When every dose is made to count

Punakha: Kinley Wangmo, 28, walks into the community health unit of Punakha District Hospital, in western Bhutan, holding her four-month-old daughter close to her chest. She looks slightly flushed with excitement. In a few minutes, her baby will receive the third round of routine vaccines.

As she lays her child on the examination table, health assistant Sonam Tobgay checks the baby’s weight and height. He tests her neck strength and response to sound. He gently presses her tiny fingers to test her grip. 

“Everything is fine,” he says, before preparing the pentavalent and oral polio vaccines.

Sonam has vaccinated children for 28 years, nine years in Punakha. Kinley has not missed a single appointment. Between Sonam’s experienced hands and Kinley’s commitment lies a system that has protected nearly every child from vaccine preventable diseases in Bhutan.

This daily routine at the community health unit in Punakha anchors a national effort that began with the Expanded Programme on Immunization in 1979. Behind what looks simple and routine lies careful planning, reliable supply, and the discipline of health workers.

Over the past decade, Bhutan reduced neonatal mortality from 21 deaths per 1,000 live births in 2012 to 6.9 in 2023, and under-five mortality from 37.3 to 19.5. High immunization coverage, now above 99 percent, has played a central role in this progress, helping protect children from preventable diseases and contributing to longer, healthier lives. 

In the first two years of life, a child in Bhutan receives 13 injections and four doses of oral vaccines. Each visit matters. “Every dose counts,” Sonam says. “If we miss one, the child remains vulnerable to certain diseases depending on which dose is missed.”

Immunization services are fully integrated with maternal and child health services. 

In 2025 alone, over 42,000 children and adolescents were vaccinated and 99.5 percent of pregnant women received protection against tetanus and diphtheria, safeguarding their newborns from neonatal tetanus. 

During winter months, families from the highland communities of Laya and Lunana also visit the hospital. “Ten to 20 people from Laya and Lunana visit us in a month,” says Ugyen Sangay, who has served 26 years as a health assistant. He leads a team of four.

Vaccines must be stored between +2°C and +8°C. In freezing winters, facilities guard against damage. Health workers check temperature recorders twice daily. If the cold chain fails, the vaccine fails.

UNICEF supports procurement, cold chain systems, maintenance and training. All immunization guidelines and manuals are developed with UNICEF support. The cold chain in Punakha and across the country functions because of this partnership.

Parents, who know little about the science behind vaccines, speak of trust. 

Milan Ghallay, 30, and his wife Nar Maya, 28, have brought their first child for the first vaccination. “We feel relieved and happy,” Milan says. “We trust the hospital and the health workers.” The parents have already visited the hospital three times.

Pasang Dolma, 35, from Dagana, who now lives in Punakha, has brought her third child. “I do not know which vaccine prevents which disease,” she says. “But I trust the health workers enough to bring my child for routine vaccination.” 

When parents miss appointments, staff track them through the Electronic Patient Information System and telephone them. They follow up even with families who return to Laya or Lunana after receiving initial doses. “It takes personal dedication to have every child vaccinated,” says nurse Dema, who has served for 30 years and has seen some parents neglecting appointments.

For all the success, challenges remain. The clinic staff says it takes persistence and trust to help parents overcome vaccine hesitancy. “We patiently explain to every parent what the vaccines protect against, how they work, and what minor side effects to expect,” says Sonam Tobgay. “We have to be clear and honest with them to build trust.”  

“I can see change in parents’ attitudes towards vaccination since I started working,” says Dema. “Getting to know the parents personally helps a lot.”