Lessons Learned From an Iranian Epidemic

The Islamic Republic of Iran has experienced the most severe known outbreak of coronavirus in the Middle East. The country has reported some 1.3 million infections and 58,000 Covid-19-related deaths to the World Health Organization: figures now understood to be several times short of the reality, and only a small part of the picture.

Like other countries that experienced multiple “waves” of SARS-CoV-2 infections and vacillating public health interventions throughout 2020, the whole-society impact of coronavirus in Iran has been devastating.

How and why this happened is the subject of IranWire’s new comprehensive report, which takes in a year’s worth of daily Covid-19 coverage on our English and Persian websites together with a long view of governance practices in Iran ever since the 1979 Islamic Revolution.

Taken all together, we found the same outdated approaches to policymaking that have stymied development in Iran for the past 42 years had a direct and deadly impact on the trajectory of the epidemic in 2020.

The non-health-related exigencies of the country’s powerful unelected establishment – chief among them the Supreme Leader, Ayatollah Ali Khamenei, the Shia clerical caste and the Islamic Revolutionary Guard Corps – had a direct and formative bearing on the decisions that Iran’s thus-compromised officials could practicably take during the epidemic.

For ideological and economic reasons, Covid-19 was construed by the Iranian establishment as a threat to regime stability: one to be combated, in the time-worn fashion, with aggressive propaganda and securitization. Only later did the virus come to be officially recognized – by degrees, and with lethal tardiness – as a public health emergency, not a war.

There are countless examples of this fatal mistake documented in IranWire’s coverage of last year’s events. Influential clerics claimed coronavirus was “secular” and trying to lead Muslims astray. The Supreme Leader stated Covid-19 was the result of “enemy” connivances against Iran. Anti-US and antisemitic conspiracy theories were given unprecedented airtime in state-controlled media, to an extent probably unmatched outside the Kremlin.

Public health interventions were first delayed on the orders of the Civil Defense Organization. Then, they were prematurely lifted by the government. This was borne partly out of economic concerns, but also because certain events deemed necessary for regime stability – such as the February Anniversary of the Revolution, the February parliamentary elections and thousands-strong Shia mourning ceremonies for Muharram in August – eclipsed public health and safety in the eyes of decision-makers.

Accurate reporting of the situation on the ground in Iranian hospitals was brutally suppressed by the Revolutionary Guards and indeed criminalized by Iran’s Chief Justice from the start of the year. At the same time, partly inevitably but also partly by design, the official Covid-19 figures on Iranian state television presented tens of millions of viewers with a deformed picture of the epidemiological situation.

In an attempt to address this, IranWire’s report deferred to research conducted by a transnational group of scholars in 2020. By examining Iran’s official mortality figures, these researchers arrived at an estimate of “excess deaths” per province recorded in winter 2019/20, spring 2020 and summer 2020. Based on their findings, well over 100,000 Iranians are thought to have died from Covid-19 in the first year of the epidemic.

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Some of the poorest and most deprived parts of the country appear to have suffered disproportionately during the epidemic. This also seems to be borne out in IranWire’s coverage of outbreaks in areas such as Khuzestan and Hormozgan, where provincial officials begged central government for restrictions to be reimposed but went ignored.

These areas were also blighted by some of the most severe health inequalities even before the pandemic. Before 2020 the cost of healthcare in Iran was far outstripping the amount the government was able to spend on it. From eye-watering rates of catastrophic health expenditure and out-of-pocket payments to sharp increases in deaths from non-communicable diseases, the impact of this was evident long before the arrival of SARS-CoV-2.  

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During the pandemic, uneven distribution of the scant medical resources that were available, from CT scanners to PPE to ICU beds, correlated with a higher proportion of Covid-19 deaths in some areas. It also risked the lives of health workers, many of whom were called into work while sick with Covid-19 and who are known to have died in their thousands over the course of 2020.

In addition, IranWire’s study examined the contrast between statements and research conducted by the Universities of Medical Sciences, which operate acute hospitals in major cities across Iran. We found that in many instances local Covid-19 figures shared by these bodies, which are officially answerable to the Ministry of Health, themselves rendered the Ministry of Health’s official country-wide figures obsolete.

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The outbreak also took place in the midst of a long-observed atrophy of public trust in both the Iranian state and official sources of information. Because politicians and not medical professionals took charge of handling the epidemic, both in the corridors of power and on TV, public compliance and willingness to take the risk of Covid-19 seriously was not what it might have been at any point in the year.

The influence of ideology on public health in Iran led to serious derelictions by the Ministry of Health and other bodies officially tasked with managing the pandemic. Recently, for instance, it has emerged that the MoH’s research division funded live studies on the effects of Shia “traditional medicine”, such as nettle leaf infusions and prayer, on hospitalized Covid-19 patients.

On January 8 of this year, the Supreme Leader also briefly resurfaced from the largely cloistered existence he had led throughout 2020 to ban the importation of vaccines from the United States and the United Kingdom. Iran’s ongoing efforts to secure enough doses of vaccine for its 80 million-strong population already show every sign of being hampered by the same decades-old conflicts of interest.

The story of coronavirus in Iran is far from over. We hope in the year to come, those in power in Iran will take stock of the extent to which a self-interested and insular mode of governance is putting millions of lives at ongoing risk. In the meantime, we hope our findings are useful to others who wish to understand the situation a little better.

You can read the full report online here. To view in a pdf viewer or download, click here.

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