As the world struggled to vaccinate its populations with the Covid-19 vaccine, battling suspicion and prejudice amongst its peoples, how did the Himalayan kingdom of Bhutan succeed in vaccinating its population and controlling the spread of the virus so effectively? Kelzang T. Tashi discusses how a combination of a hands-on approach by the king and the government, alongside a strategic use of religious and ritual intervention, made a difference in protecting the people and society.
The first Covid-19 case in Bhutan was reported on 5 March 2020; the patient was an American man who had entered Bhutan with his wife via India, without any symptoms. Bhutan’s efforts to keep the pandemic under control have been reflected in its impressive statistics thanks to what has been viewed as one of the world’s best Covid-19 response strategies. His Majesty King Khesar Namgyel Jigme Wangchuk was at the forefront of the implementation of pandemic measures, frequently spending days and weeks in high risk areas along the country’s porous border. As of 6 June 2022, there were only 8 active Covid-19 cases although Bhutan has recorded 59,636 cases in total, with 21 deaths according to the Ministry of Health, Royal Government of Bhutan. This places Bhutan in the sixth position after Vanuatu, Kiribati, Tonga, Palau, and North Korea in terms of low Covid-19 related fatalities.
Despite being one of the poorer countries in the world with only 337 doctors for a population of less than 800,000 people, this incredible success at managing the pandemic has offered bigger nations that are struggling to handle the Covid-19 pandemic with lessons ranging from the centrality of attentive leadership to the collective mitigation efforts by all citizens.
One of the aggressive measures to stop the spread of Covid-19 was the enforcement of the mandatory 21-day quarantine for visitors entering the country. This notorious quarantine policy was reduced to 14 days for fully vaccinated travellers in September 2021. From 4 April 2022 this was further reduced to 5 days, with the option of home or hotel quarantine being offered from May 2022. The cost of quarantine at the government-approved facilities was covered by the state and, as of November 2020, the government has spent more than Bhutanese Ngultrum (BTN/Nu.) 289 million / US$ 3.4 million. However, the National Covid-19 Task Force also accepts donations from citizens toward quarantine and testing expenses.
Like elsewhere, there were multiple lockdowns at national and district levels. One town in southern Bhutan underwent a 4-month strict lockdown, and is often dubbed the world’s longest lockdown. Bhutan began gradually reopening its borders for international travel after the implementation of the travel ban in March 2020 by welcoming the first lone tourist in August 2021. Bhutan reopened its borders fully to international travellers on 23 September 2022, although it did receive a larger group of 34 tourists only in early April 2022.
Highest vaccination rate
Bhutan also had the highest vaccination rate and a swift vaccine rollout amidst the chaos provoked by the pandemic in bigger nations. According to the Johns Hopkins University vaccine tracker, 87.16 per cent of the eligible population, including youths and children aged between 5–18 years are fully vaccinated to date. This puts Bhutan among the top ten nations of the world — 8 places behind Malta, Samoa, UAE, Brunei, Chile, Qatar, China, and Cuba — in terms of the highest number of fully vaccinated population.
By July 2021, more than 90 per cent of its adult population were fully vaccinated at a time when half of the world’s population received their first dose, and what’s more, many ‘least developed countries’ — a category to which Bhutan belongs as well — were yet to start their vaccination program. Given the logistical challenges and the notoriety of Bhutan’s rugged terrain, vaccines were delivered on foot and by planes to ensure that the Covid-19 vaccines are available for everyone.
People aged 65 and older and those with underlying conditions or immuno-compromised people were administered the fourth dose of the vaccine in April 2022, and children aged between 5–11 years have already received at least two doses of the vaccine.
In fact, Bhutan was the first nation to commence the roll-out of the Covid-19 vaccine to younger age groups in South Asia. This success story of the vaccine roll-out and the control of the spread of the virus in a resource-challenged country like Bhutan is attributed to the leadership of the committed King and to the ‘solidarity, small size of the nation, and science-based policy-making’.
Buddhist rituals and vaccination drive
One of the forces that complemented the swift vaccination roll-out in the country are its Buddhist rituals. Bhutan received different types of Covid vaccines through generous donations from multiple countries. The first consignment was the 450,000 doses of AstraZeneca, donated by India in early Spring 2021. Given the widespread misinformation which fuelled vaccine hesitancy particularly in relation to AstraZeneca around the world, Bhutan tackled it by resorting to Buddhist rituals and astrological forecasting. The roll-out was therefore delayed until 27 March 2021, sitting on vaccines for months.
This was due to the strong belief in astrology — which is central to Bhutanese Buddhism — and its influence on the everyday lives of its peoples. Senior astrologers from the state-sponsored Pangrizampa Astrology School in Thimphu advised the government that the five-week period between 14 February – 13 March is ‘inauspicious’ and thus the result of any activities held during this time will not be favourable.
According to the Buddhist astrological system, 27 March was deemed the most auspicious day and a person who is female and was born in the Year of the Monkey was the ideal person to receive the first jab at 9:30 am. Accordingly, 27 March 27 was identified as the roll-out day, and a woman born in the Year of the Monkey received the first jab from a female staff who was also born in the same year, in the presence of the Prime Minister, Health Minister, other politicians, and top clergies as fervent prayers were said for a successful vaccination drive. Furthermore, the ritual invoking the Medicine Buddha — the Buddha of healing and medicine in Mahayana Buddhism — was performed for weeks, and the empowerment of Medicine Buddha’s mantra was conferred by the Je Khenpo (the spiritual leader of Bhutan) to people via national television prior to the nationwide roll-out. Holy water and medicinal pills from the ritual were then distributed across the country through the district monastic centres to complement the efficacy of the soon-to-be administered vaccines.
Every package of vaccines that landed at Paro International Airport underwent additional purification through a series of Buddhist cleansing rituals. But this of course did not prevent the district offices from conducting their share of cleansing rituals upon receiving the share of the vaccine even as the fear of Covid-19 infection provoked people to become more interested in Medicine Buddha. Indeed, such cleansing rituals not only helped to increase the acceptance of the vaccine amongst the people regardless of their status, it also established a sense of agency in the vaccine itself, which was seen as somewhat responsible for inverting the adverse effects of the ritually uncleansed vaccine.
In any case, the chanting of Medicine Buddha’s mantra constituted the main prayers among the subsequent vaccine recipients. Even children could recite Medicine Buddha’s mantra now, which would otherwise be quite difficult to memorise. Fortunately, the woman who received the first jab did not experience any side effects of the vaccine, thereby foregrounding the role of Buddhist rituals as well as astrological forecasting. The rituals of and astrological consultations with Buddhist monks by the government have consequently played a vital role in successfully administering the first doses to more than 93 per cent in less than two weeks time, to say nothing about Bhutan’s high vaccination rate today.
The views expressed here are those of the author and not of the ‘South Asia @ LSE’ blog, the LSE South Asia Centre or the London School of Economics & Political Science.
Banner image: Markus Spiske, ‘Chalk crayon symbolic imagery, Coronavirus disease outbreak, COVID-19 – Warning Alarm Message’, 2020, Unsplash.