Commentary: How mountainous, sparsely populated Bhutan successfully ramped up COVID-19 vaccination

But getting hold of second doses was a challenge. India’s second wave soon arrived, causing it to prioritise domestic immunisations and ban vaccine exports.

Bhutan’s immediate source of doses had dried up, while India’s mounting caseload over the border posed a rapidly increasing infection risk.

After a tense wait, 500,000 doses of the Moderna vaccine came from the United States through COVAX, the vaccine-sharing initiative.

An additional 250,000 doses of the AstraZeneca vaccine came from Denmark, followed by supplies of AstraZeneca, Pfizer and Sinopharm vaccines from Bulgaria, Croatia, China and other countries.

DISTRIBUTION CHALLENGES IN THE REMOTE HIMALAYAS

Distribution was another big part of the puzzle. Bhutan is remote. Land access is only possible on a few roads from India.

The COVAX vaccines arrived by air at Paro International Airport. One of the most challenging landings in the world, Paro sits in a deep valley. The surrounding peaks are as high as 5,500m.

Domestic transport is also challenging. Bhutan’s population of almost 750,000 is scattered over an area roughly the size of Switzerland. Not all of the mountainous country is accessible by road.

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