A rapid and coordinated response to COVID-19 in Bhutan
Bhutan’s first reported COVID-19 case was imported in March 2020. The government reacted quickly to contain the case but new importations remained a considerable risk. Bhutan shares long land borders with India and China and has a relatively low density of health workers; only 370 medical doctors, 1500 nurses, and 700 community health workers serve a population of 760 000 people. Rapid transmission of COVID-19 in Bhutan would threaten to quickly overwhelm the health system as an inevitable consequence. Fortunately, years of infectious disease preparedness activities conducted by the government with technical and financial support from WHO prepared Bhutan to rapidly detect and respond to COVID-19. Bhutan’s rapid, harmonized response prevented thousands of COVID-19 infections and saved hundreds of lives. From 2020-2021, 2660 COVID-19 cases and four deaths occurred in Bhutan, a lower disease burden than many other countries.
Photo Credit: © WHO Country Office, Bhutan
Photo Caption: Tabletop simulation exercises in Phuntsholing, Bhutan.
How did Bhutan do it, and how did the WHO Secretariat support Bhutan?
- By investing in preparedness – In the months preceding the first COVID-19 case arriving in the country, WHO had provided financial and technical support to strengthen screening procedures at Paro International Airport. Thermal scanners were installed to monitor the body temperatures of arriving passengers, and COVID-19 simulation exercises were conducted to develop, assess and test functional capabilities of emergency systems, procedures and mechanisms to respond to COVID-19. In the years preceding the pandemic, the WHO Country Office provided technical expertise to the Ministry of Health to develop the health emergency contingency plan, strengthen International Health Regulation core capacity, and upgrade biosafety laboratory capacity from level 2 to level 3. WHO had also placed medical camp kits around the country to ensure continuity of primary health care services. When COVID-19 arrived, the camps were quickly converted into flu clinics as part of the COVID-19 response.
- By deploying a prompt, evidence-based response – The WHO Country Office updated and shared technical guidelines and strategies with the Ministry of Health, enabling a response that was based on the latest evidence and support from the daily epidemiological situation analysis. WHO was the only organization in the Government of Bhutan’s Technical Advisory Group for the COVID-19 response.
- By assessing the readiness of the health system and ensuring the availability of COVID-19 trained health workers – Bhutan assigned and trained workers to lead the frontline response using WHO protocols. WHO delivered gowns, gloves, goggles, and hundreds of thousands of medical masks to those on the frontline. In June and July 2020, WHO provided financial support for weekly trainings on the proper use of personal protective equipment.
Photo Credit: © WHO Country Office, Bhutan
Photo Caption: WHO delivering personal protective equipment for COVID-19 in Bhutan.
- By strong, coordinated, strategic action that was developed and communicated through timely simulation exercises – In June and July 2020, the WHO Country Office and the WHO Regional Office for South-East Asia provided funding and technical expertise to the Government of Bhutan for nationwide tabletop simulation exercises. Conducted in strategically important areas (five high risk border areas and the capital city), they tested standard operating procedures for pandemic management and identified and addressed gaps to strengthen the pandemic response plan. The 70 national and subnational level officials in attendance were left better equipped to implement COVID-19 protocols as a coordinated team. As one elected city council member expressed, “Attending the tabletop simulation exercise was an enriching experience. During the lockdown, I felt like I could easily communicate with other task force members and support my community. Before the exercise, I did not know how to work with others on the task force. We were ready with standard operating procedures but did not know exactly how to implement them.”
“The simulation exercise was carried out in a very timely manner. We tested the different roles and responsibilities needed for coordinating internal and external partners and the community. It helped us to identify gaps and fix them to strengthen our response. A clear understanding of logistics was necessary to ensure we could provide food, water, and medical services to people during lockdown.”
Thinley Norbu
Chief Program Officer, Department of Disaster Management
Bhutan’s successful response to COVID-19 stems from years of preparedness in addition to a rapid, strongly coordinated, and well-led response. His Majesty, the King of Bhutan, has been at the forefront of the response since the emergence of SARS-CoV-2, building national solidarity through strong and invested leadership. WHO’s activities to support the government by strengthening Bhutan’s preparedness and coordination received praise from Bhutan’s Prime Minister and Health Minister. The WHO Country Office has been recognized by the United Nations in Bhutan with a certificate for “Facilitating delivery in the time of COVID-19".