Covid-19 Deaths Surge in Iran Amid Vaccine Delays and 40 Percent Hesitancy

At least 2,000 Iranians who received two doses of vaccine have since died, more than half after testing positive for Covid-19.

According to a letter sent to Health Minister Saeed Namaki by the ministry’s Center for Statistics and Technology, of the around 2.75 million Iranians who have so far received both doses of vaccine, 17,000 were then hospitalized with Covid-19 symptoms.

“Of these 2,000 who died,” Dr. Mohammad Reza Mahboubfar, a viral epidemiologist and a former member of the National Coronavirus Taskforce, told IranWire, “57 percent had tested positive. Most of them were aged over 70, meaning they’d had priority for vaccination.

“According to figures from around the world, the mortality rate among those who have received both doses of vaccine is about 10 per million. Based on the Health Ministry’s letter, the rate in Iran is 753 per million. In other words, the mortality rate in Iran after receiving both doses is more than 75 times the international average.”

The figures caused widespread consternation on being published, with many pointing fingers at the already-beleaguered Saeed Namaki and the person of Ayatollah Khamenei; in  early January the Supreme Leader banned American and British vaccines from Iran.

Health experts and lay observers alike believe the fourth and fifth waves of coronavirus infections in Iran, which respectively in spring and summer 2021, were made drastically worse by a lack of availability of vaccines. Imports have been repeatedly delayed while Iran has struggled to mass-produce the necessary quantity of domestic vaccines such as CovIran-Barekat.

According to official statistics, every day around 600 people who have tested positive for Covid-19 die in hospitals around the country. The Iranian Medical Council estimates that the real number of fatalities is as much as three or four times the official figure.

Iranian Vaccine Hesitancy Stands at 40 Percent

So far around the world, Covid-19 vaccination drives have generally progressed in age order, with the oldest citizens inoculated first followed by those in high-risk professions. The Islamic Republic has designated people in certain public-facing roles, such as government employees, teachers, journalists, bus and taxi drivers and health workers, as among the priority groups for vaccination.

However, according to Dr. Mahboubfar, some 40 percent of people who have so far been named as eligible have not gone to vaccination centers when called on. “People say they don’t trust either imported vaccines or domestic ones,” he said. “This is one of the main factors behind the increase of fatalities in the country.”

To compound the confusion, ever since the initial outbreak of coronavirus in Iran, promoters of so-called “Islamic” and “traditional” herbal medicines have been spreading misinformation about how to treat Covid-19. The strange remedies touted included placing cotton soaked with violet oil in the anal cavity, consuming alcohol or using camel urine; their promotion has not ceased even after the development of domestic Covid-19 vaccines. Belief in herbal remedies permeates all strata of Iranian society and could be a contributing factor to people’s reluctance to get vaccinated.

Vaccination Against International Guidelines

The Health Ministry has invited a number of people aged 25 and over and working in the designated professions to get their first jab. In some cases this will be the the AstraZeneca vaccine, which has been designated for use only in the over-40s, 50s and 60s by some European nations and other countries due to blood clotting being a rare possible side effect.

“The vaccine basket currently available to various age groups in Iran includes AstraZeneca, Sputnik V, Sinopharm and [the Iranian-made] Barekat,” Dr. Mahboubfar said. “They’re injecting individuals aged over 25 or 30 with AstraZeneca whereas in European Union countries, Canada, the United States, Australia and a number of Middle Eastern countries using AstraZeneca in individuals aged under 40 or 50 is banned.

“In Iran young people are being inoculated with this vaccine. Some have later died after being hospitalized while suffering from extreme convulsions.”

So far, Iran has imported around three million doses of AstraZeneca made in Japan, 315,000 doses manufactured in Russia and more than two million doses of this vaccine made in Italy and South Korea through Covax, the World Health Organization (WHO)’s equitable vaccine access program.

The Efficacy of Available Vaccines against the Delta Variant

Since the first recorded outbreak of coronavirus in the city of Wuhan, China, a number of variants of SARS-Cov-2 have emerged in different parts of the world and spread rapidly. In each instance, vaccine developers have communicated their findings about the efficacy of their products against the new variants to the World Health Organization.

Iran has so far failed to provide data to the public about either the efficacy of CovIran-Barekat against the original strain, or any of the variants. Meanwhile, Dr. Mahboubfar notes, a recent study conducted in Hungary on the efficacy of the Chinese-made Sinopharm and Russian-made Sputnik V vaccines found “these two are 50 to 60 percent effective against the original coronavirus that started in Wuhan – but their efficacy against the Delta and Lambda variants is very low.”

Recently the UK’s Oxford University estimated the efficacy of Pfizer and AstraZeneca vaccines against the Delta variant would fall to around 65 percent three months after receipt of the jab. To improve their efficacy a third, booster shot is recommended three months after the second dose.

“The number of second AstraZeneca shots administered in Iran has not been considerable and definitely there are not enough doses of this vaccine in Iran for a third shot,” Dr. Mahboubfar said. “The makers of Sinopharm, Sputnik V and Barekat have not said anything about the need for a third shot. In this situation, how are we going to know whether or not vaccinations have been sufficient?”

The vaccination process in Iran so far, he said, had been “chaotic”, with long lines forming outside out-of-stock health centers. Health Ministry officials recently announced that Iran had enough doses of vaccine at its disposal to last two weeks – in contrast to a claim by Tehran’s coronavirus chief that stocks would only last for five days. Local centers in some Iranian cities closed due to shortages in the past few days, even as residents continued to receive text messages for the Health Ministry instructing them to go for their first jab.

Previously shortages saw vaccinations in some areas suspended for as long as four weeks, meaning people who had received their first dose of Covid-19 jab were left waiting for a much longer interval between doses than recommended. This can affect vaccine efficacy to the point that if patients go for too long without receiving their second dose, they have to start over. For a while health officials considered mixing and matching imported jabs with CovIran-Barekat; whether this ended up happening at some clinics remains unclear.

Dr. Mahboubfar said he believes one of the reasons for the high mortality rate among patients who received both Covid-19 jabs was the extended delay between the first and second shots.

Infections Are Ahead of Vaccinations

The very slow pace of vaccinations in Iran, and the spread of the Delta variant, have caused the number of new infections to rapidly outstrip the number of people vaccinated. Other major problems include shortages of medical necessities such as oxygen capsules, drugs to treats Covid-19 symptoms and IV fluids.

According to the Health Ministry, as of now more than 16 million Iranians have received at least the first dose of the vaccine. But Dr. Mahboubfar points out that the number of those who have received the second dose is much lower. “For as long as the number of vaccinated people remains low, and the infection rate high, given the low efficacy of these vaccines against the Delta variant there is a high degree of probability that even those who have received both shots are going to get infected.”

Many people who have received both jabs in Iran assume they are immune to coronavirus and stop following health protocols. According to the Health Ministry, compliance with guidelines such as mask-wearing and social distancing across Iran has fallen to below 40 percent.

“The only way to fight the virus is to comply with health guidelines, because vaccination does not make you invulnerable,” warned Health Minister Saeed Namaki on August 18. “There will be many mutations of the virus in future and it’s likely these future variants will also raise questions about the efficacy of vaccines.”

Police: We Can’t Stop Muharram Processions

Nowhere is the delusion of invulnerability more manifest than in the mass gatherings and processions taking place in venues across Iran for Muharram: the Shia holy month that commemorates the martyrdom of Husayn ibn Ali, the third Shia Imam, in 680 AD.

The National Coronavirus Taskforce officially banned mourning ceremonies in closed spaces and street processions, but just like last year, the rule has been openly and repeatedly violated from the get-go. Religious Iranians have been documented packing into small spaces, shouting and crying without wearing masks, in a plethora of images and videos that have since found their way online.

On Wednesday, August 18, Mohammad Reza Farahbakhsh, the deputy commander for social affairs of Qom police for social affairs, bluntly stated that the police cannot stop Muharram processions by force; only religious associations and the Islamic Propaganda Organization have the power to stop the organizers from flouting the rules. In response, the director-general of the Islamic Propaganda Organization in Qom province shifted the blame back to the police.

Earlier this month on August 10, Deputy Health Minister Iraj Harirchi had warned that even without mourning ceremonies the number of Covid-19 fatalities in Iran was going to surge.

Regardless of who is responsible for the lax or non-existent enforcement of restrictions, the five-day lockdown that started on August 17 only contributed to an increase in inter-provincial travel and as a result, to the spread of coronavirus.

The National Coronavirus Taskforce had announced that private sector would be locked down as well as the public sector. But a resident of Tehran told IranWire this wasn’t true in practice: “It’s just empty talk. They issue sham orders that they themselves cannot enforce. For the last five days our business, like always, has only shut at the weekend. The metro is crowded and there’s the same amount of traffic in the streets as usual.”

Official Coronavirus Statistics

According to the Health Ministry’s weekly statistics, a total of 4,040 patients are known to have lost their lives to Covid-19 in the week ending August 19: an increase of 453 over the preceding week’s death toll of 3,587. With 655 deaths, August 16, the last day, had the highest officially-recorded number of fatalities for the week.

At the week’s end, 7,538 Covid-19 patients in Iran were being treated in ICUs. According to the Health Ministry, at the time of writing 5,236,423 Iranians had received both doses of vaccine.

There are currently 359 Iranian cities on red alert for coronavirus transmission. Another 59 are rated orange and 30 are yellow. No city in Iran is currently on “blue” alert.