Against the odds, tiny Bhutan rolls out a second round of mass vaccinations

Less than two weeks ago, a charter flight carrying half a million doses of Moderna’s Covid-19 vaccine took off from Kentucky and touched down at the international airport in Bhutan. By Monday, most adults in the remote Himalayan kingdom had been fully vaccinated against the coronavirus, all through donated shots.

The July 12 flight was the culmination of a weeks-long diplomatic scramble in which Bhutan’s government asked 28 countries to supply doses for its second round of vaccinations, according to Will Parks, the country representative for the United Nations’ children’s agency.

The plane carried doses donated by the United States and distributed through COVAX, a global vaccine-sharing partnership. Separately, Denmark sent 250,000 AstraZeneca doses directly; Bulgaria, Croatia and other nations sent another 100,000; and China sent 50,000 doses of its Sinopharm vaccine. Most of Bhutan’s second-round shots were administered over the past week, including to yak herders at high altitudes.

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Bhutan’s success is notable because the campaign to vaccinate the world’s poorer nations is mostly floundering as wealthy nations delay shipments of doses, exacerbating inequalities in the pandemic response that analysts see as both a moral and epidemiological failure.

“I hope that this piece of good news functions as a prompt for the international community to do more to also reach other countries in need of vaccines,” said Lisa Herzog, a professor of philosophy at the University of Groningen in the Netherlands who has studied the ethics of the COVAX distribution model.

Back in March, Bhutan pulled off a remarkable feat: vaccinating more than 93 per cent of eligible adults with first doses in a country where some villages are accessible only by helicopter or on foot. But the success of that undertaking meant that the government needed to complete a second round of vaccinations within the recommended window of 12 to 16 weeks.

The first round — 550,000 doses of the AstraZeneca vaccine — had been 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. But India later cut back on vaccine exports as its own outbreak surged.

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“Bhutan had that kind of circumstantial imperative to chase, chase and chase vaccines in sufficient quantity to arrive en masse in a limited time, to be used in a mass vaccination for the second round,” said Parks, the UNICEF representative. “Other countries have not had that kind of circumstance, where they’ve done a massive first round. It’s been a trickle effect.”

Tashi Yangchen, a representative from Bhutan’s Health Ministry, said the second round of mass vaccination had ended Monday with 90.2% of eligible adults fully vaccinated. Parks said the official figure would inch up a bit further in the coming days as people in hard-to-reach groups, such as nomadic tribes, received second shots.

Parks credited leadership from Bhutan’s government and royal palace, plus low levels of vaccine hesitancy and a robust cold-chain infrastructure.

Another reason, he said, was that the success of the first round of shots helped prove to donors that the country of fewer than 800,000 people could roll out a second round efficiently and effectively.

“Some of the other countries — which were struggling with using vaccines that they had available — couldn’t really fall back on that demonstration that ‘if you give, we will use,’” he said.