As we come together to celebrate the 94th birth anniversary of our beloved Royal Grandmother Her Majesty Ashi Kesang Choden Wangchuck, our hearts fill with lasting admiration and profound gratitude for Her Majesty’s tireless resolute, resilience, and dedication in nurturing our King, country and the people. Of the many farsighted initiatives, Her Majesty’s legacy in healthcare is nothing short of extraordinary.

With boundless compassion and unwavering perseverance, she championed many causes aimed at improving the health and wellbeing of Bhutanese from all walks of life. And today, as we ponder on our achievements and limitations to chart the way forward to fast-track progress towards 2030 global and regional commitments, Bhutan’s health sector will undoubtedly harvest the fruits of Her Majesty’s decades of hard work and dedication. 

I remain inspired that Her Majesty, in her manifestation as a public health advocate, changed the course of Bhutan’s public health journey through the introduction of the essential vaccine program in the country.  In Bhutan, as early as the late 1960s, vaccines have saved hundreds of lives and averted thousands of disabilities, mostly those of our precious children. 

Even prior to the official launch of the essential vaccine program on 15thNovember 1979, Her Majesty has been a fervent advocate of national immunization programs, recognizing its invaluable role in saving countless young lives and ensuring that the future of our country is saved from the scourges of infectious diseases.  

It is interesting to note that just a month back in April, health ministries around the world came together to celebrate the 50th anniversary of the Expanded (now Essential) Programme on Immunization (EPI) globally. The EPI, which the WHO started in 1974 with a goal to save children from infectious diseases secured 154 million lives till date and led to 40 percent global reduction in infant mortality. 

While the idea of immunization prevailed before that, in May 1796 English physician Edward Jenner conducted the first ever inoculation of an 8-year-old James Phipps that later led to the development of what we know as vaccines today. According to the WHO, till date the world holds a repository of vaccines that can save humanity from more than 20 life-threatening diseases. 

This brings us to the vaccines repository of Bhutan, and one that is a special gift to the young girls from Her Majesty the Royal Grandmother is the Human Papillomavirus (HPV) Vaccine. 

During the early bloom of the spring when schools resume each year, young Bhutanese girls in sixth grade queue to get their HPV shots. The young faces appear as innocent and oblivious of its benefits, let alone know the fact that more than half the girls at their age around the world are deprived of this life saving gift. But here, Her Majesty the Royal Grandmother has made it possible for our girls. 

Time travel back to almost a century when the first papilloma virus was discovered in 1933 by virologist Richard Shope. More researches and discoveries ensued, with German virologist Harald zur Hausen publishing his work in the 70s that established HPV as a cause for cervical cancer and successfully found HPV-16 and HPV-18, the two HPV subtypes we now know to cause cervical cancer. What came out of Dr. Zur Hausen’s discoveries was a pathway for the creation of HPV vaccines which is in common use at present. 

The HPV vaccine to prevent cervical cancer was approved by the FDA in 2006 and was later recommended by the World Health Organization in 2009.  HPV is the most common viral infection in the genital tract and majority of the cervical cancers are caused by infections from carcinogenic HPV types which can be effectively controlled through targeted vaccination. 

Since the development of the HPV vaccine, it has been widely introduced in high-income countries. Unfortunately, due to lack of resources and political will, its adoption in low- and middle-income countries are still low despite the cervical cancer being a leading cause of death amongst women in low- and middle- income countries. 

But the situation in Bhutan is wonderfully unique. Thanks to Her Majesty the Royal Grandmother, we were the first country in the region to introduce HPV vaccine on 5th May, 2010, only a year after WHO’s recommendation.  Through the goodwill and blessing, Her Majesty brought together Merck, the vaccine producer and Australian Cancer Society who supported the HPV introduction. In collaboration, Bhutan launched the HPV vaccination programme for girls aged 12–18 years against four of the most common and carcinogenic HPV types. 

The campaign, which was first in the WHO Southeast Asia Region had a resounding success, with an initial reported coverage reaching about 95 percent in the targeted age group.  Building on the success and recognizing the urgent action to save women and eliminate cervical cancer, Bhutan became the only low middle income country to introduce gender neutral HPV program with highest coverage of 97 percent in 2020 despite the numerous challenges presented by the pandemic.  Although almost all countries in the Southeast Asia region today have introduced HPV as part of their routine vaccine schedule, access and coverage is an uphill battle with the regional coverage below 10 percent. 

Being a woman and from a region with the highest rate of cervical cancer cases and deaths, it is with deepest reverence that we offer our heartfelt gratitude to Her Royal Grandmother. Knowing factually that a woman dies from cervical cancer every two minutes and that the likelihood of it happening  in low middle income countries is considerably high, we the Bhutanese women are blessed beyond words for Her Majesty’s profound and farsighted  initiative. 

When we look back today, the decade of 1970s when the vaccine program was introduced in Bhutan, was also a period when our young King had to take on the sacred duty of the Nation at a tender age, following an untimely demise of his father. Despite circumstances that we cannot even comprehend today, Her Majesty the Royal Grandmother provided immeasurable strength, courage and direction to the Nation at the time. 

Today, as we look into the future and project our trajectory towards delivering on the global agenda of cervical cancer elimination by 2030, Bhutan and Bhutanese women will fare exceptionally well. We have not only integrated HPV vaccine into our routine immunization program, but also adopted HPV DNA testing as a part of our screening programs. Come 2030, Bhutan may be amongst very few countries in the world that would go on to achieve the global target of cervical cancer elimination because of Her Majesty the Royal Grandmother’s profound stewardship. 

Public health is not just about science, but about taking bold decision, having the courage to do what is right and possessing the sincerity and determination to achieve our collective goal. And to us today, Her Majesty the Royal Grandmother personified the best of public health.  From all the women and young girls, we offer our deepest and heartfelt gratitude to Her Majesty the Royal Grandmother for the giving us rare gift to embrace the miracle of life! 

Contributed by

Dechen Wangmo