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.
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."