Iran’s COVID-19 Pandemic Response: Mission Critical

This article is part of the series on “COVID-19 in the Middle East and Asia: Impacts and Responses”. Read more ...

Electoral “engineering” propelled Ebrahim Raisi to the presidency and further entrenched conservative rule in Iran.[1] But the Islamic Republic’s eighth president, who campaigned on a populist agenda and officially took office on August 3, has inherited three intersecting challenges: a public health emergency, a sanctions-stricken economy, and a crisis of public confidence in government. Of the three, the COVID-19 pandemic demands the most urgent attention, as the country is experiencing its most devastating wave yet of the virus. However, the Iranian government’s mismanagement of the pandemic response to date, which has contributed to unnecessary loss of life and hardship, suggests that it may be many months before the Coronavirus is contained.   

COVID-19 in Iran: An “Uninvited and Inauspicious Passenger”^[2]

On February 19, 2020, Iran reported its first two confirmed cases of infections, in the holy city of Qom.[3] However, numerous accounts suggest that the COVID-19 outbreak may have occurred weeks earlier, and that the delay in officially acknowledging the appearance of the virus, whatever the explanation, proved costly.[4] A year and a half later, with the virus spiraling out of control, public adherence to health protocols waning, and Iran’s vaccine rollout sluggish, outgoing Health Minister Saeed Namaki warned in a letter addressed to Supreme Leader Ali Khamenei that the country’s health system could collapse.[5]

As Iran’s new president chaired his first meeting of the National Task Force for Fighting Coronavirus the day after his inauguration, the country was experiencing a fifth wave of the COVID-19 virus, fueled by the Delta variant.[6] As of August 15, 2021, Iran had recorded an estimated 4.8 million cases of the disease and suffered over 98,000 fatalities.[7] Cities across the country are now classified “red,” the highest level in Iran’s color-coded scale for denoting the severity of COVID-19 outbreaks.

Figure 1. Iran: Daily COVID-19 Cases

Source: Worldometers, https://www.worldometers.info/coronavirus/country/iran/.

That Iran has arrived at this tragic and alarming juncture was not inevitable. Choices have mattered, not just circumstances. The critical first weeks after the discovery of the virus in Iran were squandered, with denials and mixed messages substituting for decisive intervention. The adoption and scaling up of prevention and mitigation measures were impeded by political and ideological roadblocks, as well as difficult tradeoffs — all the while exacerbating societal and economic fragility and deepening public disillusionment and discontent.

Doctored Messaging

Conflicting information and misinformation about COVID-19 poses a threat to public understanding and decision-making, thereby compromising efforts to mount an effective pandemic response. There are countless examples in the United States and elsewhere of contradictory messaging, propagation of conspiracy theories and false medical cures, and politicized public health measures regarding the Coronavirus. In the case of Iran, inaccurate, misleading, and demonstrably false information has been both a symptom and a cause of the mismanagement of the pandemic and, at the same time, a means by which the regime has sought to avoid accountability domestically while promoting its geopolitical interests.   

Iran’s initial response to the Coronavirus is widely regarded as having been inadequate.[8] Although Iranian officials were apprised by doctors of an increasing number of domestic cases of flu-like virus, they withheld the information from the public, reportedly in order to ensure high turnouts for important occasions, namely the funeral processions for slain Islamic Revolutionary Guard Corps (IRGC) Quds Force Commander Qasem Soleimani, the ten-day celebration marking the 41st anniversary of the Islamic Republic, and the February 21 parliamentary election.[9]

Jagged turns in the official narrative regarding the Coronavirus persisted for weeks, undercutting initial efforts to staunch the spread of the disease. Senior officials downplayed the severity of the outbreak, attempted to reassure the public that they had mobilized all resources to contain the disease,[10] warned against overreacting,[11] and/or proclaimed that the situation was or soon would be fully under control.[12] Senior government and health officials contradicted one another regarding the trajectory of the virus and progress in combating it.[13]

Iranian state media were harnessed to the task of promoting unity and engendering individual sacrifice. In performing this task, they crafted a discourse of crisis and mobilization featuring slogans and visual iconography distributed across the media landscape intended to convey the image of a nation under threat. The current public health emergency was framed through reference to past crises. By tapping into the memories and experiences of national traumas that have spanned the history of the Islamic Republic, state media outlets sought to create a unifying narrative of struggle and resistance.[14]

The regime’s information apparatus also advanced claims that Iran was being intentionally targeted by its Western adversaries and depicted the Iranian government’s pandemic response as being superior to theirs.[15] In addition, state media outlets were also used to deflect blame, foster anti-Western sentiment, and improve Iran’s international position.[16] COVID-19 was thus framed as a security threat, rather than as a public health emergency.[17]

None other than Supreme Leader Ali Khamenei declared that fear of the virus was a “Western plot” to depress turnout in the Parliamentary elections[18] and cited a conspiracy theory initially spread by the Chinese government blaming the United States for creating the novel coronavirus. It was only later, as leading Iranian officials fell victim to the virus, that he began to acknowledge the gravity of the situation and issued a religious decree prohibiting unnecessary travel.

Nevertheless, credible information about the origins, nature, and spread of the virus continued to be concealed and/or suppressed. Senior Iranian medical professionals and others raised concerns about the compilation and disclosure of virus-related data, contending that the actual number of Coronavirus infections and fatalities far exceeded official estimates whether due to inadequate testing capabilities or deliberate under-reporting.[19] But Iranian authorities took steps to stifle independent reporting regarding the true extent and their handling of the COVID-19 outbreak.[20] Their actions included the criminal prosecution of physicians who contradicted the “official line,”[21] the harassment and arrest of journalists and citizen-journalists,[22] and the shuttering of at least one daily newspaper, Jahane Sanat, for publishing an interview with an epidemiologist who said that the government tally of COVID-19 cases and deaths only accounted for 5% of the actual toll.[23]

To be fair, many Iranian health officials did sound the alarm about the threat posed by the virus.[24] And, as the death toll from the disease mounted, public messaging did shift, from providing assurances that the virus would quickly recede to strongly encouraging the adoption of mitigation measures. But conflicting information, occurring within the broader context of an “infodemic” in Iran, likely added to the public trust deficit, making an effective COVID response even more difficult to mount and sustain.[25]

A Securitized Approach

The Islamic Republic is governed through a system which combines religious authority, state-bureaucratic power, and parallel structures, notably the Islamic Revolutionary Guard Corps (IRGC). These distinctive features of the country’s political system have been reflected in the centralization and militarization of Iran’s Covid response as well as in reconciling the tension between religious and state authority during the pandemic.

Following the public confirmation of the first cases of Coronavirus in the country, Iran’s Supreme National Security Council (SNSC) issued an order establishing the National Task Force for Fighting Coronavirus.[26] The creation of the Task Force, in effect, transferred power for managing the crisis from Iran’s elected institutions to a relatively small decision-making body composed primarily of cabinet members, answerable to the Supreme Leader.

This centralized institutional arrangement[27] has provided a useful channel through which the Supreme Leader lent his support to the enforcement of mitigation measures of a religiously sensitive nature such as the closure of mosques and Friday prayers. However, in some respects, the decision-making structure was problematic. Although, for example, the Task Force’s sub-committees included epidemiologists and other health experts, decision-making power resided mainly in the hands of political appointees — an arrangement that might have contributed to the initial mishandling of the pandemic.   

Supreme Leader Khamenei’s personal intervention is responsible for having shaped — or misshaped — Iran’s pandemic response institutional architecture. It was he who ordered the establishment of the Imam Reza Health and Medical Treatment Headquarters and place it under the Armed Forces General Staff (AFGS), the military’s highest body.[28] The order to mobilize the armed forces to assist in the pandemic response was not in itself extraordinary. Militaries are increasingly being used in natural disasters and public health emergencies,[29] with their activities ranging from the performance of discrete tasks such as the enforcement of curfews and lockdowns and distribution of medical supplies, to the overall management of the state’s response.

Militaries tend to be disciplined, resourceful, decisive and effective in ways that civilian/non-military systems seldom are, or perhaps ever can be. A strong argument can be made that, in an emergency, a state’s only option is to use coercive and authoritative means to enforce measures that will ultimately benefit their citizens. However, securitizing the pandemic response runs the risk of politicizing it by fueling tension between civilian and military authorities, and by creating a permissive environment in which the military’s encroachment on civilian authority may prove difficult to reverse and repression is normalized.[30]

With respect to Iran, what is striking is that the order issued by the Supreme Leader placed troops under the control of Iran’s highest military body, and not that of its highest civilian authority, the president. The ensuing ‘militarization’ of Iran’s pandemic response entailed the mobilization of the Islamic Revolutionary Guard Corps (IRGC) and Basij, whose activities included conducting disease surveillance, disinfecting public spaces, and even overseeing victims’ burials. The Revolutionary Guard was also assigned responsibility for disbursing aid packages to millions of needy Iranians.[31] However, these otherwise positive contributions to the pandemic response should be placed in their proper context. For the IRGC — the same force that had killed hundreds of protesters the previous November[32] — playing a high-profile role in combating the pandemic served as an opportunity to portray itself as the country’s ‘true guardian.’[33]

Furthermore, in effect, Khamenei’s order provided the license for the military to sideline the civilian administration, if necessary. In this sense, it represented yet another step in the process of the consolidation of power within the ruling establishment favoring the conservative faction and fortified by the coercive power and financial heft of the security and other institutions under the authority of the Supreme Leader (i.e., bonyads and the Execution of Imam Khomeini’s Order, the latter a massive holding company).

As it happens, Iran’s COVID response was beset by competing strategies between civilian and military leaders.[34] It led to clashes, for example, between those who resisted restrictions that infringed on religious practices and IRGC leaders who advocated for a stricter lockdown and accused the Rouhani cabinet of an anemic response.[35] In addition, security forces personnel contributed to the spread of the disease — including within their own ranks — by spinning conspiracy theories about the origins of COVID-19, eschewing social distancing, and turning out large crowds for funerals of their members.[36]

The pandemic also exposed the inherent tensions in “Islamic government.” The pandemic put the clerical establishment in an unfamiliar and uncomfortable position, forcing them to suspend religious rituals that they consider an essential part of the theocratic state’s political identity. In Qom, the acquiescence and cooperation of the senior clergy was instrumental in subduing the spread of the virus.[37] Elsewhere, however, some clerics resisted state virus mitigation mandates, making it difficult to assure strict compliance with bans on mass gatherings and with protocols during religious holidays.[38] Others have subverted the attempt to bring the virus under control by propagating “religious misinformation.”[39] Thus, religious leaders — powerful social assets — both supported and thwarted constructive efforts to combat COVID-19.[40] The most recent such instance occurred when, with the number of Covid infections soaring, Supreme Leader Khamenei overruled the Health Ministry’s warnings to cancel Shiite mourning rituals during Muharram.[41]

A Short-term Tradeoff

Iran is by no means the only country that has struggled to bring the pandemic under control. The United States, for example, leads the world with 36.5 million COVID-19 cases and over 618,000 virus-related deaths. And the number of cases related to the Delta variant has risen at an alarming rate worldwide.[42] Yet, in the case of Iran, efforts to contain the spread of the virus were hampered by a unique set of economic circumstances, notably the country’s trade links with China, where COVID-19 originated; and the direct and indirect effects of sanctions.

These circumstances presented Iranian officials with difficult trade-offs. Imposing travel bans risked disrupting vital trade and diplomatic ties with China. Closing borders with neighbors incurred the risk of an even heavier economic burden, as religious tourism is a big part of revenue generation. Decisions as to whether to solicit or accept Western assistance and actions taken to secure it were ensnared in geopolitics. Balancing these considerations was more difficult given the combination of suffocating economic sanctions, which hampered the country’s ability to access medicines and health supplies,[43] not to mention unmistakable evidence of growing domestic discontent.

Forced to choose, the Rouhani government traded pandemic mitigation measures for economic stability.[44] Clearly reluctant to impose a stringent and lengthy nationwide lockdown, Rouhani declared “there is no other way” but for the economy to remain active while fighting Coronavirus.[45] Rouhani’s concerns were echoed in the Majlis, where in April 2020 lawmakers rejected an emergency bill requiring a one-month nationwide lockdown to stem further cases of the virus.[46] Thus began a cycle of partial, temporary lockdowns and premature reopening.[47] [48] With each successive phase of this cycle, Iranian health officials repeatedly warned that Iran’s flattened curve was fragile, the return to normalcy was not imminent, and precautions would have to continue to be observed.[49]

In addition, Iran’s efforts to combat the disease have been entangled with and subverted by its fraught relations with the West. To be sure, Iran’s ability to respond effectively to the pandemic has been hindered by sanctions, which have limited the country’s access to medicines, health supplies, and funds. But the difficulty of tackling the virus has been compounded by the regime’s enforced delay in providing protection to the population as the result of its import ban on protective masks,[50] rejection of humanitarian assistance,[51] and politicization of vaccine acquisition.

In a broader sense, seemingly ‘impossible’ tradeoffs have been imposed not by the Coronavirus pandemic itself but by a costly strategy of “resistance,” which notwithstanding its achievements in building domestic capacity, has not made Iran impervious to sanctions, liberated the country from excessive dependence on oil, or better able to cope with pandemic disease. On the contrary, some of the shortcomings of Iran’s pandemic response can be understood as collateral damage from the regime’s strategic choices.

An Acute Socioeconomic Crisis

Even as the government of Iran grapples with COVID-19, it is laboring to cope with the socioeconomic fallout from the pandemic.[52] The stakes could not be higher. The Islamic Republic’s ‘egalitarian promise’ has been increasingly difficult to fulfill given the cumulative effects of the mismanagement of the economy, corruption, US-led sanctions, the fall in oil prices — and lately, the adverse impact of the pandemic.

Much of the discourse surrounding the 1979 Iranian Revolution pertained to rising inequality and the goal of social justice in the name of the “downtrodden.”[53] Upon taking power, the post-revolutionary leadership established various redistributive mechanisms.[54] Channeling the popular mobilization of the revolution and the war with Iraq into a “warfare-welfare complex,”[55] the government of Islamic Republic instituted an extensive social welfare program featuring generous subsidies of energy and food items.[56]

These efforts succeeded in delivering material goods to segments of the population formerly excluded from the pre-revolutionary social compact. However, the introduction of neoliberal economic policies generated social inequalities.[57] The “illiberal neoliberalism”[58] under Rafsanjani and Khatami never reached economic targets.[59] High inflation eroded the value of the universal cash transfer schemes instituted during the Ahmadinejad years and made possible by windfall oil revenues.[60] Similarly, galloping inflation and the weakening of the rial neutralized the effects of efforts to increase spending on lower income groups by President Rouhani, who left office with the price of public services, staple items, energy, and duties on imported goods having skyrocketed;[61] and with the intricate direct and indirect subsidies straining the budget and the banking system.

The proportion of Iranian society that has become marginalized by unemployment or precarity is arguably much larger than official statistics reveal. Some experts contend that the Islamic Republic has managed to keep poverty relatively low and contributed to the expansion of the Iranian middle class,[62] though it has made little headway in improving income inequality.[63] Others, however, question the reliability of the official poverty statistics upon which most studies have relied, claiming the actual figures are much higher than recorded. [64] Even so, the Iranian Parliament Research Center recently reported that 35% of the population live under the poverty line.[65] According to the World Bank, multiple years of recession and high inflation, compounded by the adverse effects of the pandemic, have stalled poverty reduction.[66]

The official unemployment rate has remained stubbornly high, increasing from 12% in 2018 to above 16% by the beginning of 2020 (i.e., prior to the virus outbreak).[67] Over the past decade, the youth unemployment rate (ages 15-24) has averaged around 25% and in some parts of the country exceeded 50%.[68] Since the onset of the pandemic, the prices of goods — including food staples — have risen dramatically, placing more economic pressure on low-income households.[69] The Statistics Center of Iran (SCI) reported last December, amid the pandemic, that at least 28 million in 17 provinces were malnourished.[70] Thus, in real terms, with household budgets, salaries and wages having fallen even before the onset of the pandemic, the middle class has been shrinking while poverty, by any definition, has been on the rise.

Iran’s Labor Ministry, which each year sets the national minimum wage, last March increased it by 39%, which, however, was still less than the rate of inflation.[71] The government of Iran also announced economic measures designed to ease the pressure on families and businesses, including a three-month moratorium on health insurance, tax and utility bill payments; and cash disbursements and low-interest loans to the poorest households.[72] Nevertheless, inflation last year reached 39.5%, the Iranian rial has lost 80% of its value, and the government has had to draw down currency reserves to balance the budget due to a shortfall in oil export and other expected sources of revenue.[73] In its World Economic Outlook report, “Managing Divergent Recoveries,” the IMF projects an inflation rate of 39% and a 11.2% jobless rate for Iran in 2021.[74] Thus, if the Islamic Republic’s “petro-populism” is deeply rooted,[75] so too are its economic problems.

Foreign direct investment in Iran declined from more than $5 billion in 2017 to $1.5 billion in 2019 and $1.3 billion in 2020.[76] The country’s exports of goods and services also plunged, from $111 billion in 2017 to $98 billion in 2018 to less than $29bn in 2020.[77] COVID-related expenditures and plummeting oil revenues have caused Iran’s fiscal deficit-to-GDP ratio to soar. The government of Iran finds itself being boxed in, struggling to avoid having to decide between two unpalatable choices: printing money and risking hyperinflation, or opting for austerity and risking an even more threatening upsurge of public discontent.

Disillusionment and Discontent

The Coronavirus arrived in Iran after years of eroding trust and crumbling confidence in the competence of the Iranian government. In a Gallup World Poll conducted in August 2020, 47% of respondents said they had confidence in the Iranian government, while 50% said they did not.[78] With the health-related and economic hardships resulting from the pandemic and the government’s floundering response, societal discontent and desperation has only deepened. This disposition can be seen in plain view in the form of public non-compliance with COVID protocols and in the recurring protests and strikes during the pandemic.

Trust in public institutions — a complex concept with various dimensions — basically refers to whether institutions are perceived to be competent and effective. Trust is critical in blunting the impact of the virus and preventing subsequent waves of infection. Yet, Iranians’ trust in their national government, already in short supply prior to the Covid outbreak, has likely further diminished since. Moreover, this lack of trust has almost certainly contributed to non-observance of state infection control measures.

Indeed, Iran’s public health officials have openly expressed their concern and dismay with their inability to secure strict public compliance with COVID-19 guidelines in order to break the chain of disease transmission.[79] When in late November of last year, lockdowns for non-essential businesses and travel bans between major cities went into effect, streets in Tehran reportedly remained crowded despite the restrictions,[80] prompting the authorities to threaten to fine businesses that violated lockdown.[81] As the fifth wave of COVID-19 was peaking in July, health officials expressed frustration with the public’s non-compliance virus control measures.[82] And though reluctant to impose fresh curbs on business and travel, the decision to impose a six-day “general lockdown” in cities across the country has presented the new administration with an early test of its ability to enforce it without resort to violent coercion and to assure that the measure helps slow the spread of the disease.[83]

Displays of public anger and disgruntlement have persisted during the pandemic. Over the past two decades, Iran, which has a robust history of protests,[84] has experienced numerous nationwide demonstrations and strikes, animated by many grievances. While sociopolitical grievances have figured prominently in media analyses and scholarly work on rising popular discontent, festering socioeconomic problems have not received the attention they deserve.[85] Economic issues have in fact been central to Iranian politics,[86] and economic distress has been central to political unrest in Iran. The proximate causes of the spate of protests that have taken since the 2009 Green Movement [87] have ranged from rising food prices[88] to teachers’[89] and railway workers’ rights[90] and cuts in fuel subsidies.[91] The widespread protests that rocked Iran just weeks before the onset of the COVID-19 pandemic followed an abrupt three-fold hike in gasoline prices.[92] With the number of COVID infections surging in July, demonstrators were surging into the streets in Khuzestan Province because of water shortages.[93]

In recent years, the pace of protests has picked up, their social class composition has changed, and the government’s reaction has grown more violent. The incidents of unrest that preceded the onset of the pandemic and that have continued despite it reflect protesters’ deep-seated anger and frustration with “the uncertainty of their lives, the insecurity of their moment and precarity of the future.”[94] The protests’ wide geographic scope and the fact that protesters are largely from the country’s working class, long regarded as the social bedrock of the post-revolutionary state, are telling.

Conclusion

Iran’s newly inaugurated president, Ebrahim Raisi, has taken the helm at an extraordinarily difficult time for the country — and for the regime that governs it. Negotiations to salvage the nuclear agreement have stalled. Crippling sanctions remain in effect. The June election produced a record-low voter turnout.[95] The most recent wave of protests, which started in Khuzestan province, subsequently spread to other cities.[96] Meanwhile, Coronavirus infections and fatalities fueled by the Delta variant are skyrocketing, and the country’s healthcare system — widely regarded as one of the most resilient in the region[97] — is buckling under the strain.[98]  

The COVID-19 pandemic has exposed the Islamic Republic of Iran’s dysfunctions and vulnerabilities. Despite frontline health workers’ heroic efforts to save lives, the infection rate and daily death toll continue to mount. Eight months after banning imports of any vaccines developed in the United States or the United Kingdom, only 3.8% have been fully vaccinated.[99] Among the Iranian president’s first acts was to nominate Bahram Eynollahi — an opthalmologist and a signatory to a January letter calling for a ban on Western vaccines — as Minister of Health and Medical Education.[100]

The management of the Islamic Republic’s economy has long functioned as a subordinate element of national security policy.[101] In important ways, it appears that the management of the pandemic has as well. An ethos of national resilience was forged during years of war and duress. And for over a decade, the concept of resistance has been a central motif of Supreme Leader Khamenei’s political messaging. Thus, some of the shortcomings of Iran’s pandemic response can be understood as collateral damage inflicted by the regime’s “resistance strategy.” For how long the regime can sustain maximum resistance — and without resorting to maximum repression — is likely to depend not just on how deftly it plays its hand in seeking sanctions relief but how competently it manages the critical mission of responding to the pandemic.