As the world grapples with the Covid-19 pandemic, Bhutan has adopted some innovative approaches to deal with the crisis. In an interview with Asia Times, Health Minister Dechen Wangmo discussed digital tracking, global collaboration, tourism and surveillance.
She offers rare insights about the management of the pandemic from her perspective. Her understanding and vision lend insight on how other countries are responding to the pandemic.
In 2020, health has been a major concern for everyone, and many health departments are coming under more scrutiny by the people they serve. Dechen Wangmo’s interview with Asia Times follows.
Vidhi Bubna: What are some measures taken by Bhutan during the Covid-19 pandemic to curb an increase in cases?
Dechen Wangmo: Bhutan’s approach to the pandemic is guided by the compassionate leadership of our king. At the helm of our response is His Majesty the King leading with unconditional love and care for every Bhutanese.
The Health Ministry continues to draw inspiration from His Majesty’s words of wisdom: “We must exhibit the strength that comes out of our smallness, remain united and support one another. During such exceptional circumstances, the government will take the responsibility of alleviating any suffering to the people due to the virus.” [Jigme Khesar Namgyel Wangchuck, king of Bhutan, in his first National Address, March 22, 2020]
From the very initial days of the pandemic, Bhutan adopted the three T’s (test, trace and treat) strategy and rigorously engaged it in our response. All available national channels and resources were mobilized to ensure the availability of adequate resources (such as testing kits, PPEs, manpower) to effectively implement the three T’s.
Trace: Bhutan started putting everyone coming from overseas and primary contact of the positive cases under facility quarantine (designated by Ministry of Health) for 14 days beginning March 14 initially and then for 21 days beginning March 31. All costs such as rooms and meals were fully covered by the government.
To ensure good adherence and comfort, all designated quarantine facilities are star-rated tourist hotels with amenities including free internet. Strong and efficient border control systems were put in place to reduce the risk of cross-border transmission of the virus. All international borders have been closed since March 23.
Test: Early on, Bhutan adopted an aggressive testing protocol. All individuals entering Bhutan are tested on arrival and then prior to release from the 21-day quarantine. Every patient visiting health facilities with flu symptoms is tested for Covid. All frontline workers minding our borders and health workers are routinely tested every month.
Treat: Every positive case is managed in a hospital where baseline vitals and X-rays are taken.
VB: To what extent do you think surveillance is important to curb cases of Covid-19 in Bhutan?
DW: Surveillance is one of the key interventions in combating the pandemic, and it is one intervention that we rigorously engaged in our fight against the virus.
Bhutan started institutionalized Covid-19 surveillance systems at all the POEs [points of entry] beginning January 2020, which was two months before the detection of our first cases in the country. We have also surveillance teams at two levels: the central and the district levels. These teams were thoroughly engaged in tracing the primary and secondary contacts of the positive cases and following them up with the 3T strategies.
Furthermore, we have also carried out extensive active surveillance of high-risk communities whenever positive cases were reported to ensure that everyone is adequately traced, tested and treated accordingly.
As an intervention that was unique to Bhutan, we set up 54 flu clinics across the country to enhance our surveillance of active cases. These facilities also acted as a buffer to safeguard our health facilities from Covid-19.
VB: What are some ways in which Bhutan is planning to integrate technology in health care?
DW: Ever since the early days of the pandemic, we developed the Druk Trace app, which played an important role in helping the surveillance team trace possible contacts of the confirmed cases. Below is the list of currently available systems:
| Type of surveillance | Target population | System | Focal Person |
| Active community surveillance | Community population | Reporting via mobile | Village health workers and Local government |
| Active schools/institutes surveillance | Students /offices | NEWARS information system | School/institute health coordinators |
| Active surveillance among high risk groups | Mobile population | Covid integrated influenza surveillance system | Health workers in respective districts |
| Active/passive health facilities bases surveillance | Symptomatic patients | Covid integrated influenza surveillance system | Health workers |
VB: Currently Bhutan is closed for tourism because of Covid-19. Do you think tourism will start again soon with better tracking methods for cases?
DW: The Tourism Council of Bhutan [is] working with the Technical Advisory Group of MoH and other stakeholders on how tourism could be organized or how tourists could come to Bhutan when it reopens for tourism.
Currently, there is no clear understanding on how Bhutan may open. Similarly, with the increasing coronavirus cases globally it is difficult to indicate when Bhutan will open its borders to tourists. Therefore, it is difficult for tour operators and partners to plan and promote.
The Tourism Council of Bhutan is hoping and therefore planning to reopen for tourism by early next year, that is, February/March 2021, which was the start of the tourist season during the pre-Covid years. The following are some of the options that are being proposed for reopening tourism in the country:
- Travel bubble: In order to restart tourism, a travel bubble concept could be considered where only allowing tourists from those countries who have managed the pandemic well and have no new cases.
- Green lanes: This is similar to the travel bubble but with added security by ensuring greater confidence in Covid-19 safety and screening protocols and easing visits to Bhutan for tourists coming from those countries with green lanes agreements.
- Chartered flights: The initial chartered flights could be considered from those above countries with travel bubble agreement.
- Daily tourist number quota: Bhutan could also look at setting maximum daily tourist quota so that it is manageable and safety mechanisms are well implemented. By having a limit on tourist numbers, it will also allow them to get experience and prepare for the future.
VB: What are some ways in which Bhutan and India can collaborate to solve the Covid-19 crisis?
DW: Bhutan and India are two countries that have always shown exemplary and exceptional friendship in the face of adversity. Even in the times of Covid-19, India has greatly supported Bhutan in our efforts in containing the pandemic. India has donated important PPEs [personal protective equipment], medical consumables, medicines and vital testing kits to Bhutan and has extended exceptional support in border control.
Going forward, the Ministry of Health has proposed participation in the clinical trial for Covid-19 vaccines that is being coordinated by India’s Department of Biotechnology. Border control and safe transportation of goods between the two countries will be one of the key areas the two governments will continue to collaborate on.
VB: Currently we are seeing more collaboration in the world to come up with a vaccine. In what ways do you see Bhutan collaborating with other countries?
DW: On April 24, WHO [the World Health Organization] hosted the launch of the Access to Covid-19 Tools (ACT) Accelerator, a new global collaboration to accelerate development, production and equitable access to Covid-19 diagnostics, therapeutics and vaccines.
With the Accelerator, GAVI, CEPI [the Coalition for Epidemic Preparedness] and WHO together with multinational and developing countries vaccine manufacturers are working on COVAX (vaccine) pillars to develop COVAX facilities. It is a global framework to ensure equitable and fair allocation of Covid-19 vaccines and other products.
VB: There have been increased discussions about how the pandemic is impacting the mental health of people. What measures has Bhutan taken to tackle the mental-health crisis that has increased because of Covid-19?
DW: Ever since the initial days of the pandemic, Bhutan has mobilized a National Mental Health Response Team comprising psychiatrists, clinical psychologists and counselors for Covid-19. The team has been actively involved in developing awareness and advocacy materials on mental health in the times of Covid-19.
Further, as a part of Bhutan’s … response to the pandemic, five mental-health hotlines have been established for counseling purposes.
VB: Do you think that the small population of Bhutan makes it any easier to tackle the pandemic?
DW: Yes, as a critical influential factor in public health and epidemiology, population has played a key role in Bhutan’s response to the pandemic. The small population that our country is blessed with has made it easier to enforce the national interventions and strategies to curb Covid-19.
VB: What are the biggest challenges that you have faced during your time as health minister of Bhutan?
DW: As many developing countries do, Bhutan too faces the challenge of inadequate health human resources and medical supplies.