April 30 – May 6, 2021:

The fourth wave of coronavirus infections now appears to have subsided in most Iranian provinces. But the death toll remains high, at an officially-recorded 300 to 400 per day. Two other variants of SARS-CoV-2 first detected in India and South Africa have also reportedly entered Iran, with cases confirmed in the provinces of Hormozgan, Yazd, Bushehr and West Azerbaijan.

Eid al-Fitr, the holiday that marks the end of Ramadan, will fall this year on Wednesday, May 12 and the National Coronavirus Taskforce has announced that from midday on May 11, private vehicles will not be allowed to travel between provinces. Considering the ban’s scheduled start time, it seems likely most travelers will either end up stuck on the roads or simply make their journeys the night before.

Cases of Two New Coronavirus Variants Are Confirmed

Health Minister Saeed Namaki reported on May 4 that five confirmed and 30 suspected cases of infection with the coronavirus variant first detected in South Africa have been recorded in the southern province of Hormozgan.

He also said three cases of the variant first found in India have been reported in Qom, while at least 10 cases of infection with the so-called “Indian-Californian” hybrid variant have been detected in an industrial complex staffed by Indian workers in West Azerbaijan. Cases of the same hybrid variant have also been detected in Yazd province in a factory employing both Iranian and Indian workers.

Elsewhere, Bushehr University of the Medical Sciences announced that of 21 Pakistani and Indian nationals are in quarantine, of whom three tested positive for the “Indian coronavirus” while nine had been infected with the “original” coronavirus.

As with other so-far recorded variants, the strain identified in India is more infectious and so far appears to spread more quickly between young people. Minoo Mohraz, a member of the National Coronavirus Taskforce, claimed this variant is “very deadly” and the only effective way to fight it would be a “total quarantine” of any province where it is found. She said failing to impose a total quarantine might lead to the spread of the variant across the whole country.

The government has already closed Iran’s eastern borders with Afghanistan and Pakistan. But these borders are historically porous and how effective the latest move will be remains to be seen.

Vaccines: Promises Made, Promises Not Kept

According to Jamshid Ansari, Rouhani’s vice president for Administrative and Recruitment Affairs, Iran has signed contracts to buy more than 90 million more doses of coronavirus: around 21 million from COVAX, the global vaccine-sharing initiative overseen led by the World Health Organization, 60 million from Russia and more than 10 million from China.

This is a big promise. So far Iran has imported only around 2.1 million doses of any type of vaccine for a country with a population of close to 84 million. The vaccines listed above must be injected twice to be effective.

According to the Health Ministry, as of now a total 1,425,767 doses of vaccine have been administered: 1,181,241 first doses and 244,526 second doses. Those inoculated are medical staff and the elderly over 80. The promised date for mass vaccinations has been put back on several occasions and is now set at September 2021, when around 40 million Iranians are supposed to be vaccinated.

This week Deputy Health Minister Alireza Raeesi who is also the spokesman for the National Coronavirus Taskforce blamed vaccine companies for the delay, claiming that they had failed to deliver the promised shipments on time. But at the same time, he claimed that Iran would be one of the first countries to vaccinate the whole population.

Raeesi also called on "international organizations" to arrange for other countries to contribute some of their own vaccine rations from WHO's COVAX program for the vaccination of "foreign nationals" in Iran so that these individuals can receive the jab free of charge.

According to the Iranian census for 2016, more than 95 percent of foreign nationals residing in Iran are from neighboring Afghanistan. This in turn has led to "foreign nationals" being used almost synonymously with Afghans in Iran. Officials say there are also around 1.5 million undocumented Afghan migrants in addition to the nearly 1.6 million who have refugee or other legal status.

Despite the fact that no domestic vaccine has completed phase 3 of clinical trials, officials continue to make outsize promises. On April 30, Hojjat Niki Maleki, head of the information office of the Executive Headquarters of Imam's Directive, which created the CovIran Barekat vaccine, announced that "within the next couple of weeks” one million doses of this vaccine will be produced.

On May 4, Kianoush Jahanpour, spokesman for Iran’s Food and Drug Administration, said it was “expected” that domestically-produced Sputnik V vaccines would be available within the next two months. He reported that four Iranian companies are candidates to produce this vaccine and three of these are now “under review” by the Russian manufacturer of Sputnik V.

Official Coronavirus Statistics

According to official statistics announced daily by the Health Ministry, a total of 2,555 patients lost their lives to Covid-19 in the week ending May 6. With 407 deaths officially recorded, April 30 had the highest number of fatalities for the week.

At the week’s end, 5,155 Covid-19 patients were being treated in ICUs and the total number of officially-recorded coronavirus fatalities came close to 74,000.

At the week’s end the Health Ministry announced that 102 Iranian cities are currently on red alert, 235 are orange, 111 are yellow. No city in Iran is currently on blue alert, the lowest alert level during the pandemic.

May 10 – May 13:

On Monday, the acting governor of the port city of Mahshahr in Khuzestan sounded the alarm about new, more infectious strains coronavirus spreading to and from the city via water corridors. The lack of public awareness about vaccines, he said, was making the situation all the more dangerous.

Speaking at a meeting of the Mahshahr Coronavirus Headquarters, Fereydoun Bandari told those present: "Since the initiation of the city’s vaccination plan, despite all efforts, we have not yet reached the desired level.”

He demanded the media take part in a drive to boost uptake and urged the city’s Friday Imam to encourage people to take up the offer of a jab during sermons for Eid al-Fitr, the holiday marking the end of the Muslim holy month of Ramadan.

The Covid-19 situation in Khuzestan is critical and most of the cities in this deprived province are on red alert. Tensions ran high on Thursday as many people were expected to gather to celebrate Eid in defiance of health protocols set by the government.

Experts across the globe are more or less unanimous that mass vaccination is the only way to bring an end to the SARS-CoV-2 pandemic. But in Iran, authorities up and down the country have publicly remarked on the initial failure of the country’s vaccination plan.

Aside from delayed shipments, there is a terrible fear that even as infection and death rates continue to surge, many Iranians are not willing to get the shot even when offered it. IranWire spoke to a number of citizens and physicians to try to understand why.

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Vahid is a citizen of Andimeshk north of Mahshahr in Khuzestan, a province that was devastated by an early second wave of coronavirus infections last summer.

His elderly mother has been at home for months and has only nominal interaction with her the children and grandchildren. Vahid and his siblings have been eagerly awaiting the day when their 76-year-old mother will be offered the vaccine – but now that the time has come, she has refused to take it.

“My mother says she’s lived her life,” Vahid told IranWire. “She’s not satisfied with the vaccine at all. She says it might make her condition deteriorate and place an extra burden on us.

“We’re also afraid to insist, and we’re also afraid something bad might happen to her, because we’ve heard that vaccines are not without side effects. If something happened, we’d never forgive ourselves."

Vaccine hesitancy is not uncommon in certain parts of Iran, and some experts are already worried that a lack of uptake will have a disproportionate impact on some of the country’s poorer and less-developed communities. “As far as I know,” says Alan Tofighi, a doctor and political analyst living in France, “vaccination is fairly welcomed in urban areas and in the central provinces. But more broadly, there is public distrust in both the quality and function of vaccines, spread among various segments of the population."

Anti-vaccine conspiracy theories as well as general fear are spreading all over the world. But in Iran, Dr. Tofighi says, they are turbo-charged by real deficiencies in the health system. “Putting the rumors aside, in Iran’s case, factors such as the chaos in the health system, the lack of a definite strategy and the unprofessional interventions of the Supreme Leader also play an important role in people not willing to get the vaccine in some areas."

The Role of Trust in the Vaccination Process

Sahar Motalebi, a physician and population health expert, also said Iranians’ willingness to be vaccinated was relative to the location and in other parts of the country, vaccine hesitancy did not seem to be widespread.  I don’t know about Mahshahr city specifically,” she said, “but in Tehran and the places for which I have data, people are very interested and have rushed to register – even for the vaccine said to be produced in Iran."

Where reluctance is observed, she said, it is likely down to a lack of trust in the state rather than any scientific basis. “Trust is a very important issue. This is not unique to Iran; in countries like Sudan, Afghanistan, and Somalia, for example, people thought their governments wanted to kill off some of the population through vaccines or were infecting them with another disease.”

By means of a positive counter-example, she added: "The United Arab Emirates signed contracts with six different countries and tested the Chinese Sinopharm vaccine on its own citizens, while Sinopharm was still the trial phase. How did this happen? Because there was societal trust. The citizens of the UAE believed that the government would make the best choices for them."

In Iran, Dr. Motalebi said, a lack of transparency and data-sharing by the health sector is helping to fuel distrust, making its position untenable.

“Were something similar to what the UAE’s government did attempted in Iran, people would be confused, because there is no transparent information-sharing. The authorities and officials of the Ministry of Health were told at one point not to talk about what type of vaccine [was being developed by Iran], what phase it was in or whether it had been approved. Knowing the type of vaccine is important, as it’s important to know about the possible side effects. This dearth of transparency makes citizens sceptical."

Vaccines Re-Routed Away From the Vulnerable

In late April a vaccine scandal erupted in the cities of Abadan in Khuzestan province, Aliabad Katoul in Golestan, Ardakan in Yazd, and finally Tehran’s District 6.

According to numerous reports in media, municipal officials had confiscated doses of the vaccine intended for street cleaners and frontline municipal workers and used them for themselves.

"Based on the ‘documents’ has received,” wrote the website Event 24, “more than 70 male and female employees of Tehran Municipality’s District 6 have been inoculated with vaccines from the sweepers’ quota.”

Trying to calm the situation, the Mayor of Abadan ‘explained’ that the move had been meant as an incentive. “Municipal workers and clerics were reluctant to get vaccinated,” he said. “We got vaccinated to encourage them.” He also said around 91 of the earmarked doses in Abadan were still unused.

The news seeped through other towns in Iran and caught the attention of locals, including Roya, a hairdresser in the Khuzestani city of Sarbandar. Her business is shuttered due to Covid-19 and she has been drawing from her savings for months.

Roya believes that the governor of Mahshahr's claim that people were refusing the vaccine is intended to justify the same ‘queue-jumping’ by people close to this municipality. "I am 40 years old,” she said. “My husband is 44. Tell us to go and get vaccinated right now, and we’ll do it. With such claims, they’re planning to vaccinate 'certain people' and justify that by saying ‘The people did not want their share, so we injected it into others who did want it.’"

Dr. Motalebi, who is also an expert in population health, said in contrast that she believed the claims of the governor of Mahshahr and the mayor of Abadan. “The degree of deprivation and the economic conditions are a factor in people’s reactions to vaccines.

“The people of Khuzestan are likely to have less trust in the government than people in other parts of Iran due to long, historic deprivations. The failure to vaccinate in some cities is probably related to this.”

Senior Doctor’s Disavowal of Sputnik Sparks Panic

As shipments of the Russian-made Sputnik V vaccine began to arrive in Iran this spring, Dr. Minoo Moharez of the National Coronavirus Taskforce – now also the head of the monitoring team for clinical trials of the CovIran-Barekat vaccine – said she would not be accepting Sputnik V herself, adding the Russian shot was “a misfortune for Iranians".

"I am not satisfied with this choice at all,” she said. “The government has prepared and imported the Russian coronavirus vaccine because no information has been released about it so far."

So far Sputnik V has not been approved for use by any leading world regulatory bodies. Dr. Moharez’s remarks prompted widespread reactions online and since then, other Iranians have also refused the jab, citing the same reasoning.

One resident of Mahshahr, 33-year-old Seyed Mehdi, told IranWire he was filled with trepidation about the Russian vaccine. “It’s not my turn, but my father is over 70 years old and has not been vaccinated either. In fact, two of his retired friends were vaccinated, and two or three days later their Covid tests came back positive. This is what Russian and Chinese vaccines are."

May 21 – May 27:

The two coronavirus variants first detected in South Africa and India are still stalking southern Iranian cities. Meanwhile, it has been confirmed that cases of “black fungus” infections have been found among Iranians who recovered from Covid-19.

Ahead of the presidential election on June 18, Iran’s National Coronavirus Taskforce has warned about the potential risks of large gatherings. The body is poised to impose fresh travel restrictions in a bid to prevent a “fifth wave” of infections.

On Saturday, May 22 Iran began to vaccinate people aged over 70. But there have been complaints about disarray at vaccination centers, while Health Ministry officials promise the vaccination drive will pick up speed once Iranian-made vaccines are introduced in early summer.

Electricity outages across Iran have not only have created problems for the people in general but they have also created problems in using oxygen in hospitals, treatment centers and even homes.

Black Fungus Putting Patients and Health Systems Under Strain

In recent months thousands of Indian Covid-19 patients have been hospitalized not only due to Covid-19 but an outbreak of mucormycosis: a serious but rare infection commonly known as “black fungus”.

The disease is caused by a group of molds called mucormycetes. It generally affects people who have pre-existing health problems such as diabetes, or take medicines that lower the body’s ability to fight germs and sickness. Mucormycosis commonly affects the sinuses or the lungs after spores are inhaled from the air, and can also occur on the skin after a cut, burn, or other type of skin injury.

Indian officials says that as of May 24, 9,000 cases of this infection have been confirmed in India, generally among those who have recovered from Covid-19. At least 90 people had died from related complications in the last week of May.

Cases of this infection have been registered in Iran as well. On May 26, Dr. Masoud Mardani, a specialist in infectious diseases and a member of the National Coronavirus Taskforce’s Scientific Committee, tried to assure people that widely-used Covid-19 medications are safe.

“Fungus infection follows using dexamethasone or corticosteroid,” he said, “which these days are used across the world as anti-inflammatory drugs for Covid-19 patients.” He also said black fungus is not currently widespread in Iran.

The Dangers of Unpredictable Power Outages

With the onset of warmer weather in Iran and the increase in electricity usage for various purposes, including air conditioners, multiple power outages at all hours have plagued some Iranian cities. Hospitals and medical centers have not been spared.

This poses a serious risk to Covid-19 patients who are on ventilators. One person on oxygen is already reported to have died during a blackout. Dr. Ali Jamalian, president of Tehran’s Shahid Lavasani Hospital, said power outages in hospitals were occurring without warning and said the consequences for patients could be “irreversible”.

“When it comes to power outages Health Minister must defend us,” he said, “because it has created problems for hospitals across the country, like the disgraceful event a while ago when a patient died because the electricity went out.”

Hospitals must be forewarned if the power is likely to go out, said Dr. Hossein Kermanpour, director general of the Iranian Medical Council’s public relations office. “If the Ministry of Energy believes the power outages are going to continue,” he said, “then it must work with hospitals, private or state-run, so that necessary preparations are made.”

People with Covid-19 who are using ventilators at home are also at risk. These patients have no immediate access to doctors and nurses, and are also less likely to have backup generators of the sort installed at many Iranian hospitals.

The damage caused by power outages is touching other parts of Iran’s coronavirus response a well. On May 26, Dr. Mostafa Ghanei, chairman of the National Coronavirus Taskforce’s Scientific Committee, reported that power outages have cost millions of dollars to the project to develop domestic vaccines.

“In producing coronavirus vaccines,” Dr. Ghanei said, “if the machine stops working, the product is useless and millions of dollars are lost. There must be emergency backup so that there won’t be so much as a few moments of interruption. This makes the production of vaccine in Iran very expensive.”

General Vaccination: Promises, Promises

Last winter, the Health Ministry announced several times that general vaccination would start “soon”. But the promised start date was soon kicked down the road, first to March, then to April and, finally, to June. No domestically-produced vaccine has completed trials yet, but there have been claims inoculation with Iranian-made vaccines will begin in September.

The most recent promise was made last week Health Minister Saeed Namaki, who said general vaccination would start in June. He added that not only imported vaccines but also an Iranian-made vaccine would be used in the program.

Then on May 23, Deputy Health Minister Ghasem Jan-Babaei said that the vaccine set to be used is CovIran-Barekat, adding that the health ministry had already received the first batch of doses, although he did not specify how many.

According to official announcements, around 1.5 million health workers and members of high-risk groups have been inoculated in Iran. In phase two, which is due to be completed by late July, everyone aged over 60 – and those aged over 18 who suffer from health complications that put them at particularly high risk – will be offered the jab. The Health Ministry has also separately announced that the vaccination of teachers will start in late July.

As of now, the Islamic Republic has succeeded in importing 5.6 million doses of vaccine. Of this, close to 3.5 million doses have so far been used. More than three million people have received their first shot and close to half a million have been inoculated twice.

Reports of Disarray and Preferential Treatment

On Saturday, May 22, the vaccination of people aged over 70 got underway. Many of them were accompanied to clinics by family members and this led to chaos and overcrowding at some vaccination centers. Many have protested that the long queues and close contact in waiting rooms will contribute to the spread of the virus.

Another controversy emerged last week after it was reported that the ministry had given vaccine priority to 3,000 employees of Islamic Republic of Iran Broadcasting (IRIB) when it had previously been said that reporters would be vaccinated in the third phase.

“The IRIB has numerous employees,” said taskforce spokesman Alireza Raeesi, “but the National Coronavirus Taskforce has decided to vaccinate those involved in covering the [presidential] election.”

This preferential treatment of IRIB employees has been widely criticized. One complaint levelled at the taskforce was that if giving priority to reporters made sense, why have journalists working for for non-governmental news outlets been denied the same privilege?

Official Coronavirus Statistics

According to the daily official statistics announced by the health ministry, a total of 1,390 patients lost their lives to Covid-19 in the week ending May 27. With 251 deaths , May 24 saw the highest number of fatalities of the week.

At the week’s end, 4,475 Covid-19 patients were being treated in ICUs and the official death toll of Covid-19 since the pandemic started drew closer to 80,000.

“Red” Cities Near-Triple in a Week

At the week’s end the health ministry announced that eight Iranian cities are currently on red alert, 233 are orange, and 207 are yellow. No city in Iran is currently on blue alert: the lowest level, whereby coronavirus infection rates are low but not at zero.

The week before, just three cities were on red alert. One reason for the surge was an increase in infections with coronavirus the variants first detected in India and South Africa, in the southern provinces of Sistan and Baluchistan, Bushehr and Hormozgan.

On May 22, the Islamic Republic’s Ports and Shipping Organization confirmed that the variant from India had reached the port of Chabahar on the coast of the Gulf of Oman. Meanwhile, the district mayor of Nikshahr in Sistan and Baluchistan warned that people in his district had become so used to coronavirus that they no longer attended medical centers even are infected. He added that medics have been left with unused doses of vaccine that were set aside to inoculate the elderly.

In the southern port of Bandar Abbas, city governor Azizollah Konari announced that 32 villages and five towns in the county had been quarantined for a week due to the increase in the number of Covid-19 patients.

Tehran is on an orange state of alert and, according to Nahid Khoda Karami, chairwoman of the City Council’s Health Committee, the number officially-recorded Covid-19 fatalities since the pandemic started is now close to 31,000. According to the Ministry of Health, so far 79,384 Iranians have lost their lives to Covid-19 but statistics announced by local officials leave no doubt that the real number of fatalities is much higher.

Presidential Election and the Danger of a Fifth Coronavirus Surge

The fourth wave of coronavirus in Iran has subsided but, given the presidential election scheduled for June 18 and an expected increase in travel during upcoming holidays, numerous health officials have warned of an impending fifth wave.

One of them is Abbas Aghazadeh, an official of Iran’s Medical Council, who said another spike is very likely: “Both the Medical Council and the Ministry of Health have warned about this,” he said, “and have announced that considering the likelihood of campaign gatherings in the coming days and weeks, the danger of a surge is very high.”

He added that two factors make this likely increase in cases more dangerous: coronavirus variants from India and South Africa, and the utter exhaustion of the medical staff and health workers who only recently dealt with the fourth peak.

The National Coronavirus Taskforce has accordingly announced that traveling between provinces is banned from June 1 to June 7. Past experience, however, shows that these bans are often ignored and not adequately enforced by the police.

This is part of IranWire's coronavirus chronology. Read the full chronology

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