This February, Iranians had hoped to celebrate the 43rd anniversary of the country's Islamic Revolution by gathering and marching in person, but instead thousands of Iranians rallied using only cars and motorcycles, as they had in 2021 amid COVID-19 restrictions. This is because Iran was hit by the sixth wave of coronavirus infection, which resulted from the easily transmissible Omicron variant of COVID-19, first seen in the country on December 19, 2021. For the next two months, the country struggled with high infection rates and hospitalizations, although the virus has now seemingly passed the peak.
The number of fatalities this time around, however, was far below that seen in late August 2021, when the Delta variant was dominant and access to COVID-19 vaccines was still limited in Iran. A push for a widespread vaccine campaign and booster shots from the health authorities may have been instrumental in achieving this downward trend.
Iran has faced an uphill battle since the first cases of COVID-19 were found in the country, although with limited resources Iran has also had its share of successes and innovations in combating the virus. Our study, conducted between February 2021 and May 2021, identified several common challenges, successes, and innovations regarding COVID-19 faced by Iran and the MENA region.
Iran was one of the nations that was hit the hardest—both regionally and globally—in the early days of the pandemic.Share on Twitter
Iran was one of the nations that was hit the hardest—both regionally and globally—in the early days of the pandemic. The first cases of coronavirus in Iran were announced in Qom City on February 19, 2020. Iran quickly became a pandemic hotspot, and flight restrictions were imposed on Iran by other countries. Within the country, it took about a month after the virus began spreading for people to accept the seriousness of the COVID-19 pandemic, largely due to lack of public trust in government and misinformation spread on social media. As of April 2022, Iran has registered more than 140,000 deaths from the virus.
The Iranian government responded to the initial spread of the virus by imposing public health interventions such as social distancing (rather than mandatory quarantine), followed by mask requirements. Overall, the Iranian population appeared to have a high level of knowledge about safe practices; however, our interviews with local health care providers indicated that compliance with social distancing and masking recommendations varied by community, even in the same city. Barriers to effective safeguarding (PDF) against the virus included the high cost and lack of hand sanitizer, gloves, and masks. This led to dangerous rumors and unanticipated public health challenges. For example, in March 2020, Fars province experienced a surge in methanol poisoning cases after demand for ethanol to use in producing hand sanitizer led people to use methanol as a replacement for bootleg alcohol.
To compound the pandemic burden, economic sanctions on Iran may have contributed to shortages of personal protective equipment (PPE), intensive care beds, diagnostic equipment, ventilators, and COVID-19 diagnostic kits. In some Tehran hospitals, health care staff resorted to using overalls, aprons, masks, and visors for protection. By May 2020, more than 10,000 medical workers were infected with COVID-19, and 100 had died. Furthermore, the Iranian health care providers we interviewed informed us that critical care is an emerging field in Iran; therefore, physicians and nurses without intensive care training routinely treated critical COVID-19 patients and had to operate specialized equipment.
Successive COVID-19 virus waves have battered Iran for over two years now, negatively affecting health care workers' mental health and resulting in burnout. The general population has also seen an increase in depression and anxiety during the pandemic.
Iran's response to the pandemic gradually improved over time. To mitigate staff shortages and burnout, medical specialists and nursing staff from other divisions of the Iranian health system, such as educational and research medical centers, were temporarily transferred to where they were needed most. In addition, many retired or nonworking nurses and other health care specialists, as well as nonspecialist volunteers, rejoined the health care workforce.
Iran also leaned on innovation and technology on several fronts. Examples include development of an online self-screening platform to control the massive influx of patients to medical centers; production of COVID-19 test kits for use in free government sites, and utilization of WhatsApp to increase access to teleradiology specialists in North America to compensate for the limited number of local thoracic radiologists. The nation also embraced a self-sufficient approach to curbing the spread of the virus such as manufacturing ventilators locally and producing PPE and COVID-19 vaccine domestically.
The biggest turning point in containing the pandemic was when Iran began accelerating the daily administration of COVID-19 vaccines.Share on Twitter
The biggest turning point in containing the pandemic was when Iran began accelerating the daily administration of COVID-19 vaccines last summer under the newly elected president. Despite economic sanctions and vaccine politics, 67 percent of the Iranian population today is fully vaccinated against COVID-19. This led to the implementation of “smart protocols,” which freed vaccinated Iranians to engage in a wide range of activities while placing restriction on the unvaccinated, before the country entered the sixth wave of the pandemic.
Iran is eager to defeat the coronavirus. To that end, Iranian officials continue to work with WHO and other partners to strengthen the country's health system in diagnosing and treating patients with COVID-19. Additionally, Iran is increasingly emphasizing mass vaccination campaigns and pushing for booster shots to curtail future spikes.
Nazia Wolters and Emily Hoch are policy analysts and Mahshid Abir is a senior physician policy researcher at the nonprofit, nonpartisan RAND Corporation.
Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis.