The lessons for Bhutan from India’s COVID-19 crisis

India averted major deaths or health system burdening in the 2020 wave of COVID-19. But today, and as per official records, India clocks more than 4,000 deaths and 4,00,000 new infections every day due to COVID-19.  The unfolding humanitarian crisis has brought India to its knees.

Modelling by the Institute of Health Metrics and Evaluation estimates that about 1.5 mn Indians will die due to COVID-19 alone by September 1, 2021.India is a cautionary tale to Bhutan- an exemplar on how rapidly COVID-19 might turn rapidly into a full-blown humanitarian crisis.

Towards the beginning of the year, riding high on the so-called “success” of last year, its vaccine- manufacturing prowess, and low case count, India launched its own vaccination drive.

Bhutan, India’s soul -sister received vaccines from India, almost immediately after it. But a few weeks down the line, cracks started appearing. By March 2021, many Indian states started complaining of vaccine shortage. The slow rate of vaccination overall was also a major concern.  With cases increasing, by April, it was evidently clear that a massive surge is nearby, and vaccines were indeed not available.

Scientists called for a national lockdown, to stop religious congregations and curb massive election rallies being organised by political leaders with open violation of COVID protocols (including in West Bengal, near Bhutan).  With almost nothing being done, COVID spread its tentacles and more and more people became sick, and soon there were no hospital beds, no oxygen, no medicines and no healthcare workers to care for patients. There is only death and despair. The crisis continues – with ordinary citizens, doing all they can to help each other – in real and through social media. However, the magnitude is too large and too overwhelming, and the humanitarian crises continues.

Bhutan has one major advantage over India (and any other country in the world) – it has the worlds most efficient and successful COVID-19 vaccination program. Almost all the target vaccine population was covered, in a matter of few weeks.

While everyone talks about its success (which it was), it is also important for Bhutanese people to be reflective.  Bhutan delayed starting its vaccination program for many weeks after receiving vaccines. This might be due to need to prepare the health system and/or the need to take into cognizance Bhutanese customs to enhance vaccine acceptance. If the former, it is a learning to anticipate health system challenges before-hand and prepare. If the latter, India is an example of what goes wrong when religion and customs take precedence over science.

Bhutan has far less resources and medical infrastructure compared to India so prevention of transmission should be a top-level focus. Bhutan has a digital equivalent to India’s Aarogya Setu app for contact tracing. The use of DrukTrace app has reported fallen sharply, but there are more fundamental questions to ask instead of pushing for more app usage- questions, Indian policy makers and scientists should have asked long back. What proportion of our population has smartphone? How many asymptomatic cases are being detected through contact tracing by the app?  Should not digital health systems be replaced, if it is actually not doing what it is supposed to? Bhutan’s vaccination program did not use any digital platforms, unlike that of India – and was very successful.

Lockdowns and movement restrictions are also a key measure to control transmission and Bhutan is an exemplar of using it successfully since the beginning of the pandemic. Lives should always take priority over economics, and movement restrictions should not be political decisions but technical ones. Developing a fit-for-purpose and contextually relevant multi-indicator technical criteria for decisions on movement restrictions at Dzongkhags level , and linking it with graded public heath response should be a top priority.

The Government of Bhutan has already arranged for genomic sequencing of Bhutanese samples to enable detection of variants of concerns. This is commendable but a key thing to invest on is also a public health measure which works irrespective of variants – masks.

Providing information about masks is not enough. A trial in Bangladesh demonstrated that mask usage can be normalised by a community-based program consisting of free mask distribution, along with education, role modelling and reinforcement through nudges in public places. India’s mask usage has also faltered prior to this surge and in many areas continues to be a challenge.

Last but not the least, it is essential for Bhutanese people to have their second vaccine dose. Latest evidence indicates that a 12-week dosing interval might be more effective than a less than 6-week interval. The Indian Government had promised to supply second vaccine doses. Promises to soul-sisters should not be broken, even in difficult times. 

With a caring and strong leadership, Bhutan is well poised to continue its success. However, as outlined above, Bhutan needs to ensure preparedness, and invest in preventive public health measures backed by science.

By Dr Soumyadeep Bhaumik

The author is a medical doctor and international public health specialist working in The George Institute for Global Health, India. The views are personal.

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