The Islamic Republic of Iran (hereinafter referred to as Iran) has witnessed a high incidence and prevalence of COVID-19 cases and deaths since the first case was detected on 19 February 2020. As of 28 February 2022, Iran reported more than 6.6 million cases and approximately 140 000 deaths [1]. Amidst the rapid spread of new variants as the pandemic evolved, Iran’s limited capacity to effectively conduct genomic sequencing significantly hampered surveillance and tracking of SARS-CoV-2 variants and inform Iran’s pandemic response. From the onset of the pandemic until December 2021, Iran conducted genomic sequencing analysis of viral samples from only 86 COVID-19 diagnostic positive cases. Low vaccination coverage (20% total population coverage (with two doses): 85 million nationals and +4 million refugees), in part due to the inability to procure vaccines until end August 2021, impacted Iran’s response to the pandemic. Sanctions have further challenged an already strained market for the procurement of COVID-19-related supplies.

WHO and its partners provided critical support to Iran to overcome these challenges and scale up the response to COVID-19, which resulted in mobilizing more than 130 million vaccine doses and capacity to conduct genomic sequencing analysis of 7700 viral samples. Genomic sequencing has been very important for the COVID-19 response. As with all viruses, SARS-COV-2, the virus that causes COVID-19, continues to evolve as it continues to spread. Genomic data has guided countries to make quick and informed public health decisions since the start of the pandemic. Data help countries prepare for potential surges and take important steps, such as increasing oxygen supply, opening more hospital beds or ramping up testing for more transmissible variants. It has also been crucial to help countries select the safest and most effective vaccines [2].

How did Iran do it, and how did the WHO Secretariat support Iran?

WHO extensively engaged European Union Member States, Japan and other donor countries as well as COVAX, together with the United Nations Children's Fund (UNICEF), to mobilize bilateral donations. WHO and partners undertook intense diplomatic efforts to mobilize donations through COVAX, extensively trained and provided supplies to vaccination centres, undertook aggressive risk communication and community engagement campaigns to mobilize the community, mobilized vaccines for refugees from the COVAX humanitarian buffer, procured genomic sequencing machines and provided training, and robustly monitored adverse events of special interest.

 “The Islamic Republic of Iran has had five waves of COVID-19 but the vaccination rate has been growing in recent weeks with imported and locally produced vaccines, covering all age groups, and more importantly, the most vulnerable, such as pregnant women, adolescents and children with safe vaccines, and even refugees and displaced populations mainly from Afghanistan. This universal COVID-19 vaccination gives us hope for smart re-opening of businesses and other entities in a gradual and vigilantly monitored pace.”

His Excellency Dr Bahram Eynollahi

Minister of Health and Medical Education, Iran

Intense advocacy resulted in mobilizing more than 130 million vaccine doses, including direct procurement from manufacturers. WHO led regulatory and legal aspects as well as strengthening vaccination capacity which led to a record 1.7 million dose administrations each day. As a result, Iran reached 60% total adult population coverage (with two doses). To strengthen genomic sequencing capacity, WHO mobilized funds to procure advanced genomic sequencing machines equipped with next generation sequencing technology, including kits, software and training from the manufacturers. The sudden upward surge in sequencing capacity resulted in genomic sequencing analysis of 7700 viral samples. The success of genomic sequencing efforts mobilized further resources to procure four additional advanced genomic sequencing machines to the country. Robust risk communication and community engagement campaigns rolled out through mass media and local chancellors enabled community-centred approaches and generated demand for testing, treatment and vaccines.

Iran has faced several obstacles in its response to COVID-19, including sanctions which affected the health sector even prior to the pandemic. Sanctions have threatened equitable access to vaccines, for example, through restrictions of transferring Iranian investments into the COVAX facility as a self-financing member. Iran continues to fight the battle against the viral infection amidst the challenges, and WHO stands by the national health system, the people of Iran, and all partners to increase access to lifesaving COVID-19 products and services.

REFERENCE

[1] Iran Ministry of Health and Medical Education (MOHME)

[2] https://www.afro.who.int/news/why-genomic-sequencing-crucial-covid-19-response

Photo Credit: © WHO Country Office in Iran

Photo Caption: A public COVID-19 vaccination site in Tehran, August 2021.