Bhutan's lessons for other low/middle-income countries include the superiority of school-based vaccination and the feasibility of a broad catch-up campaign in the first year.

Pneumomediastinum is defined as the presence of air or other gas in the mediastinum and is also known as mediastinal emphysema [1]. Pneumomediastinum can be categorized as spontaneous (SPM) or traumatic. Traumatic pneumomediastinum is caused by blunt or penetrating trauma to the chest, or iatrogenic injury, such as that produced by thoracic surgery. Mechanical ventilation is a common cause of barotrauma and pneumomediastinum. Pneumomediastinum caused by mechanical ventilation is often considered a type of traumatic pneumomediastinum, rather than SPM (UpToDate). We report a case of spontaneous pneumomediastinum, pneumothorax and surgical emphysema in a 20-year-old patient with COVID-19. He was managed conservatively.

Vaccination remains a key public health intervention against the COVID-19 pandemic. However, vaccine distribution and coverage are variable between countries due to access and implementation issues. Vaccine inequity was evident with some countries having no access to the vaccines while others have initiated multiple booster doses. We share Bhutan’s approach to COVID-19 vaccination and lessons learned during the successful conduct of a nationwide vaccination program. As of 12 December 2021, 80.3% of the Bhutanese population have received at least one dose of COVID-19 vaccine and 77.0% have received at least two doses. Considering age groups, 97.2% of adults (18 years) have received at least one dose and 93.6% have received at least two doses. The first dose coverage for the adolescents 12–17 years was 99.7% and second dose coverage was 92.3% since some were not yet due for their second dose at the time of writing this report. The well-established existing national immunization program was especially useful in the implementation of the national COVID-19 vaccination program. The Bhutan Vaccine System, a digital platform for registration and monitoring of vaccination, was rapidly developed and extensively utilized during the campaign. The selfless leadership of the king, the government, and prior detailed planning with multi-sectoral collaboration and coordination, was the key in this exemplary vaccination program. Bhutan has successfully vaccinated children between 5–11 years with high coverage and no serious issues. Many adults have also received first and second booster doses, based on their risks and preferences.