Bhutan has achieved and maintained seven out of eight South-East Asia Regional (SEAR) Vaccine Action plan (2016 -2020) goals.

Strengthening routine immunisation systems and services, measles elimination and rubella or congenital rubella syndrome control (CRS) is the first two goals of the action plan. 

Senior Programme Officer with the vaccine preventable disease programme, Tshewang Dorji Tamang, said currently Bhutan sustain high immunisation coverage above 90 percent.

However, he said it needed to be sustained with a focus to maintain the same level of immunisation coverage in all districts and basic health units, targeting difficult to reach area and nomadic population. 

Bhutan eliminated measles before the regional target of 2020 in June 2017. WHO recently announced that Bhutan was one of the first six countries in the region to control rubella and CRS.

Bhutan maintained polio-free status since 1986, achieving the third goal. WHO awarded polio-free status certificate to all WHO SEAR member countries including Bhutan in 2014.

Tshewang Tamang said to sustain polio-free status, it was important to maintain high oral poliovirus vaccines (OPV) coverage above 95 percent in all districts and BHUs.

A high quality of Active Acute Flaccid Paralysis (AFP) surveillance should also be maintained, he said. It is a strategy to actively collect information by visiting health facilities.

Bhutan has achieved the goal to eliminate maternal neonatal tetanus. Tshewang Tamang said the ministry with UNICEF revalidated the Maternal Neonatal Tetanus Elimination (MNTE) status in 2014. The report shows that Bhutan still maintains MNTE elimination status.

“To sustain MNTE elimination status, we should maintain tetanus-diphtheria (TD) two vaccination coverage above 90 percent for pregnant women and maintain high institutional delivery,” he said. 

In institutional delivery, there is less chances of getting tetanus because of the use of sterilised equipment.

Tshewang Tamang said though the current surveillance showed low incidences of Japanese Encephalitis cases in Bhutan, there was a need to strengthen Japanese Encephalitis surveillance in the country. 

Acceleration of the Japanese Encephalitis control is the fifth goal.

“The outbreak of the disease is reported frequently in the border town areas like Assam so, in future, Bhutan might have to go for Japanese Encephalitis vaccine based on the disease burden,” he said.

The next goal is the acceleration of Hepatitis B control. “To sustain Hepatitis B control goal, we need to maintain high Hepatitis B birth dose coverage which has to be given to the newborn within 24 hours of birth and Hepatitis B third dose coverage at all level.”

Bhutan achieved Hepatitis B control in 2017 and a serosurvey prevalence was conducted. The serosurvey found that Hepatitis B prevalence in Bhutan is 1.6 percent. There is no prevalence of the disease in children aged between one and four years. The prevalence of the disease in children aged between five and 17 years is 0.7 percent and 2 percent in adults above 20-years-old.

“Hepatitis B prevalence is very low among vaccinated cohort,” he said.

In terms of introduction of new vaccines and the acceleration of technology goal, Bhutan currently has 11 antigens into routine immunisation services including the human papillomavirus (HPV). 

Bhutan introduced mumps vaccines in 2016 in the form of measles, rubella and mumps (MMR) vaccine. He said three new vaccines – pneumococcal, rotavirus, and flu vaccines – would be introduced in the country.

Ensuring access to high-quality vaccines is the eight goal of theSouth-East Asia Regional (SEAR) Vaccine Action plan (2016 -2020).

Tshewang Tamang said all vaccines procured were WHO prequalified and brought through UNICEF. “We need to strengthen the capacity of health workers on vaccine and cold chain management skill to maintain the high quality  of vaccine using  standard temperature monitoring device for the vaccine.” 

Dechen Tshomo