A large part of Bhutan’s success in fighting the COVID-19 pandemic—with zero deaths, zero infections among health workers, low overall infection rates and high patient recovery—despite having the world’s two most populous countries and high case rates in its vicinity can be attributed to WHO’s work in the country.

Bhutan, with WHO’s support, acted early and took bold and decisive steps while implementing core public health measures to detect, test, trace, isolate and treat cases. The country has been scaling up capacities of health workers, hospitals, laboratories and ensuring that the delivery of essential health services are not affected even in times of lockdown.

Leading Bhutan’s fight against COVID-19

When we recently talked with Dr Rui Paulo de Jesus, WHO Representative to Bhutan, it became clear that the country’s record in the fight against COVID-19 was the result of diligent preparation and a timely response to the COVID-19 health emergency.

“Even before COVID-19 outbreak emerged, WHO made efforts and invested a significant amount of funds to enhance preparedness for both natural disasters and disease outbreaks.” Emergency preparedness and response is one of the eight flagship programs in the WHO South-East Asia Region and its importance is emphasized in every workplan, explains Dr de Jesus.

Leading WHO’s activity in Bhutan, he traces the country’s successful COVID-19 preparation efforts all the way back to 2018 when the country underwent a joint external evaluation of its emergency readiness.

WHO has worked closely with the Royal Government of Bhutan to set up a health emergency operations centre as well as a WHO emergency operations centre. Another example of preparation was investing in equipment such as Medical Camp Kit (MCK) tents which can be deployed within hours if there is disruption in providing services in health care facilities. So far, one way the tents have been used is as flu clinics to treat patients with respiratory disease symptoms to prevent them from mixing with other patients and spreading infectious diseases including COVID-19. The clinic also serve as screening site for COVID-19

Medical Camp Kit training in Bhutan

Looking ahead

In November 2019, WHO in collaboration with Ministry of Health conducted a simulation exercise at the Paro International airport. The scenario was a passenger arriving from abroad with a suspected case of a “coronavirus disease”. One month later, “the original Wuhan outbreak was identified and hit us”, he said. 

That exercise involved national authorities including armed forces, police as well as civil aviation, customs and food safety authorities, flight crews, health officials and a volunteer group called Desuung which was initiated under the patronage of his Majesty, the King of Bhutan. The exercise allowed all participants to identify areas of improvement.

Even before the pandemic was known to the world, WHO and Ministry of Health in Bhutan have been working towards strengthening laboratory capacities including upgrading the Royal Centre of Disease Control from biosafety level from ll to lll by providing equipment and building the capacity of staff. This work continues and has been a critical part of Bhutan’s COVID-19 preparedness and response.

Another early key activity was assessing the readiness of the health system and availability of health workers. Using protocols provided by WHO, Bhutan assigned and trained workers to lead the frontline response. Training on donning and doffing personal protective equipment was crucial and was carried out on a weekly prior to the first case so it would become second nature, says Dr de Jesus.

A point of pride for the WHO Representative is that the Organization is the only one listed as part of the Technical Advisory Group for the COVID-19 response. The advisory team provides a daily analysis of the epidemiological situation. In the initial days of the outbreak, the WHO country office played a crucial role in updating and sharing the latest technical guidelines and strategies to design a timely national response with the Ministry of Health. 

Other WHO activities have included supporting the development of the health emergency contingency plan, conducting joint evaluations.  

When the very first case was identified in March, the team was ready to move very quickly. The lab results came at midnight. By 6 am all the primary contacts were identified and isolated and put in quarantine. 

One of WHO’s major contributions to keeping COVID-19 at bay in Bhutan was its timely delivery of personal protective equipment and funding support.

The Organization’s work has received praise from Bhutan’s Prime Minister and Health Minister.

In its response to a pandemic with the severity COVID-19 WHO is not alone. Its partners include the United Nations Development Program, the United Nations Population Fund and other agencies.

The WHO country office team in Bhutan was recognized by the UN system in Bhutan and awarded the UN Certificate for “Facilitating delivery in the time of COVID-19”.

Worth the investment

No country in the world can be 100% prepared for a public health threat, says Dr de Jesus. But if there is anything to learn from Bhutan, it is that early preparedness is the first step toward winning the battle. “It is now evident to all of us that it is worth to invest in emergency preparedness in all aspects. As WHO, we need to continuously review our readiness because the COVID-19 pandemic is not the last one.”

While Bhutan’s forward-looking preparation has helped stop the country from being overwhelmed by the pandemic, a one-size-fits is not appropriate for every country, the Dr points out. Aspects like geography, income, social determinants of health and other factors must be considered.

Echoing WHO Director General Dr Tedros Adhanom Ghebreyesus, Dr de Jesus believes that the response to a global crisis like COVID-19 must be “an all of government approach and an all of society approach”.

While the COVID-19 pandemic is far from over, Dr de Jesus’s messages of readiness and working together are more important than ever.

More about WHO’s response to COVID-19

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