The Dzongkhags in red have local transmission

Bhutan in touch with 17 countries for vaccines as time runs out and a new variant spreads

As the 12 weeks gap from the first dose comes to a close by 29th June there is a growing sense of anxiety in the government to get hold of the second dose of AstraZeneca vaccines.

The anxiety is all the more given a much more infectious strain that has come to Bhutan and its spread in the high risk areas of Phuentsholing, Samtse, Samdrupjongkhar and Merak leading to around 600 local cases since the first outbreak from Phuentsholing seven weeks ago.

Bhutan’s health officials suspect that this strain could most probably be the Delta variant first detected in India and also known as B.1.617 or the Indian variant which is spreading rapidly across the world with it already being the dominant variant in UK and the fastest growing variant in USA.

Given the immune escape properties of Delta, studies are showing that the first dose of AstraZeneca provides only around 33% protection with a second dose bumping it up to around 60%.

Data from UK which has done the most extensive studies on the delta variant show that a person is two and half times more likely to be hospitalized and that it could be around four times more infectious than the original Wuhan strain.

The delta strain can also result in more severe illness which may explain the more need for oxygen for Bhutanese patients this time.

The delta strain also attacks children unlike in the earlier strains and that explains the large number of children infected in the latest outbreak in Bhutan.

Health Minister Dasho Dechen Wangmo said this is the main concern for now and what keeps her up at nights. She said the infectious strain in Bhutan could spread among school children and this is why they are completely relooking at the entire protocol to protect school children.

Lyonpo said that she has also written to the Education Minister to revise and enhance the measures to protect school children.

This means that the only long term chance that Bhutan has of stopping the delta variant is to get in a second dose as soon as possible.

Lyonpo said that this is the reason why Bhutan has not increased the gap to 16 weeks.

Showing how vulnerable Bhutan is, Thimphu underwent a three-day lockdown after an eight-year-old boy tested positive on the antigen test but the luckily the boy and his contacts all tested negative on the RT-PCR test.

She said it will be hard to say from where Bhutan will get its second dose but requests have been put to 17 countries that have the AstraZeneca vaccines and every effort is being made to get them whether they can support Bhutan’s target partially or wholly.

Lyonpo said that given the low protection of the first dose against the Delta variant it is important to fully vaccinate the adult population, but she said the first dose had at least prevented severe illnesses otherwise given the numbers and modeling Bhutan should be seeing more numbers of severe cases.

The minister said that if Bhutan does not get sufficient doses then it will first prioritize the people in the high risk areas for the second dose.

Lyonpo said that Bhutan’s needs are very small but the threat to Bhutan is very real wedged in between the two epicenters of the pandemic, the weakness of the health system and the porous borders. She said that if any country gives vaccines to Bhutan then the country can roll out the second dose very efficiently with minimal wastage.

Lyonpo said that given that Bhutan’s needs are small even if the countries give around 50,000 doses each then it would go a long way.

The Foreign Minister Dr Tandi Dorji said that the government is equally anxious as the 12 weeks’ gap comes to a close and it is working very hard to get the vaccines by contacting 17 countries.

Lyonpo said that Bhutan is following up with Japan and Denmark that have the vaccines. Denmark recently decided to give 360,000 doses to Kenya. In the case of Japan, it is like the USA which requires clearance from a local regulatory agency.

Lyonpo said that the health minister also talked to her counterpart in Switzerland. Bhutan has also approached Canada and Norway for their unused doses.

Bhutan is also in touch with Russia as an option to buy 1 mn Sputnik doses.

The Foreign minister said that Bhutan in the longer run is also looking at buying Pfizer, Moderna and Johnson and Johnson vaccines. He said the USA helped Bhutan to get in touch with J&J and Bhutan is looking at buying from them as even after the second dose the annual booster shots would be needed against COVID-19.

Lyonpo said Bhutan is also looking at purchasing a COVID and Flu vaccine combination through Novax and other companies.

The minister said that while there is anxiety, both medically and clinically there is nothing to worry as the first does is quite effective is preventing serious illness.

He said that in the absence if the vaccine the non medical measures like closing the borders, 21 days’ quarantine, 7-day quarantine are better at protecting the people than the vaccines.

The minister said that earlier India had asked Bhutan if it can extend the gap to 16 weeks as India had done the same and Spain even increased it to 20 weeks. Lyonpo said that from July SII in India would be significantly ramping up its production of vaccines.

However, in the case of India given the dire situation there until recently, Bhutan does not want to put pressure.

SII has already said it can resume exports only by around October 2020.

Apart from India, a source of hope for the AstraZeneca vaccines is the 60 mn AstraZeneca doses in the USA which is yet to get their Food and Drug Administration approval.

Lyonpo said that it was just last week that Bhutan’s Ambassador to India Major General Vetsop Namgyel had met his US counterpart requesting that USA prioritize Bhutan’s request for 550,000 doses placed around two months ago.

Last week, The Bhutanese in a telephonic press conference asked the US State Department Coordinator for Global COVID-19 Response, Gayle E. Smith, about Bhutan’s request for around half a million doses of the AstraZeneca vaccine, when it’s FDA would approve its 60 million AstraZeneca doses for export and how much Bhutan would receive given that Bhutan’s second dose is due by the end of this month. 

Gayle E. Smith said, “Yours is a really important question.  There are many countries who have been able to do, to some extent, the first shot in the vaccine series but don’t have the supplies to do the second shot.  We’re well aware of that and AstraZeneca is key on that.  As you rightly suggest, our ability to deploy those AZ vaccines depends on receiving clearance from the FDA.” 

She said, “So we are hopeful we will get a clearance soon.  We are not in a position to say when that will come true because that’s the purview of the FDA,” she said. 

She told The Bhutanese in terms of dose amounts, that is something that is going to be worked out in consultation with a number of the parties involved and based on the type of vaccine.

According to government sources Bhutan is expected to get some vaccines from the USA. 

Earlier, Jeffrey Dunston Zients, the White House Coronavirus Response Coordinator in a press briefing clarified that the first batch of 25 mn doses being sent out to various countries are a mixture of Johnson and Johnson, Pfizer and Moderna which got Emergency Use Authorization (EUA) for use in the USA. 

Bhutan was not in the list of countries getting this first batch of 25 mn vaccines. Almost all South Asian countries were on the list. 

According to the Foreign Minister Dr Tandi Dorji Bhutan was informed a day earlier that it is not the first batch as it does not meet the urgency criteria of deaths and severity of cases.

This update was important as Bhutan has requested for the AstraZeneca doses from USA for its second dose which is due by the end of June after a 12-week gap. 

This means there is still some hope for Bhutan to possibly get some AstraZeneca doses from the USA whenever FDA approval is given there. 

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