line, and then his family. In the devout Buddhist nation, choosing the right time to roll out the vaccine was crucial to ensuring locals had faith in the jab.

And the results speak for themselves.

Since Ms Dema was vaccinated, Bhutan has surged past Israel, the US and Bahrain to have the world’s highest proportion of adults who have received one dose.

In just 16 days, Bhutan has vaccinated 93 per cent of its adult population. That means 63 per cent of its 800,000 citizens have received their first injection.

But it wasn’t just a lucky star that got them there. Here’s how they did it.

Vaccine diplomacy, an army of volunteers and cold chain storage

Having a population roughly equivalent to the city of San Francisco certainly makes a swift vaccine rollout more achievable.

But this landlocked nation tucked between China and India faced many other challenges to reach people in remote mountain villages and low-lying valleys.

Even before the pandemic was declared, the small nation had been warning of doctor shortages.

The World Health Organization had recommended the doctor-population ratio be 1:1000, meaning 1,000 people should have a doctor. Going by this, Bhutan needed about 700 doctors. Instead, they had just 337.

In order to roll out the vaccines, the country was reliant on volunteers, known as ‘desuups’, who trekked through difficult terrain to deliver vaccine equipment. They have also encouraged locals to keep up wearing a mask and social distancing.

Through the Asian Development Bank (ADB) and UNICEF, the government procured the necessary equipment — in this case, two refrigerated vans — for the Ministry of Health to help transport the vaccines across the country.

“The mass vaccination was a collective exercise, spearheaded by His Majesty The King,” UNICEF representative in Bhutan Will Parks said in a statement to the ABC.

“UNICEF leveraged its expertise in procuring cold chain equipment, critical medical supplies and technical assistance, all of which helped in preparing the rapid vaccination rollout.”

Vaccine centres were kept open on weekends to allow as many people as possible to get their jab, while the elderly and those with mobility issues got home visits.

The nation relied on large supplies of donated vaccines from neighbouring India — likely given to counter Chinese influence.

They also received about 5,900 Pfizer syringes through the WHO’s COVAX program to help inoculate low-income countries.

The Pfizer jab will need to be kept at freezing temperatures, but the country already had experience in cold chain storage from previous vaccine drives.

“We achieved universal immunisations in the 1990s and we have always been very successful in vaccinations,” Bhutan’s Health Minister Dasho Dechen Wangmo told the UK Telegraph.

“So the current immunisation is riding on the existing programs, there were already a lot of systems in place and it made it very easy to introduce a new vaccine through a lot of advocacy and micro-level planning.”

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What other countries might learn from Bhutan’s success

According to the Atlantic, there were five key factors to Bhutan’s strategy: engaged leadership, preparedness, acting speedily, drawing on existing strengths, and providing enough support to those who isolate.

But some of Bhutan’s success is also in no small part due to timing. Just one month before the coronavirus was reported in China, the country had been working with the World Health Organization to simulate what a national response to a global pandemic could potentially look like.

It allowed the country to identify possible areas of weakness and, according to the WHO and Bhutan officials, largely contributed to the country’s success in fighting COVID-19.

The medical background of its leadership has also had a part to play. Prime Minister Lotay Tshering, a highly regarded doctor before he entered politics, has remained engaged with the pandemic since last year, acting quickly to build a national framework that would prevent outbreaks from occurring.

That included implementing the gold standard for public health measures: detect, test, trace, isolate, and treat cases. The country also worked to increase the capacity of healthcare workers, hospitals, laboratories, and ensure delivery of essential health services.

“We’ve been so focused on … epidemiology of this vaccine rollout, we’ve forgotten about the importance of strong leadership and fast, decisive actions which is what we’ve seen happen in Bhutan,” Elizabeth Jackson, an expert in supply chain management and logistics from the School of Management & Marketing at Curtin University, told the ABC.

The Government has been credited with maintaining trust with the public, who have come out in droves to be vaccinated.

But having a smaller population size and a sense of civic duty has also been key.

“Our strength lies in our smallness and inherent value of solidarity,” Dasho Dechen Wangmo, the Bhutanese Health Minister, said.

Dr Jackson agrees that Bhutan has used its size to advantage, which sets it apart from other countries.

“[In Australia] we have got to get our vaccines to a lot more people,” she said.

“We have got a much, much more diverse population with much more diverse attitudes towards government decision-making, which in some respects is extremely good. This is why we love to live in Australia.

“But it does add a level of complexity to consumer attitudes and the generosity of the population.

“So one of the lessons that we have learnt from Bhutan is the positive outcomes of listening to instructions and following guidance when it comes to successful vaccine rollout and … the fast, decisive action with strong leadership, but we’re in very, very, very different countries.”

The fight isn’t over yet

The small Himalayan kingdom has remained largely sealed off from visitors since March last year and imposed a mandatory quarantine for travellers returning from abroad.

It has also enacted lockdowns, and only recorded its first COVID-19 death earlier this year.

But while Bhutan has been praised for its speedy vaccination drive already, public health officials have cautioned that they have not reached the end of the road just yet.

With COVID-19 cases escalating once again around the world, the local community has been urged to remain alert.

“Our fight must continue with renewed vigour and commitment to safeguard our country from this dreadful pandemic,” Ms Wangmo said.

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