How the Tiny Kingdom of Bhutan Out-Vaccinated Most of the World

THIMPHU, Bhutan — The Lunana area of Bhutan is remote even by the standards of an isolated Himalayan kingdom: It covers an area about twice the size of New York City, borders far western China, includes glacial lakes and some of the world’s highest peaks, and is inaccessible by car.

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.”

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.

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

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