Bhutan Blunts COVID-19

Sandwiched among India, China and the Himalayan Mountains, Bhutan is a country where a virus like SARS-CoV-2 could not only take root but also blossom.

And yet, for all of the hundreds of thousands of people who live there, and after nearly a year and a half of the COVID-19 pandemic, the country’s official count of those who have died from the disease is incredibly low: one.

It’s a figure that shocks global health experts. But to Bhutan Health Minister Dechen Wangmo, M.P.H. ’07, who has led the national COVID-19 response alongside King Jigme Khesar Namgyel Wangchuck, much of the country’s success against the pandemic is the result of hard work, public solidarity and trust in the health system—along with years of close collaboration with members of the Yale School of Public Health.

“What we have achieved so far ... is a testament to the collective effort and solidarity of our public and the selfless and compassionate leadership of our King, who throughout this journey [has] touched [the] lives of every Bhutanese with love, kindness and support,” Wangmo said. “The interaction with [YSPH faculty] and fellow students along with having worked as international consultants in many countries all have greatly contributed to our systemic approach that was critical for planning and implementing our interventions to avert a major public health crisis.”

Wangmo’s effort to improve the public health of Bhutan has earned international recognition. In May, she was elected president of the World Health Assembly, the decision-making body of the World Health Organization, as it entered its second year of pandemic response. Wangmo is the first YSPH graduate to occupy the prestigious role. “What I have learned at YSPH will continue to guide,” she wrote on Twitter after the announcement.

The relationship between Yale and Bhutan goes back more than a decade before the novel coronavirus appeared. As early as the mid-2000s, faculty and researchers were hard at work in Bhutan, bolstering the nation’s health capacity and improving its research infrastructure.

With the help of the Bhutan Foundation and other organizations, Yale affiliates began making a difference, according to YSPH lecturer Mary Alice Lee, Ph.D. Before long, Bhutanese researchers could participate in health research methods and writing workshops and could apply for funding for original research projects. The peer-reviewed Bhutan Health Journal began publication as well.

Wangmo has played a key part in this effort of collaboration between Yale School of Public Health and the only university of medical sciences in Bhutan–Khesar Gyalpo University of Medical Sciences of Bhutan. After graduating from YSPH in 2007 with a master’s degree in public health with a focus on global health, Wangmo was an independent consultant for a variety of countries in Southeast Asia and the founder and executive director of the Bhutan Cancer Society. When the Druk Nyamrup Tshogpa, formerly the Social Democratic Party, began leading the Bhutanese government in 2018, she was selected as minister of health.

“As I take on this sacred responsibility to serve my country, I am humbled and touched by the confidence and trust placed on me by the party and the people of my constituency,” she said at the time.

Wangmo traveled to medical facilities across the country and assessed health capabilities firsthand in an effort to improve health coverage in rural areas and to narrow the gap in health service delivery. She even developed the first-ever policy to accelerate maternal and child health services to provide income support and maternal and child health care across Bhutan.

“She understands the social dimensions of health and the role that good governance plays in ensuring equitable access to health care, from prevention to COVID-19 to end-of-life care,” said Lee. “Health Minister Dechen builds effective partnerships that improve health outcomes across Bhutan.”

YSPH Professor Kaveh Khoshnood, M.P.H. ’89, Ph.D. ’95, noted that part of Wangmo’s efforts included creating a pandemic preparedness plan just weeks before the coronavirus emerged—a timely action that undoubtedly saved lives.

The surge of coronavirus cases in early 2020 none-theless proved to be difficult to manage. Wangmo said that only a handful of experts in the country were able to work on a newly formed technical advisory group. Medical personnel and equipment were also scarce. She told The Diplomat magazine that Bhutan had only one intensive care doctor in the entire country. The models, she said, were daunting. “I said, my God, we really need to focus [on] prevention and non-pharmaceutical interventions,” Wangmo recalled.

That’s where her training from YSPH came in.

“What I have contributed in the process of developing guidelines, formulating strategies, is a result of what I have learned during my education at Yale,” she said.

Khoshnood said Wangmo slept in a containment apartment for days at a time–leaving her young son at home—to deal with the early days of the pandemic.

The monarch dropped by, too, to give much-needed moral support. Their work paid off: Almost a year and a half later, the nation managed to sidestep major surges in COVID-19 cases and has administered the first dose of the vaccine to at least 94% of all eligible citizens, with the second dose rollout in the pipeline.

Last December, the King conferred on Wangmo the Royal Red Scarf—one of the country’s highest civilian honors—“in appreciation of the capable manner in which she performed her duties to safeguard the nation against COVID-19.”

“Her leadership skills, her really high level of engagement with the community, her [commitment] to believing in science and public health … her humility, I think, are huge,” Khoshnood said. A major part of Bhutan’s success, he added, is the public’s overwhelming trust in government. Masks were not politicized, and neither were vaccines or social distancing. “Wangmo is well-respected. People really take her work seriously.”

Challenges remain in Bhutan. The delta variant’s spread is a cause for concern across the globe, and India’s ban on vaccine exports means that many of those who received the first dose of a vaccine may not get their second before the variant spreads. Wangmo has asked the international community for help, warning of a collapse of Bhutan’s health care system if the pandemic worsens.

Still, she said, the chance to serve her country during these times has been a blessing.

“For me personally, to be able to serve my country during this difficult time has truly been an honor and a lifetime opportunity that I will forever cherish,” she said.