Bhutan’s Health Minister on Navigating the Pandemic as a Small State

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Bhutan’s Health Minister on Navigating the Pandemic as a Small State

Dechen Wangmo, the 44-year-old health minister of Bhutan and the newly elected president of the World Health Assembly, shares her goals for advancing world health.

Bhutan’s Health Minister on Navigating the Pandemic as a Small State

Her Excellency Dasho Dechen Wangmo, in her capacity as president, formally closes the 74th World Health Assembly on May 31, 2021.

Credit: Ministry of Health, Royal Government of Bhutan

Her Excellency Lyonpo Dechen Wangmo, the 44-year-old health minister of Bhutan and the newly elected president of the World Health Assembly (WHA), aims to pursue three main goals in her new position at WHA: one, build a humanitarian corridor for exchange of health resources; two, make the World Health Organization’s programs and interventions available for the most vulnerable populations; and three, improve access to routine non-COVID-related health services amidst the pandemic.

“Inequities like not having adequate access to medicines, PPEs, therapeutics, diagnostics were really exacerbated under the traditional fault lines of economic status, country’s influence, and more,” she told The Diplomat.

“This is where I am calling the WHO member states to come together to decide a safe humanitarian corridor where you have uninterrupted supplies of these essential commodities, especially during a public health crisis. This pandemic has shown that geographical boundaries don’t matter when it comes to diseases.”

Bhutan, a small constitutional monarchy in South Asia, has been one of the most successful countries globally in combating COVID-19 – a success Wangmo aims to replicate at the WHA, the highest health policy setting body in the world and the forum through which the World Health Organization (WHO) is governed by its 194 member states.

While joining politics was never on her agenda, Bhutan’s increasing focus on the health agenda drove Wangmo to run for political office in 2018. On December 17, 2020, she was conferred the “Red Scarf,” one of Bhutan’s highest civilian honors, by His Majesty Jigme Khesar Namgyel Wangchuck, for her service to the nation.

“I was in the U.S. and decided to move back to contribute to nation-building,” she said. “I had a wonderful childhood, free education, free health[care], and I wanted to ensure that my children have the same Bhutan as I did growing up. I have a 9-year-old boy and I want him to have a good-quality education, good-quality healthcare, and not have to worry about spending your whole life’s earning on trying to beat a disease.”

Healthcare is predominantly public financed and managed in Bhutan and is also one of the nine key domains to measure Gross National Happiness (GNH), Bhutan’s alternative measurement to GDP. According to Wangmo, a big challenge to Bhutan’s public health strategy was the shortage of medical personnel and infrastructure in Bhutan. The Health Ministry called Bhutanese students abroad studying in different parts of the world to come back and serve the nation.

“Bhutan has one ICU doctor in the country so initially when we started modeling our worst-case scenario for Bhutan it was daunting numbers,” Wangmo remembered. “I said, my God, we really need to focus [on] prevention.”

So far, only one person has died due to COVID-19 in Bhutan since the outbreak began in March 2020. The small Himalayan kingdom wedged between India and China has managed to vaccinate nearly 95 percent of its population in a short duration, largely aided by India’s “vaccine diplomacy.” According to Wangmo, Bhutan was successful in mitigating the harms of the pandemic due to the three S’s: solidarity, small size of the nation, and science-based policy making.

“Wearing masks was never a political debate, physical distancing was never a political discussion. We knew that there is science and that there is value in the belief in science,” she said. “If you look at our strategies, we have gone into aggressive testing in the hope of picking up cases early on. We believed in the three Ts – testing, tracing, and providing treatment.”

Wangmo’s experience with Bhutan’s struggles to access infrastructure and commodities in the first wave informed her focus for the WHA and Bhutan’s strategy to mitigate the impact of the second wave in South Asia. Vigilance and case detection is at the forefront and Bhutan has instituted an enhanced population-based surveillance system where the country is routinely testing asymptomatic people, high-risk communities, frontline workers, and health communities.

“We are extremely worried about getting our health system compromised,” she added. Bhutan has seen the consequence too closely as cases spiked in neighboring India and its healthcare system collapsed. Citizens are still struggling and pleading online and to find hospital beds, medicines, and oxygen.

For resource-challenged nations like Bhutan, Wangmo recommends a “whole of” collective approach that focuses not just on the public health interventions and preventions but also on people’s economic and social wellbeing. Along with a strict 21-day lockdown in the first wave, Bhutan was one of the few countries to provide monetary relief very early on in the pandemic. Through the royal kidu program, it was able to protect the vulnerable section of the society and provide for those who lost their jobs and livelihoods in both formal and informal sectors, particularly those in the tourism sector that was badly impacted as borders shut down.

“Lockdowns are never easy and sometimes they bring out the worst in humans. These services [for vulnerable populations] are equally important when designing a framework,” Wangmo said.

Dechen Wangmo is the only female minister in the Bhutanese cabinet. She also leads Bhutan’s cross-party women’s caucus in the Parliament and speaks of how it has been instrumental in not just encouraging female leadership but also pursuing legislative programs with a gender lens.

Despite doubling from last election, female political participation in Bhutan remains low at just 15.2 percent in 2018. Even in global bodies like the World Health Assembly, just 23 percent of the 2020 delegations were female-led, a decline from the peak of 31 percent in 2017. Wangmo argues that while politics is a non-traditional role for the women of Bhutan, the people have shown that women are electable, with seven out 10 women who ran for office being elected in the 2018 elections.

“In our part of the world you don’t see many [female] role models. For many young girls it is hard to imagine women can lead, you have to see something to internalize it, to visualize it. The more of us they see, the more women, I hope, will come forward.”