Overcoming COVID-19 the Bhutanese Way

Bhutan is among a handful of countries in the world with more than 90 percent of its eligible population fully vaccinated and boosted. The Himalayan kingdom with a little over 750,000 people has lost only nine lives to COVID-19 to date. This is no mean feat for a small country with limited resources.

Not much has changed over the last two years since Bhutan caught international attention through its remarkable handling of the pandemic, despite being resource challenged. Able, informed, and compassionate leadership continues to set the country apart. Bhutan’s prime minister and foreign minister are doctors while the health minister is a public health expert and the incumbent president of the World Health Assembly.

The king of Bhutan, Jigme Khesar Namgyel Wangchuck, has gone above and beyond to protect his citizens. He instituted a National Resilience Fund (NRF) in April 2020 to provide economic relief to Bhutanese impacted by COVID-19. The fund grants monthly income support and loan interest payment support. The support is ongoing, and replenished through the king’s own funds. Prime Minister Dr. Lotay Tshering, in his State of the Nation 2021 report, stated that the fund had offset about $39 million in economic losses. To date, about $52.2 million has been spent supporting 54,000 individuals and more than 100,000 loan account holders from across various sectors impacted by COVID-19. The king has repeatedly said that money can be replaced, but lives cannot.

Besides economic support, the king regularly visits regions affected by COVID-19, inspecting services and providing moral support to frontline workers. The visits are mostly on foot without any VIP comforts. He was already the people’s king, but his benevolence during the pandemic has endeared him even further to his citizens. The most visible proof of this is through the institution of De-suung, a national volunteer program launched by the king in 2011. Before the pandemic, less than a thousand Bhutanese signed up annually. During the pandemic, thousands applied for a spot in one training batch, crashing the website.

Participants in the program, known as Desuups or volunteers, are deployed in times of trouble, disasters, and whenever the need for an extra pair of hands arises. Unofficially dubbed the king’s army, thousands of these volunteers have been serving as frontline workers assisting the armed forces and medical personnel since 2020. During the pandemic, more than 21,000 Bhutanese trained as volunteers. In a historic first, trans women also joined as Desuups. Without these volunteers, successful management of COVID-19 would have been quite impossible.

Impact of COVID-19 on Various Sectors

Bhutan’s economy contracted by 10.08 percent in 2020, the biggest decline in the country’s history. However, thanks to hydropower, much of the impact was absorbed. The hydropower sector contributed at least 24 percent of direct revenue to the national treasury. It continues to play an important role in the overall balance of trade. As of the second quarter of 2021 (April-June), it offset about $77.41 million in trade deficit.

Economic Affairs Minister Loknath Sharma predicted a 2-3 percent growth rate for 2021 despite the hurdles presented by the pandemic, and an even higher growth rate for the next few years with the relaxation of COVID-19 safety measures.

“We had to balance economic growth with safety of our people till now. Health has been a priority,” the minister said. “Now that the majority of the population has been vaccinated, we will be focusing on the construction of hydropower projects and pushing to commission the 1020 megawatt Punatsangchhu-II hydroelectric project by 2023.”

Sharma added that these projects will stimulate economic activity, especially for hard hit areas like the construction sector.

Besides hydropower, tourism contributes the most to Bhutan’s treasury. There was a 90 percent drop in direct revenue from tourism in 2020; earnings fell from $27.23 million in 2019 to $2.63 million in 2020. More than 50,000 Bhutanese have been impacted in the tourism sector.

“COVID-19 has devastated the tourism industry. 95 percent of income has been lost,” said Sonam Wangchuk, chairperson of the Hotel and Restaurant Association of Bhutan (HRAB). “But His Majesty has been like a ventilator in the ICU,” Wangchuk added, referring to the financial support from the NRF.

There was a lone tourist in 2021, creating some excitement, but no other tourists followed. If Bhutan lifts its quarantine for international travelers, the Tourism Council of Bhutan (TCB) projects an annual arrival of 50,000 tourists. This is based on the World Tourism Organization’s (UNWTO) global forecast, said Dorji Dhradhul, the director general of the TCB. But it will not be until 2025 that the country can expect tourist arrivals to reach 2019’s peak of 300,000.

Bhutan still has a strict quarantine in place, with 14 days for vaccinated travelers and 21 days for the unvaccinated. By the end of April, this will be reduced to five days for the vaccinated and 10 days for the unvaccinated as part of the new “dynamic COVID-19 strategy” announced in March.

Dhradhul of the TCB is optimistic. “Bhutan will do well as a travel destination when things settle down. It will be a slow start as global travel itself is inconvenient, but slow is better for Bhutan in the long run as we will be better prepared to cater to tourists in the new normal. If even a hundred tourists leave Bhutan unhappy, it will undo all our achievements over the last 50 years.”

The tourism and services sector has the largest share of non-performing loans, amounting to about 2 billion Bhutanese ngultrum (around $26.3 million). Hundreds of these loan account holders are beneficiaries of the NRF, so hoteliers worry about life after royal support. Wangchuk, the HRAB chair, shared that without continued financial concessions from the government till the sector gets back on its feet, there is the real danger of an economic blackout.

Sonam Dorji, the executive director of the Association of Bhutanese Tour Operators (ABTO), echoed Wangchuk. “It will be an uphill task to reach pre-COVID times. The government should provide the tourism sector further fiscal and non-fiscal concessions until then. The multiplier economic impact is undeniable. It should not focus on direct revenue alone.”

Many in the tourism sector have pivoted to other businesses to survive during the pandemic. Some have ventured into real estate, others into retail, and quite a few have opted to farm on government-leased land. Hotels have turned into quarantine centers, apartments, and even hostels. “It’s not about sustainability, it’s about survival,” said Wangchuk.

Tshering, the prime minister, said the government will continue to offer business licenses, loans, and other forms of support to the ailing sector.

The impact of COVID-19 on education has been the most visible. More than 170,000 students were affected. There was a paradigm shift as teaching moved to platforms like television, radio, and the internet. Hundreds of teachers volunteered for tele-education and thousands contributed virtually.

While it was a much-needed step in the evolution of teaching, the circumstances under which it happened were less than ideal. Since the switch was made in emergency mode, Bhutanese students faced challenges in accessing smartphones, television, and even the internet despite the government offering a special data tariff for students. Self-instructional materials were produced quickly and distributed to students without access to technology as well.

Although great effort was made by the government, teachers, and students to continue learning through the pandemic, a UNICEF report on COVID-19’s impact on education does state that most Bhutanese students did not find online learning as effective and affordable as classroom learning. High schools reopened in mid-2020. Other schools, colleges, and early childhood care and development programs re-opened by early 2021. The government, prioritizing education, took special measures like moving students from high-risk to low-risk areas to prevent interrupted learning in schools, and even made special arrangements for board exams to be taken in containment mode while many parts of the country remained under lockdown in March 2022.

Social Impact of COVID-19

Around the world, the pandemic made domestic violence worse, and Bhutan was no exception. Although government and civil society organizations (CSOs) stepped up their advocacy efforts as well as provision of services, there was a 53.5 percent increase in reported cases of domestic violence by the end of 2021. This is as per records maintained by RENEW, a CSO working to protect and uplift women and girls and survivors of gender-based violence. Shelters were set up for domestic violence survivors by the end of 2020 upon royal command.

One upside of the pandemic was that mental health was identified as a top priority right from the start. A national mental health taskforce was created to cater to the mental health needs of the population. The queen of Bhutan, Jetsun Pema Wangchuck, also initiated the construction of the country’s first hospital for mental health and well-being in November 2021. At the moment, mental health services are extremely limited, with only two psychiatrists, six clinical counselors, and a handful of education counselors available in the country.

Health Minister Dechen Wangmo says mental health is important for a country known for its Gross National Happiness (psychological well-being is one of the nine domains used for measuring GNH). The minister added that the royal initiative would bring much needed attention to mental health and help build a better system of care.

Transition in COVID-19 Management

After two years of a zero COVID-19 policy, the government is now moving toward a dynamic COVID-19 strategy that looks at more than prevention and mitigation. The announcement was made in March 2022 amid growing frustration with the capital, Thimphu, and several districts in lockdown.

Besides reducing international travel quarantine times, this new phase is a major pivot from what was done previously and will focus mostly on protecting Bhutan’s vulnerable population. There will no longer be contact tracing and bi-monthly testing for high-risk Bhutanese, and there will be no more testing of asymptomatic cases. Moving forward, isolation centers will only be for symptomatic cases. Asymptomatic people will isolate at home. The government will soon be allowing the sale of home test kits in the country as well.

The king has instituted reverse isolation facilities in all 20 districts of Bhutan for the care of vulnerable Bhutanese during a surge in community cases. The Health Ministry has begun the registration of Bhutanese with health comorbidities or disabilities, those who are above the age of 65, and those who are destitute so they may be protected. These facilities will have dedicated health professionals and personal caregivers.

Despite relaxing its COVID-19 management, the government has also made it clear that Bhutan, unlike other countries, is in no position to live with the virus. Even now, with extensive preparedness the country has five COVID-19 hospitals in addition to the existing hospitals, providing a little over 2,000 beds in total nationwide. Bhutan has more than 300 doctors, but it still falls short of the WHO requirement of one doctor per 1,000 population. It has one ICU expert and one chest specialist. Despite limitations, 500 nurses and 100 general duty medical officers have been specially trained to deal with COVID-19 over the last two years. There is also a virtual clinical management team comprising doctors attending to every positive case in the country.

But this has come at a cost.

Wangmo, the health minister, noted that the impact of COVID-19 management on routine health services has been significant. As these services are the need of the hour, the health system will prioritize maintaining low hospitalization rates and preventing premature mortality due to COVID-19, she said. As of mid-March, the hospitalization rate was at 0.18 percent despite an unprecedented surge in Omicron infections.

Bhutan recorded its highest daily count of new COVID-19 cases – 562 – in mid-March. The daily tally of active cases jumped from 14 in January to more than 2,000 active cases by February and over 5,600 in mid-March. The Omicron variant has infected more than 15,000 Bhutanese to date and continues to spread despite targeted lockdowns. As of late March, however, it seemed the worst of the Omicron surge was past, with case counts beginning to fall.

Hospitalization has been low due to the majority of the population being fully vaccinated. The country’s first nationwide vaccine campaign in April 2021 made global headlines as one of the fastest COVID-19 vaccination drives in the world. A full 93 percent of Bhutan’s eligible population was vaccinated in less than two weeks. The second nationwide vaccine rollout in July 2021 was also internationally lauded for its speed. More than 85 percent of adults were vaccinated within a week. About 97 percent of children from 5-11 years were vaccinated within a week in March 2022 as well.

Community Vitality and Public Trust

The pandemic brought out the best in Bhutanese. The rich and poor alike have offered to help in cash and in kind throughout the pandemic. Landlords waived rent for a certain period, farmers offered their homes and produce for free, and hotels were volunteered as quarantine centers when the country lacked them. At the behest of the public, the government also set up a donation account for Bhutanese to contribute toward COVID-19 relief efforts.

Buddhism is an integral part of life in Bhutan. It has remained central in the fight against COVID-19 too. The monastic community across the country has been engaged in daily prayers for the safety of Bhutanese and the world at large since the start of the pandemic. Vaccine doses are greeted at the airport with special prayers. The first nationwide vaccination campaign started on an auspicious date, and the first jab of the vaccine happened only after prayers. A young woman was chosen according to the year of her birth to take the first vaccine and a little girl was chosen the same way to take the first vaccine for children to ensure a favorable rollout of the vaccination campaign. The Je Khenpo or chief abbot and other religious leaders also influenced Bhutanese to trust science and vaccines via national media and other platforms.

Despite the various challenges brought on by the pandemic, public trust in Bhutanese leadership continues to remain high. The government holds regular press briefings, and publishes a daily health dashboard with updated COVID-19 data so the public remains informed. Dissenting voices on the government’s pandemic management have increased due to the impact of multiple lockdowns on financial security, but these are expected to fade as the country switches to its a dynamic COVID-19 strategy, in which lockdowns will be used only as the last line of defense. The general population overall appears to be confident about Bhutan not having to see the worst of the pandemic due to the country’s vaccination status as well as a surveillance system that routinely tests high-risk groups.

What really does set Bhutan apart, though, is that it has a leader sensitive to the needs of the people in its king – a leader who finds time to send care packages to every citizen who tests positive, including babies, while leading the battle against COVID-19 as a full-time frontline worker. Over the last two years, the king has spent more days with his subjects than with his family in his palace.

Hope is what is required for weary hearts to trudge on in battle, and the king is hope personified for all Bhutanese.