[The Himalayan nation has given
more than 60 percent of its people a shot. Some villages were reached by
helicopter, and health workers hiked through ice and snow.]
By Chencho Dema and Mike Ives
Still, most people living there
have already received a coronavirus vaccine.
Vials of the Oxford-AstraZeneca
vaccine arrived last month by helicopter and were distributed by health
workers, who walked from village to village through snow and ice. Vaccinations
proceeded in the area’s 13 settlements even after yaks damaged some of the
field tents that volunteers had set up for patients.
“I got vaccinated first to prove to
my fellow villagers that the vaccine does not cause death and is safe to take,”
Pema, a village leader in Lunana who is in his 50s and goes by one name, said
by telephone. “After that, everyone here took the jab.”
Lunana’s campaign is part of a
quiet vaccine success story in one of Asia’s poorest countries. As of Saturday,
Bhutan, a Buddhist kingdom that has emphasized
its citizens’ well-being over national prosperity, had administered a
first vaccine dose to more than 478,000 people, over 60 percent of its
population. The Health Ministry said this month that more than 93 percent of eligible
adults had received their first shots.
The vast majority of Bhutan’s first
doses were administered at about 1,200 vaccination centers over a weeklong
period in late March and early April. As of Saturday, the country’s vaccination
rate of 63 doses per 100 people was the sixth highest in the world, according
to a New York Times database.
That rate was ahead of those of the
United Kingdom and the United States, more than seven times that of neighboring
India and nearly six times the global average. Bhutan is also ahead of several
other geographically isolated countries with small populations, including
Iceland and the
Maldives.
Dasho Dechen Wangmo, Bhutan’s
health minister, attributed its success to “leadership and guidance” from the
country’s king, public solidarity, a general absence of vaccine hesitancy, and
a primary health care system that “enabled us to take the services even to the
most remote parts of the country.”
“Being a small country with a
population of just over 750,000, a two-week vaccination campaign was doable,”
Ms. Dechen Wangmo said in an email. “Minor logistic issues were faced during
the vaccination but were all manageable.”
All of the doses used so far were
donated by the government of India, where the drug is known as Covishield and
manufactured by the Serum
Institute of India, the world’s largest vaccine producer. Bhutan’s government
has said it plans to administer second doses about eight to 12 weeks after the
first round, in line with guidelines for the AstraZeneca vaccine.
Will Parks, the representative in
Bhutan for UNICEF, the United Nations agency for children, said the first round
was a “success story, not only in terms of the coverage but also in the way the
vaccination drive was executed collectively from the planning to the
implementation.”
“It involved participation from the
highest authority to local community,” he said.
The campaign has relied in part on
a corps of volunteers, known as the Guardians of the Peace, who operate under
the authority of Bhutan’s king, Jigme Khesar Namgyel Wangchuck.
In Lunana, eight volunteers pitched
field tents and helped carry oxygen tanks from village to village, said Karma
Tashi, a member of the government’s four-person vaccination team there. The
tanks were a precaution in case any villagers had adverse reactions to the
shots.
To save time, Mr. Tashi said, the
team administered vaccines by day and walked between villages by night — often
for 10 to 14 hours at a time.
The yak damage to the tents wasn’t
the only hiccup. Some villagers did not initially show up to be vaccinated
because they were busy harvesting barley, or because they worried about
possible side effects. “But after we told them about the benefits, they
agreed,” Mr. Tashi said.
As of April 12, 464 of Lunana’s 800
or so residents had gotten a first dose, according to government data. The
population figure includes minors who are not eligible for vaccines.
Health care in Bhutan, a landlocked
country that is slightly larger than Maryland and borders Tibet, is free.
Between 1960 and 2014, life expectancy there more than doubled, to 69.5
years, according to the World Health Organization. Immunization
levels in recent years have been above 95 percent.
But Bhutan’s health system is
“hardly self-sustainable,” and patients who need expensive or sophisticated
treatments are often sent to India or Thailand at the government’s expense,
said Dr. Yot Teerawattananon, a Thai health economist at the National
University of Singapore.
A government committee in Bhutan
meets once a week to make decisions about which patients to send overseas for
treatment, Dr. Yot said. He said the committee — which focuses on brain and
heart surgery, kidney transplants and cancer treatment — was known informally
as the “death panel.”
“I don’t think they could cope with
the surge of severe Covid cases if that happened, so it is important for them
to prioritize Covid vaccination,” he said, referring to Bhutan’s health
authorities.
Bhutan has reported fewer than
1,000 coronavirus infections and only one death. Its borders, tight by global
standards even before the pandemic, have been closed for a year with few
exceptions, and anyone who enters the country must quarantine for 21 days
That includes the prime minister,
Lotay Tshering, who received his first vaccine dose last month while in
quarantine after a visit to Bangladesh. He has been supporting the vaccination
effort in recent weeks on his official Facebook page.
“My days are dotted with virtual
meetings on numerous areas that need attention, as I closely follow the
vaccination campaign on the ground,” Dr. Tshering, a surgeon, wrote in early
April. “So far, with your prayers and blessings, everything is going well.”
The economy in Lunana depends on
animal husbandry and harvests of a so-called caterpillar fungus that is prized
as an aphrodisiac in China. People speak Dzongkha, the national language,
and a local dialect.
Last year, the drama “Lunana: A Yak in the Classroom” became the second film ever
selected to represent Bhutan at the Academy Awards. It was filmed using solar batteries, and its cast included local
villagers.
Lunana’s headman, Kaka, who goes by
one name, said the most important part of the vaccination campaign was not on
the ground, but in the sky.
“If there hadn’t been a chopper,”
he said, “getting the vaccines would have been an issue, since there’s no
access road.”
Chencho Dema reported from Thimphu,
Bhutan, and Mike Ives from Hong Kong.