How is this possible? Since the novel coronavirus was first identified more than a year ago, health systems in rich and poor countries have approached collapse, economies worldwide have been devastated, millions of lives have been lost. How has Bhutan—a tiny, poor nation best known for its guiding policy of Gross National Happiness, which balances economic development with environmental conservation and cultural values—managed such a feat? And what can we in the United States, which has so tragically mismanaged the crisis, learn from its success?In fact, what can the U.S. and other wealthy countries learn from the array of resource-starved counterparts that have better weathered the coronavirus pandemic, even if those nations haven’t achieved Bhutan’s impressive statistics? Countries such as Vietnam, which has so far logged only 35 deaths, Rwanda, with 226, Senegal, with 700, and plenty of others have negotiated the crisis far more smoothly than have Europe and North America.
These nations offer plenty of lessons, from the importance of attentive leadership, the need to ensure that people have enough provisions and financial means to follow public-health guidance, and the shared understanding that individuals and communities must sacrifice to protect the well-being of all: elements that have been sorely lacking in the U.S.America has “the world’s best medical-rescue system—we have unbelievable ICUs,” Asaf Bitton, executive director of Ariadne Labs, a Boston-based center for health-systems innovation, told me. But, he said, we have neglected a public-health focus on prevention, which socially cohesive low- and middle-income countries have no choice but to adopt, because a runaway epidemic would quickly overwhelm them.“People say the COVID disaster in America has been about a denial of science. But what we couldn’t agree on is the social compact we would need to make painful choices together in unity, for the collective good,” Bitton added. “I don’t know whether, right now in the U.S., we can have easy or effective conversations about a common good. But we need to start.”

Over the course of three reporting trips to Bhutan since 2012, a word I heard innumerable times was resilience. It alluded to the fact that Bhutan has never been colonized, and to its people’s ability to bear hardships and make sacrifices. Resilience, I came to learn, is core to the national identity.

That mattered when the coronavirus began spreading early last year. At the time, Bhutan looked like a ripe target. It had only 337 physicians for a population of around 760,000—less than half the World Health Organization’s recommended ratio of doctors to people—and only one of these physicians had advanced training in critical care. It had barely 3,000 health workers, and one PCR machine to test viral samples. It was on the United Nations’ list of least developed countries, with a per capita GDP of $3,412. And while its northern frontier with China had been closed for decades, it shared a porous 435-mile border with India, which now has the world’s second-highest number of recorded cases and fourth-highest number of reported deaths.Yet from the first note of alarm, Bhutan moved swiftly and astutely, its actions firmly rooted in the latest science.On December 31, 2019, China first reported to the WHO a pneumonia outbreak of unknown cause. By January 11, Bhutan had started drafting its National Preparedness and Response Plan, and on January 15, it began screening for symptoms of respiratory ailments and was using infrared fever scanning at its international airport and other points of entry.Around midnight on March 6, Bhutan confirmed its first case of COVID-19: a 76-year-old American tourist. Six hours and 18 minutes later, some 300 possible contacts, and contacts of contacts, had been traced and quarantined. “It must have been a record,” Minister of Health Dechen Wangmo—a plain-spoken Yale-educated epidemiologist—told the national newspaper Kuensel, with evident pride. Airlifted to the U.S., the patient was expected to die, but survived. According to an account in The Washington Post, his doctors in Maryland told him, “Whatever they tried in Bhutan probably saved your life.”
Bhutan then went further. At the end of March, health officials extended the mandatory quarantine from 14 to 21 days—a full week longer than what the WHO was (and still is) recommending. The rationale: A 14-day quarantine leaves about an 11 percent chance that, after being released, a person could still be incubating the infection and eventually become contagious. Bhutan’s extensive testing regimen for people in quarantine, Wangmo added at a press conference, was “a gold standard.”
While President Donald Trump was railing against coronavirus surveillance, Bhutan launched a huge testing and tracing program, and created a contact-tracing app. Last fall, the health ministry rolled out a prevention initiative called “Our Gyenkhu”—“Our Responsibility”—featuring influencers such as actors, visual artists, bloggers, and sports personalities.
But its victory, at least so far, in staving off the worst of the pandemic might give Bhutan the confidence and drive it needs to tackle these other challenges—and on its own terms. After all, that’s another aspect of resilience: moving forward when the crisis has passed.

It should be noted that a large number of smaller countries,  small island states, and those more remote from the international travel network have often done better.  This is due to a number of factors,  remoteness, social integration,  responsive governments etc.   It will be very important in the future to clearly analyze why some countries and regions have been more able to respond and better able to protect their citizens.  This may be critical to success in the next global pandemic and also can inform responses to other important risks such as climate change.

MADELINE DREXLER is a Boston-based journalist and a visiting scientist at the Harvard T. H. Chan School of Public Health. She is the author of Emerging Epidemics: The Menace of New Infections and has written extensively in recent years about Bhutan.