Employing medical anthropology approach as an additional public health strategy in promoting COVID‐19 vaccine acceptance in Bhutan

Abstract

Bhutan has been commended for their COVID‐19 vaccination campaign, in which the country became the fastest in the world to inoculate nearly all of its adult population in just a few weeks. As a profoundly religious Buddhist kingdom in South Asia, the country successfully utilized a very unique strategy in promoting COVID‐19 vaccine acceptance nationwide. Bhutan incorporated religion, culture, and tradition in their campaign wherein the royal government collaborated with the Zhung Dratsang, the country's central monastic body, in deciding the most auspicious day for the launch of their vaccination rollout by avoiding the one‐month long Dana, selecting the first person to be vaccinated in accordance to the Buddhist astrology, and leading the country in chanting the Sangay Menlha, a mantra believed by many as a powerful prayer in warding off diseases. The launch turned out as a feast for all Bhutanese since it seemingly marked the beginning of the last phase of their COVID‐19 struggle. Incorporating medical anthropology in public health approaches can greatly influence the public, especially when the people are deeply rooted in folk beliefs. This unique strategy can be emulated by many localities with strong influence of cultural traditions and folk beliefs.

1. MANUSCRIPT

As of 1 May 2021, the coronavirus disease 2019 (COVID‐19) pandemic has already reached 220 countries and territories around the world with a total of 150, 989, 419 cases. ¹ Among the affected countries, Bhutan, a landlocked Buddhist kingdom in South Asia, is one of the countries that successfully controlled COVID‐19 with only 1074 confirmed cases since their first recorded case on 5 March 2020. ¹ , ² The total number of COVID‐19 cases in Bhutan only comprised 0.12% of the country's population, which is a definite evidence of their successful COVID‐19 response despite being bordered by India, one of the pandemic’s worst‐affected countries, and China, the country where the first case of COVID‐19 was initially detected. Bhutan was able to intervene quickly and decisively, putting in place fundamental public health programs in identifying, screening, tracing, isolating, and treating COVID‐19 cases. The country has also increased the capacity of medical personnel, healthcare facilities, and laboratories to ensure that critical healthcare services are delivered and provided even during lockdowns. ³ , ⁴

More than a year after the first detected COVID‐19 case in Bhutan, the country has added another strategy in controlling the further spread of the contagious disease, which is vaccination. Although the country started late among other countries in the world, it turned out to be very successful as they have already inoculated 93% of its adult population in just more than 2 weeks. As a result, the vaccine percentage in the country already reached 66% of the total population which is very close to their goal of 70% coverage in order to attain herd immunity. ⁵ With this recent news, Bhutan became the fastest country to inoculate a vast percentage of its people in just few weeks compared to other countries with successful vaccination programs like Israel and Seychelles which took them months to inoculate the same percentage of population as Bhutan did. ⁶

As a matter of fact, Bhutan intentionally delayed its vaccination launch. Some of the vaccines were already delivered in the country two months earlier before the start of the vaccination rollout. Despite the early delivery, the royal government decided to follow the advice of the Zhung Dratsang, a body of Buddhist monks, to delay the commencement of vaccination program in the country. According to the central monastic body, the stars were not favorable and the Dana, which started from 14 February to 13 March, was an inauspicious month that might adversely affect the success of the country’s vaccination program. Since Bhutan is a deeply religious nation, the royal government and the Ministry of Health heeded the central monastic body's advice of inoculating its people after the Dana. ⁷ At the same time, the Dana also provided more time for the government to prepare for their vaccination strategy. ⁸

Led by the Chief Abbot of Bhutan, the central monastic body held a 3‐day ceremony of Sangay Menlha, a Medicine Buddha mantra, which was participated by thousands of Bhutanese through their televisions and social media platforms. ⁹ The mantra, which is believed by many Bhutanese as a powerful prayer to ward off diseases, was conducted a few days before the launch to match with the arrival of the additional doses of COVID‐19 vaccines. ¹⁰ On 27 March 2021, the chosen auspicious day by the Zhung Dratsang, the first vaccine was administered in a woman born in the Year of the Monkey, following the Buddhist astrology. The jab took place in Thimpu, the country's capital, at the fortunate and auspicious time of 9:30 in the morning while prayers were being chanted with lighted butter lamps. ¹¹ The event was like a feast for all Bhutanese since it seemingly marked the beginning of the last phase of their fight against COVID‐19 in the country. The occasion which was set by the central monastic body also increased vaccine acceptance in the country since most Bhutanese are deeply religious. Bhutan successfully utilized a very unique approach, wherein religion, culture, and tradition were all incorporated, in promoting COVID‐19 vaccine acceptance nationwide.

The success of the country’s vaccination program was not only attributed to the government’s collaboration with the Zhung Dratsang but also with the Desuups, a group of volunteers known as guardians of peace, which was initiated by the King of Bhutan. ¹² They were able to deliver vaccines to healthcare facilities, ensure people showed up for appointments, and inform them about the COVID‐19 control measures. ¹³ Their contribution in the COVID‐19 response has been very essential and indispensable to a country with only 37 physicians and less than 3000 healthcare professionals. ¹² Additionally, the success of the vaccination program is also credited to the collaborative leadership of the King, the Prime Minister who is a physician, and the Health Minister who is an epidemiologist. The leaders of Bhutan based their policy responses on evidence‐based public health strategies while respecting cultural traditions. The King also showed his deep support for their policies, which greatly influenced the public in understanding the current situation. ⁴

As a deeply religious Buddhist kingdom, Bhutan did not only utilize its existing public health strategies in scaling up the COVID‐19 vaccine acceptance in the country, but also employed medical anthropology approach. Incorporating traditions and beliefs in public health approaches can greatly influence the public, especially when the people are deeply rooted in folk beliefs. Bhutan's exceptional efforts are very commendable not only because the country became the fastest in the world to vaccinate nearly all of its adult population in just a short period of time, but also utilized a very unique approach to promote vaccine acceptance wherein cultural traditions were integrated in their scientific‐based public health strategies. This unique strategy can be emulated by many localities with strong influence of cultural traditions and folk beliefs.

ETHICS STATEMENT

Not applicable.