Health & Fitness

How Bhutan inoculated most of the world

THIMPHU, Bhutan – The Lunana area of ​​Bhutan is remote even by the standards of an isolated Himalayan kingdom: it stretches over an area roughly twice the size of New York City, borders the far west of China, includes glacial lakes and some of the highest peaks in the world. and cannot be reached by car.

Still, most of the people who live there have already received a coronavirus vaccine.

The vials of Oxford AstraZeneca vaccine arrived by helicopter last month and were handed out by health workers walking from village to village through snow and ice. Vaccination was carried out in the area’s 13 settlements even after yaks damaged some of the field tents that volunteers had set up for patients.

“I was first vaccinated to prove to my villagers that the vaccine was not fatal and safe to take,” said Pema, a village chief in Lunana who is in his 50s and has a name, over the phone. “After that, everyone here took the push.”

Lunana’s campaign is part of a quiet success story with vaccines in one of the poorest countries in Asia. As of Saturday, Bhutan, a Buddhist kingdom that has emphasized the welfare of its citizens over national prosperity, had given an initial dose of vaccine to more than 478,000 people, over 60 percent of its population. The Ministry of Health 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 given at around 1,200 vaccination centers over a one-week period in late March and early April. According to a database from the New York Times, the country’s vaccination rate was the sixth highest in the world on Saturday at 63 doses per 100 people.

That rate was higher than that of the United Kingdom and the United States, more than seven times that of neighboring India and almost six times the global average. Bhutan also ranks ahead of several other geographically isolated countries with small populations, including Iceland and the Maldives.

Dasho Dechen Wangmo, Bhutan’s Minister of Health, attributed his success to the “leadership and leadership” of the country’s king, public solidarity, the general absence of vaccine reluctance, and a primary health system that enabled us to “deliver the services to the highest degree ourselves use remote parts of the country. “

“As a small country of just over 750,000 people, a two-week vaccination campaign was possible,” Ms. Dechen Wangmo said in an email. “There were minor logistical problems during the vaccination, but all of them were manageable.”

All doses used so far have been donated by the Government of India, where the drug is known as Covishield and is made by the Serum Institute of India, the world’s largest vaccine manufacturer. The government of Bhutan has announced that it will give a second dose approximately eight to 12 weeks after the first round, as per guidelines for the AstraZeneca vaccine.

Will Parks, the representative of UNICEF, the United Nations Organization for Children, in Bhutan, said the first round was a “success story, not only in terms of coverage, but also in terms of the way the vaccination campaign is carried out Implementation was carried out from planning to joint implementation. “

“It involved the participation of the highest authority in the local community,” he said.

The campaign relied in part on a corps of volunteers known as the Guardians of Peace, operating under the authority of Bhutan’s King Jigme Khesar Namgyel Wangchuck.

Updated

April 18, 2021, 11:00 p.m. ET

In Lunana, eight volunteers set up field tents and helped move oxygen tanks from village to village, said Karma Tashi, a member of the government’s four-person vaccination team. The tanks were a precautionary measure in case villagers had negative reactions to the gunfire.

To save time, the team administered vaccines during the day and walked back and forth between villages at night – often 10 to 14 hours at a time.

The yak damage to the tents wasn’t the only hiccups. Some villagers were initially not vaccinated because they were harvesting barley or because they were concerned about possible side effects. “But after we told them about the benefits, they agreed,” said Tashi.

By April 12, 464 of the approximately 800 residents of Lunana had received an initial dose, according to the government. The population includes minors who are not eligible for vaccines.

Health care in Bhutan, a landlocked country slightly larger than Maryland and bordering Tibet, is free. According to the World Health Organization, life expectancy there more than doubled to 69.5 years between 1960 and 2014. The immunization rates have been over 95 percent in recent years.

However, the health system in Bhutan is “barely self-sustaining,” and patients in need of 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 should be sent overseas for treatment, said Dr. Yot. He said the committee, which focuses on brain and heart surgery, kidney transplants and cancer treatment, is informally known as the “death panel.”

What You Need To Know About The Johnson & Johnson Vaccine Break In The United States

On April 13, 2021, U.S. health officials called for an immediate halt to use of Johnson & Johnson’s single-dose Covid-19 vaccine after six recipients in the U.S. developed a rare blood clot disorder within one to three weeks of being vaccinated. All 50 states, Washington, DC, and Puerto Rico have temporarily stopped using the vaccine or recommended providers are suspending use of the vaccine. The U.S. military, government-run vaccination centers, and a variety of private companies, including CVS, Walgreens, Rite Aid, Walmart, and Publix, have also suspended injections. Less than one in a million Johnson & Johnson vaccinations are currently being studied. If there is a real risk of blood clots from the vaccine – which has yet to be determined – the risk is extremely small. The risk of contracting Covid-19 in the United States is much higher. The hiatus could complicate the country’s vaccination efforts at a time when many states face a surge in new cases and are trying to address vaccine hesitation. Johnson & Johnson has also decided to delay the launch of its vaccine in Europe amid concerns over rare blood clots and deal another blow to Europe’s vaccination boost. South Africa, devastated by a contagious variant of the virus found there, also stopped using the vaccine. Australia announced that it would not buy cans.

“I don’t think they could cope with the increase in severe Covid cases if this happens. So it is important that you give Covid vaccination priority,” he said, referring to Bhutan’s health authorities.

Bhutan has reported fewer than 1,000 coronavirus infections and only one death. The borders, which were already narrow in a global comparison before the pandemic, have been closed for a year, with a few exceptions, and everyone who enters the country must be quarantined for 21 days.

This includes Prime Minister Lotay Tshering, who received his first dose of vaccine last month after visiting Bangladesh in quarantine. He has been supporting the vaccination effort on his official Facebook page for the past few weeks.

“My days are characterized by virtual meetings in numerous areas that require attention, as I am closely following the vaccination campaign on site,” wrote the surgeon Dr. Tshering in early April. “So far, with your prayers and blessings, everything is going well.”

The economy in Lunana depends on animal husbandry and the harvest of a so-called caterpillar mushroom, which is valued as an aphrodisiac in China. The people speak Dzongkha, the national language and a local dialect.

Last year, the drama “Lunana: A Yak in the Classroom” was the second film ever selected to represent Bhutan at the Academy Awards. It was filmed using solar batteries and the cast included local villagers.

Lunana’s headmaster Kaka, who has only one name, said the most important part of the vaccination campaign is not on the ground, but in the sky.

“If there hadn’t been a helicopter,” he said, “getting the vaccines would have been a problem as there is no access road.”

Chencho Dema reported from Thimphu and Mike Ives from Hong Kong.

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