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Tiny Himalayan nation Bhutan shows how to fight Covid-19 pandemic

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Authorities in the country of around 750,000 people said it will start vaccinating its citizens in March.PHOTO: AFP

Bhutan was the first country to receive a goodwill consignment of 150,000 doses of Covid-19 vaccine from India in January.

However, the tiny Himalayan country has yet to use them, preferring a wait-and-watch policy on vaccination.

Authorities in the country of around 750,000 people said it will start vaccinating its citizens in March, once it has enough doses for all those eligible.

Meanwhile, it wants to look out for potential adverse effects of Covid-19 vaccines from rollouts in other countries.

But there is another reason for delaying its own inoculation programme.

The authorities in Bhutan also want to avoid launching it during Dana, an "inauspicious month" that lasts between Feb 14 and March 13.

This delay in rolling out its vaccination programme is something Bhutan can afford given its efficient handling of the pandemic so far - an unlikely success story despite its meagre financial and healthcare resources.

It has to date recorded a total of 867 cases. There are just four active cases as of Feb 24.

It recorded its first and only Covid-19 death in January this year, around 10 months after it detected its first positive case.

This success has been built on the back of a set of swift and early measures that Bhutan put in place.

It began surveilling visitors for any signs of respiratory illness at the country's only international airport in Paro in January last year, before the World Health Organisation (WHO) declared Covid-19 a global pandemic.

And when a 76-year-old American tourist, arriving from India, tested positive for the coronavirus in capital Thimphu on the night of Mar 5 - the country's first case - Bhutan immediately banned the entry of tourists.

Later in the month, those returning from abroad were made to serve a mandatory 14-day quarantine, subsequently extended to 21 days - a week more than what WHO prescribes.

Bhutan has also kept its borders sealed since - a tough decision in a country where tourism is a key driver for economic growth.

It has enforced lockdowns twice, which were not without logistical problems, set up dedicated flu clinics and intensified testing across the country. As of Feb 24, Bhutan has conducted 520,613 tests.

Timely detection of cases at flu clinics has been also backed up by efficient contact tracing.

The country's prime minister, health and foreign ministers, all of whom have extensive background in healthcare, have deployed their knowledge in the nation's fight against the pandemic.

Health Minister Dechen Wangmo has a Masters degree in public health from the Yale School of Public Health and had worked previously as an international public health consultant.

In a tweet on Feb 11, she identified "science and solidarity" as the country's strength.

Mr Tenzing Lamsang, the editor of The Bhutanese newspaper, flagged his country's social cohesion as an asset that has enabled the country to handle the pandemic more efficiently than many wealthier nations.

"When it comes to the ability to come together and face a threat and operate together as one team, what I call social capital, in that Bhutan has one of the highest social capitals in the world," he told The Straits Times.

"If there is one thing that Covid-19 has shown, it is that it is not enough just to throw money and drugs at this problem. You have to have societal responsibility that goes down to every individual, in this case every Bhutanese," he added.

This sense of solidarity was demonstrated by all strata of the society in Bhutan, from the king to ordinary Bhutanese.

In a country where the monarch is still deeply respected, King Jigme Khesar Namgyel Wangchuck launched a special relief fund in April last year that has handed out more than S$25.5 million to those affected by the pandemic.

He has also travelled extensively in the rugged country, including to border areas, to oversee Bhutan's preparedness.

Bhutanese citizens have also pitched in with farmers donating their crops to feed those at quarantine centres, and hoteliers offering without charge their facilities to set up these centres.

This solidarity, together with a high level of public adherence to Covid-19 protocol and Bhutan's robust response system, has preempted a wider coronavirus outbreak.

But the coronavirus, adept at exploiting the smallest chinks in the armour, came back with a surge in December last year when several community transmission cases were reported in different parts of the country, leading to an outbreak far worse than the one in August 2020.

The outbreak is suspected to have been caused by Bhutanese citizens returning from India on a flight.

A second round of lockdown ensued but it did not stop Bhutan from recording more than 400 cases in December 2020 and January this year - nearly half the current total.

Dr Rui Paulo de Jesus, the WHO Representative to Bhutan, told The Straits Times the official response during the second outbreak was more coordinated, inspiring greater confidence among responders as well as the public in the government's handling of the pandemic.

"Bhutan was quick to adapt its existing interventions and adopt newer interventions to better deal with the evolving pandemic," he said. One member from every household in Thimphu, a hotspot, was tested twice before the second lockdown was lifted.

Conscious of the danger of another mass outbreak, Ms Wangmo told the Kuensel newspaper this month the country will further ramp up its surveillance with a combination of passive and active measures.

While urging those with flu-like symptoms to get themselves tested at the country's 58 flu clinics, she said Bhutan would also actively test vulnerable population segments every fortnight, including those working at points of entries as well as school students and teachers.

It will also test 20 per cent of workers in factories and industries, and at places with large gatherings such as the Centenary Farmers' Market in the capital and grocery stores, once every two weeks.

As Bhutan moves ahead, Dr Jesus said that the country will have to invest more in building a resilient health system, with a focus on long-term sustainability to respond to public health emergencies, including the current pandemic.

"Government needs to continuously carry out testing, detect, isolate and treat as done so far - and at the same time provide essential services with minimal disruption," he added.