In February 2020 some countries were already fighting COVID-19, and after China Iran emerged as one of the first COVID-19 epidemic countries, quickly surpassing infection rate of other countries at that time. Operating in a vastly different context than China or Italy, health officials had to think and work quickly to design early detection methods, communication strategies, and lockdown policies.
“There were not many examples from other countries,” said Dr Christoph Hamelmann, the World Health Organization (WHO) representative to the Islamic Republic of Iran. “China, for example, is so culturally different, that we couldn’t respond in the same way. Many things had to be developed right here in the country.”
With the situation rapidly evolving on the ground in Iran, including the first COVID-positive employee on the team, the WHO country office had to brainstorm and devise its own standard operating procedures – often weeks ahead of headquarters. In early March, WHO experts travelled to the country and met with national stakeholders and health officials to plan and to scale up the response to the escalating epidemic; prioritize areas for implementing control measures; and pinpoint measures to strengthen the response in areas that had not yet been affected. There was no time to waste, also in terms of further cross-border spread between countries in the region and beyond.
Scaling up the emergency response
The most immediate priorities were early detection, isolation and treatment, implementing effective contact tracing, and ensuring a strong system of risk communications in a context rife with misinformation. Since the very beginning and up until now, WHO continues to strengthen the COVID-19 testing capacity of the national laboratory network and provides them with thousands of PCR tests. The Organization also navigated logistical hurdles and global scarcity in personal protective equipment (PPE), and delivered 3 shipments of masks and face shields, gloves, shoe covers, and other supplies to the virus-battered country. Additionally, WHO delivered shipments of medicines for Iran’s participation in the Solidarity clinical trial, one of the world’s largest studies to identify effective COVID-19 treatments.
WHO donated PCR Molecular Detection Kits to the Pediatric Infectious Diseases Research Center of Shahid Beheshti University of Medical Sciences at Mofid Children's Hospital to be used in a study conducted in collaboration with the Robert Koch Institute on the prevalence of COVID-19 disease in children, Nov 2020. ©WHO Iran Country Office
Given that misinformation about COVID-19 was evolving as quickly as the virus itself, risk communications was another crucial element that WHO had to put in place. This was important to ensuring that any information vacuum – since the virus was so new, and sometimes, information was simply not available – was not filled with harmful rumors. Early on, for example, media outlets reported that hundreds in Iran died from drinking methanol alcohol after reading false information on social media that it was a coronavirus cure. However, as Dr Hamelmann pointed out, misinformation is not specific to Iran, and is a global phenomenon that requires a comprehensive response strategy.
“What kept me up was providing a really good and thought-through communications strategy that supported health literacy and empowered the population,” said Hamelmann.
WHO Iran team package posters of ICERP, the Iran COVID-19 Response Project, to be sent to target facilities receiving medical and diagnostic equipment under the project, November 2020. ©WHO Iran Country Office
Before the pandemic, the WHO country office did not have a communications officer, but now, there are six people working with the Ministry of Health on risk communication strategies. With WHO acting as a neutral player in a highly politicized environment, its role helps add credibility and enhances people’s trust in health information. The team works in tandem with the WHO regional office and headquarters to develop locally relevant communications materials, including technical guidance, myth busters, and videos featuring demonstrations of preventive measures such as hand-washing, avoid closed and crowded environments or physical distancing.
Navigating economic sanctions
Another obstacle that Iran has had to face in its COVID-19 response is unilateral economic sanctions which are also affecting the health sector, even before the epidemic started. While the WHO country office – together with other agencies of the UN country team – are supporting the Ministry of Health and Medical Education (MOHME) to mitigate the impact, even the timely implementation of more than US$80 million which the country office has received for COVID-19 emergency procurement for life saving medical and laboratory equipment from a range of different donor countries and the MOHME is made more difficult under such conditions, in addition to the anyhow stressed global market conditions with much higher demands than supplies. WHO supports the country by directly communicating with suppliers and purchasing state-of-the-art equipment and essential supplies on the global market.
The sanctions have also had a severe impact on the economy.
“Iran has a lot less fiscal room to go through a lockdown,” said Dr Hamelmann. “The country had to open earlier because it was not sustainable to remain closed. Even now, there’s very little option to go to complete lockdown if we hit another COVID-19 peak.”
When the pandemic hits home
Before getting infected with COVID-19, Dr Hamelmann was already contemplating whether to work from home or go in the field, where he says his work is more effective.
“I prefer to schedule meetings in places where I can meet people who most need our work like hospitals and homeless centers,” he said, “People need to see my face—not just in ministry meetings but out there in the community. I need to engage not just centrally in Tehran but also within the provinces.”
When he got sick, he immediately knew it was COVID-19. “It had a certain kick against you that you knew was not normal,” he said.
At home in isolation for two weeks, he continued to work 12 hours a day to keep up with the office demands, answering emails until midnight, and editing the country’s daily COVID-19 situation report, which is distributed to international representatives in Iran; key officials and academics in the country; and UN agencies and a broad network of partners in Iran, the region and beyond. He says he keeps a close eye on that daily update because one miscommunication could create much concern and negative repercussions in a very sensitive and politicized environment.
Dr Hamelmann now has hope that he can support the response beyond the office. When he learned that China was using convalescent plasma therapy to treat coronavirus patients, he decided to donate his antibody-rich blood to the Iranian Blood Transfusion Organization. It’s important for WHO representatives, he says, to “walk the talk.” He hopes that with his example he can encourage others who have overcome COVID-19 infection to donate blood for plasma therapy.
“I want to make sure that people in the public and our counterparts see that we aren’t just sitting behind desks writing policies and giving speeches, but that we engaged practically with very tangible impact for all people living in Iran,” he said.
The winter ahead
Starting end of November 2020, Iran had to re-institute again tighter restrictions in public life including evening curfews for all non-essential movements in major cities. Restaurants and entertainment areas were closed again. These restrictions are showing positive impact, but the pressure on the health sector, the economy and the livelihoods of many citizens remains.
The country is now looking ahead to the vaccine. More than eight Iranian companies and universities are currently working on a COVID-19 vaccine. While Iran doesn’t face the same level of poverty some other countries face, sanctions create other problems that threaten equitable vaccine access for its 80 million people for example through restrictions of transferring Iranian investments into the COVAX facility as a self-financing member.
“While our whole team at the country office is still working around the clock to meet the high demand for technical and procurement support in the national emergency response, the support to ensure that people living in Iran will have timely access to an affordable vaccine of high quality and safety standard has already become a new additional major focus of our work,” said Dr Hamelmann. “I am very grateful for the high motivation and dedication of all the team members in our country office. Of course, like everybody who works on frontline in this fight against COVID-19, we have periods in which we feel exhausted after 10 months of emergency operations. But we know that others are suffering even more and at the end we draw our energy from contributing to tangible impact in saving lives and safeguarding health as much as possible.”
Visit our Eastern Meditteranean regional office website for more information on Iran