Lessons from One of the World’s Most Successful, Yet Unusual, COVID-19 Vaccination Campaigns
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This expert column was written by Kashish Aneja and Nishtha Arora.
As of April 8, 2021, the Ministry of Health of the Royal Kingdom of Bhutan reported having administered the first doses of COVID-19 vaccines to almost 93% of its eligible adult population. 85% of its eligible adult population was vaccinated within the first week during one of the most successful, and by far the fastest, vaccination campaigns in the world. Bhutan’s vaccination rate, which surpasses those of the United Kingdom and the United States, was achieved seven times faster that of its vaccine donor, India, and nearly six times the global average. Bhutan, which vaccinated 63% of its total population, is one of the six countries in the world to have vaccinated more than 50% of their total population, falling just behind Seychelles, which has inoculated about 68% of its total population to date, which took months to achieve.
Bhutan’s success extends past vaccination coverage to the execution of the vaccination drive, from planning to implementation. Much of its success can be attributed to effective laws and policies, which we evaluated based on evidence from the COVID-19 Law Lab. What factors enabled Bhutan to finish its vaccination campaign just 16 days after it began?
The first factor in Bhutan’s success was its overall pandemic response. At the time of writing, Bhutan has recorded only 1026 cases of COVID-19 and just one death. This was made possible by two carefully managed lockdowns and stringent border controls that mandate a 21-day quarantine for all individuals arriving in the country. Even the King and the Prime Minister isolated themselves when required.
Bhutan’s pandemic response is rooted in its Health Emergency Disaster and Contingency Plan 2016, the Disaster Management Act 2013, and the National Health Policy 2012. Its Ministry of Health developed a National Preparedness and Response Plan for COVID-19 as early as January 21, 2020. The government began screening for COVID-19 at entry points in January 2020, and enforced institutional quarantine starting February 2020. Several standard operating procedures were issued for home quarantine, institutional quarantine, and designed hotel quarantine.
Second, Bhutan enjoys a developed vaccination program. The vaccination plan for COVID-19 is guided by the National Immunization Policy and Strategic Guidelines, 2011. The document provides strategic guidance for increasing immunization coverage, management of adverse events following immunization, strengthening of cold chain system, vaccine management, supervisory skills, and advocacy and social mobilization.
The success of the COVID-19 vaccination campaign in Bhutan was built upon well-established cold chain vaccination infrastructure and previous successful immunization drives going back to the 1990s. According to the World Health Organization, through successful implementation of the vaccination program, Bhutan has sustained immunization coverage of more than 95% at the national level for over more than a decade.
Third, Bhutan waited to start its vaccination campaign until it had procured sufficient doses for its entire targeted population in order to avoid rationing. Bhutan received its first allotment of 150,000 doses of the Oxford-AstraZeneca-developed Covishield vaccines, manufactured by the Serum Institute of India, on January 20, 2021 but did not administer any doses until the end of March. On March 27, it launched its nationwide weeklong vaccination campaign for all individuals above the age of 18. This strategy, however, may only work well in countries with less population and where the pandemic response is successful in limiting COVID-19 caseload.
Fourth, one of the most unusual attributes that can be credited to Bhutan is how it successfully overcame vaccine hesitancy and garnered public trust and solidarity in the vaccination campaign by respecting the local culture and engaging with the local community. Although Bhutan received its first allotment of vaccines in January, it made a conscious decision to administer the vaccine later in March to coincide with auspicious dates in Buddhist astrology. The dates for the vaccination drive were decided in close consultations with Buddhist monks to avoid the inauspicious month of ‘dana’ falling between February 14 and March 13. The first dose was administered by and given to a woman born in the Year of the Monkey, accompanied by chants of Buddhist prayers.
Finally, Bhutan exhibited exemplary leadership in planning and implementing the COVID-19 vaccination drive. The two months of deliberate delay was used by the authorities to register those who needed to be vaccinated and plan an efficient drive. A group of dedicated citizen volunteers, known as “desuups”—the Guardian of Peace, an orange-jumpsuited national service corps helped set up more than 1001 vaccination stations across the country, compared to 3006 in India on its first day of the vaccination drive. They assisted in delivering vaccines to healthcare centers and educating Bhutanese on COVID-19 protocols. To ensure the vaccination of every eligible adult, authorities arranged for helicopters to transport jabs to areas inaccessible by road. The Ministry of Health even adopted a home-based vaccination strategy for the elderly and for individuals with mobility issues.
While every country across the world has unique dynamics that determine its pandemic response, there is a lot to be learned from this tiny, last remaining Buddhist Kingdom in the Himalayas. A well-defined comprehensive national vaccination policy, good governance and leadership, a successful public health emergency response rooted in laws and policies, transparency ensured through regular communication with the general public, local community engagement, overcoming vaccine hesitancy and garnering public trust in the vaccination program by respecting the local culture are some of the key ingredients to one of the most successful, and unusual, vaccination drives of the world.
Kashish Aneja is a practicing lawyer in New Delhi specializing in Global Health Law and Privacy Law. Currently, he is consulting for the O’Neill Institute and the Public Health Foundation of India. He is the co-founder of the Society for Democratic Rights, New Delhi.
Nishtha Arora is an intern at the Society for Democratic Rights, New Delhi and Law Student at the National Law University, Odisha, India.