After six weeks of the Omicron coronavirus variant battering the country, 77 cities have now been identified as being on red alert in Iran, which is reporting more than 32,000 new cases of Covid-19 per day. Iran is now at the peak of its sixth wave of the disease.
The implementation of the booster, or third vaccination, has been slow across the country, and that, along with the reopening of schools, universities and stadiums and a string of pandemic mismanagement decisions have all played their part in ushering in the new peak. Meanwhile, government officials, including the Minister of Health and Medical Education, are calling for restrictions to be lifted, criticizing the National Coronavirus Taskforce for its resistance. Taskforce officials have repeatedly expressed their concern about reopenings. At the same time, President Ebrahim Raisi heads up the taskforce that his own ministers have been criticizing.
Mistakes Made by the Health System
During the last peak of Covid-19, various officials admitted the different emerging strains of the virus took the country by surprise. At the same time, medical and political experts alike have said officials did not act quick enough and that their stalling severely exacerbated the situation.
"As always, the most important mistake that has been made is procrastination," said Alan Tofighi, a physician and political analyst who spoke to IranWire. “Officials in the Islamic Republic seem accustomed to not acknowledging a new problem until it is too late, and the same is true of Omicron."
Tofighi added that Iranian officials had largely ignored the process other countries were using to predict the speed, intensity and impact of coronavirus outbreaks. "This monitoring system, at a cost of millions of dollars a month, examines the occurrence, emergence, importance and impact of new strains of the virus in communities. These measures are aimed at predicting the future course of the virus outbreak and counteracting it."
A Lagging Vaccination Roll-out
It is hard to understand how Iran, in a short period of time, went from a relatively safe or “blue” situation to a state of red alert. According to the governor of Tehran, the number of hospitalizations has increased by 61 percent compared to the first week of January 2022.
"The Omicron strain has increased the number of cases exponentially," said Tofighi. "In fact, we are in a race against time. The tsunami this virus has created can cause severe disruption to any health care system and, as the number of cases increases, the capacity of a hospital can be saturated very quickly, which can lead to high mortality rate.”
Massoud Younesian, a leading epidemiologist and researcher for the Scientific Committee of the National Covid-19 Taskforce, recently warned that the rate of deaths in the current peak had tripled, and is rising at about four times higher than at previous levels.
Tofighi says one of the key tools for prevention would have been a higher number of fully vaccinated people throughout the population, but this did not happen.
On December 19, 2021, officials confirmed the first case of Omicron in the country. At that point, it had six weeks to increase the rate of vaccination. According to official statistics, about 20 percent of Iranian citizens have received all three doses of the vaccine. The gap between those who had received all three vaccines and those who had received two amounted to 36 million people, meaning the disease had ample opportunity to spread more easily. Between six and seven million people have not yet received the second dose. Six million have not been vaccinated at all.
According to Tofighi, if vaccination had been carried out at pace over the past six weeks, it would have been possible to reduce the severity and impact of Iran’s sixth coronavirus peak.
The Impact of Reopening Schools and Other Public Places
In the last days of January, the situation across the country was relatively calm and the country as a whole was only on a mild, or “blue” alert for coronavirus cases. Although Omicron has been detected in Iran for well over a month, there has been a lack of diagnostic testing, making it difficult to make an accurate analysis of how the virus was spreading.
At the same time, authorities were happy to keep warning people about the spread of the virus. Over the last week of January, Iranian cities moved into orange alert and eventually into red. Finally, on February 3, officials announced that 77 cities were in a state of red alert.
Although the failure to deliver the third dose of the vaccine to a large enough part of the population contributed to the spread of the Omicron strain, the fact that public places such as schools and universities were re-opened undoubtedly contributed to the situation becoming critical.
"Following the calm in the spread of coronavirus, schools and universities were ordered to open and it was even announced that spectators would be allowed to attend stadiums again,” said Tofighi. “This means the authorities thought that everything was over and that it was possible to return to normal. It was the calm before the storm."
He added that the current situation and authorities’ inability to deal with the unexpected arrival of the variant was disgraceful, a costly embarrassment. "The Islamic Republic has once again been caught out, and the people will pay for it.”
The Politics of Restrictions
How governments handled the coronavirus pandemic became a political issue in most countries, and this was true in Iran from the beginning. From the government’s decision to publish statistics that had not yet been proven to the slow vaccination program, the decisions taken were not always based on scientific or medical research.
When it came to schools and universities reopening, President Ebrahim Raisi repeatedly emphasized the importance of students being present in classrooms, a goal echoed by cabinet members. What was largely unheard was the opinion of the National Coronavirus Taskforce.
Meanwhile, the Minister of Health said on January 23 that as long as there was proper ventilation and students maintained social distance, there would be no problem in students returning to classrooms.
Previously, two members of the national taskforce told IranWire they had expressed concerns about the hasty reopening, especially of schools. Epidemiologists and other experts also considered the re-opening unnecessary.
However, as the peak of the sixth wave became obvious, Bahram Einollahi, the Minister of Health, Treatment and Medical Education, began to blame the taskforce, accusing it of failing to approve various proposals linked to restrictions.
"We regularly submit proposals to the taskforce, depending on the circumstances of the crisis, but some were approved and others were not," he said, adding that comprehensive restrictions should be imposed.
Over the last few weeks, Iranian parliament has approved a number of measures, including canceling the president’s planned trips to provinces, but no decisions have been taken regarding further restrictions on the public and their travel and conduct.
"Unfortunately, around the world it is politicians who have the final say in how the pandemic is managed," Alan Tofighi told IranWire. "As a result, global decisions are generally inconsistent with epidemiological considerations.
"In Iran, the weight of political decisions has always outweighed scientific decisions. Not a single epidemiologist agrees with the current situation —the non-compliance with protocols, the incomplete delivery of the third dose and the failure to continue allowing remote working. All of this all is necessary to prevent the spread of the virus. However, the difference between Iranian schools and many parts of the world is that there has been no decision regarding the vaccination of children. In other words, the Islamic Republic has rejected the opinion of the Scientific Committee for the National Coronavirus Taskforce, which is based on epidemiological data. Officials have preferred that schools remain open in order to show that things were normal."
Referring to the latest data regarding Covid-19 among under-18s, Mohammad Hashemi, the head of the Ministry of Health’s information center, said: "Infectious cases in children, which was previously insignificant, now accounts for 20 percent of all cases."
The Problem of Lower-Performing Vaccines
Tofighi, who is currently based in France, told IranWire that European countries had on the whole used more effective vaccines than those acquired for Iran.
"We know Chinese and Russian vaccines are less effective," he said. “In addition, there are no studies on the effectiveness of vaccines produced in Iran. Most of the information available concerns the comments of officials. Currently, the Astrazeneca vaccine is the most effective of the vaccines available in Iran."
But there has been a shortage of the Astrazeneca vaccine in Iran in recent weeks, making it difficult for large numbers of people to receive their second or third doses. Although Astrazeneca was imported into the country, due to high demand, restrictions were placed on who could receive it and under what conditions. In some cases, the vaccine was even banned.
Rumors About the Dangers of Astrazeneca
“All the vaccines have side effects," Tofighi said when asked about rumors about the health risks linked to Astrazeneca. “Decisions about whether or not to use a vaccine are taken using a risk-benefit equation. In other words, it should be considered whether the effectiveness of the vaccine in controlling the disease outweighs the health risks it can pose to some people in the community. According to this equation, in a country like Iran, vaccination is necessary."
"As for Astrazeneca, the manufacturer acknowledged that the emergence of blood clots could be a side effect of the vaccine," he added. "As a result, vaccines in European countries were initially limited to those over 55 years of age. Then, when more effective vaccines like Pfizer, Moderna, and Johnson & Johnson came on the market, they were replaced. The same method should be followed in Iran. Is there a more effective and less dangerous vaccine than Astrazeneca? If the answer is yes, the administration should shift to a more effective vaccine. But in a situation where the vaccines available in Iran are not much different from Astrazeneca in terms of both effectiveness and side effects, the authorities' decision to ban it seemed to be more political than anything else."
“In Iran, there were one or two cases where a person died after receiving the Astrazeneca vaccine,” Tofighi said. “But this does not mean the person died from the vaccine itself. It must be established whether the person died as a result of the vaccine injection or died after the injection for other reasons."