How the tiny kingdom of Bhutan managed to vaccinate its population

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Bordering the far west of China, Bhutan’s Lunana region is home to some of the world’s tallest peaks. Incidentally, the region is inaccessible by car. Yet most of its residents have already received their first dose of the coronavirus vaccine.

On Saturday, the Buddhist kingdom of Bhutan administered a first dose of AstraZeneca vaccine to more than 478,000 people, i.e. more than 60% of its population, including more than 93% of eligible adults. This vaccination rate was then the sixth highest in the world, higher than that of Great Britain and the United States. Note that all of these doses were donated by the Indian government where the serum is manufactured.

The vast majority of these early doses were administered in approximately 1,200 vaccination centers in one week, end of March / beginning of April. Bhutan had waited to receive all of its doses before starting to offer the first injections. But how do you get to the Lunana region?

A real challenge

Bordering the far west of China, the region punctuated by glacial lakes and other Himalayan peaks is indeed inaccessible by car. To reach this population isolated from the rest of the world, a corps of eight volunteers known as the Peacekeepers who operate under the authority of the King of Bhutan Jigme Khesar Namgyel Wangchuck traveled to the site by helicopter.

The health workers then walked from village to village through the snow and ice equipped with their vaccines, tents and oxygen tanks. To save time, the team administered vaccines during the day and moved between villages at night (ten to fourteen hours of walking each time). On several occasions, the tents have been ransacked by yaks.

In addition to the damage caused by these Himalayan ruminants, health workers also had to deal with some villagers who were too busy harvesting barley or too worried about possible side effects from the vaccine. In the end, everything went perfectly.

I got the vaccine first to prove to my countrymen that the vaccine does not cause death and is safe to take“, Explains to New York Times Pema, the chief of the village of Lunana. “After that everyone here took their first injection“.

The vaccinations took place in the thirteen colonies in the region. In mid-April, 464 of the approximately 800 inhabitants of Lunana had received their first dose.

A Buddhist ritual with doses of vaccine happened in Lhuntse, Bhutan, in an image posted on Facebook by the country’s health ministry. Credit: Ministry of Health of Bhutan

Prevent runaway risks

This “silent” vaccination campaign, operated in one of the poorest countries in Asia, was necessary.

Health care is free there, but the system is not “self-sufficient”. Patients who need expensive or sophisticated treatments are indeed often sent to India or Thailand at government expense, according to Dr Yot Teerawattananon, a Thai health economist at the National University of Singapore.

A government committee then meets once a week to make decisions on whether or not to send patients abroad. Usually, the committee focuses on brain and heart surgery, kidney transplants, and cancer treatment.

However, the doctor believes that a small country like Bhutan could not have coped with an outbreak of severe cases of Covid. That is why the emphasis has been placed on vaccination.

In addition to this campaign, the kingdom’s borders have been closed for a year with a few exceptions and anyone entering the country must be quarantined for 21 days. For now, Bhutan has reported less than a thousand Covid-19 infections and reported only one death.

The government plans to administer the second doses around eight to twelve weeks after the first cycle, according to guidelines from the University of Oxford which developed the serum.

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