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Policy Analysis 09 April, 2020

The Covid-19 Pandemic in Iran: Health and Policy Implications

Mehran Kamrava

Head of the Iranian Studies Unit at the Arab Center for Policy Studies and Research and is also Professor of Government at Georgetown University Qatar. He is the author of a number of journal articles and books, including, most recently, A Concise History of Revolution and Inside the Arab State.

​Introduction

On February 12, 2020, Iran marked the forty-first anniversary of the 1978-79 revolution and the establishment of the Islamic Republic. This anniversary of the revolution was then followed by elections to the eleventh parliament, the Majles, on February 21, and a month later by the start of a new year in the Persian calendar and the accompanying Nowruz celebrations. For the Islamic Republic, the revolution's anniversary and elections have long had great ideological and political significance, presenting state leaders with opportunities to showcase the revolution's accomplishments, maintain the ideological profile of the system and articulate new policies and priorities, and to ensure its long-term maintenance and health by recruiting new cadres into both rank-and-file and leadership positions.

The 2020 Majles elections and Nowruz celebrations were overshadowed by the ominous appearance of a previously unknown virus that had first appeared in Wuhan, China, a few weeks earlier. In Iran, the first case of what came to be called Covid-19 was officially reported in the city of Qom on February 18, 2020. The virus soon spread like wildfire to other cities, and soon beyond Iran, with Qom itself becoming the epicenter of the country's infections and Iran the epicenter of the rest of the Middle East. Infections, at first reported in the tens, soon amounted to hundreds, and then thousands. The death toll mounted, quickly making Iran one of the most deeply affected countries in the world. At least as far as official numbers are concerned, countries such as the United States, Italy, Spain, and China have suffered more infections and mortalities from the Covid-19 pandemic. But Iran's official numbers can be assumed to be underreported, with actual cases much higher. There are also certain to be cases that are undetected or are unreported to medical professionals.

The impact of the pandemic has not spared any segments of society or even the highest echelons of the state. As of this writing, at least 23 parliamentarians, including the influential Speaker of the Majles Ali Larijani, have been infected, as have many high ranking members of the executive branch, such as and Vice President Masoumeh Ebtekar. As of early April 2020, at least 12 serving or former government officials had lost their lives to the pandemic.[1]

This paper examines some of the main underlying causes for the rapid spread in Iran of the pandemic caused by Covid-19, also commonly referred to as the coronavirus. The spread of Covid-19 in Iran, the paper argues, is the result of several interwoven, reinforcing factors. First, while the country's primary healthcare system has witnessed significant improvements since the 1978-79 revolution, for several reasons its quality of care at the secondary and tertiary levels has been wanting. Once the initial infections hit, the country's medical system was unprepared to deal with the deluge of infected patients. Second, the country's policymakers were slow to recognize the magnitude of the crisis facing them, and their haphazard and at times dismissive response to the pandemic in the crucial early days only hastened its spread. Some of the initial responses to the pandemic, most notably by the Supreme Leader Ali Khamenei, were political and ideological. For his part, President Rouhani also sought to reassure the public early on that the situation would quickly return to normal and that Iranians can soon resume their regular routine.

This second factor reinforced a third cause for the virus's rapid spread, namely a confluence of events on the calendar that made social distancing – one of the most effective means of curtailing the virus – all the more difficult, if not impossible. These included the celebrations marking the revolution's anniversary, parliamentary elections, and then Nowruz and New Year celebrations. Prevalent social and cultural norms already make social distancing difficult in Iran, as do economic conditions and constraints of life in rural and lower income urban areas. This confluence in the early days and weeks of the outbreak further facilitated the spread of the virus.

[1] "Iran parliament speaker tests positive for COVID-19," France 24, 02/04/20, https://www.france24.com/en/20200402-iran-parliament-speaker-tests-positive-for-covid-19.