During the more than four decades of the Islamic Republic regime in Iran, the “Fatwa” of the leadership has always been the conclusion of an argument when there are conflicts within the governance body or between people and government. In fact, the Fatwas of the supreme leader in Iran are overarching policies that all other political decisions should align with. Among the sensitive issues on which the supreme leader has issued Fatwas have been “nuclear weapons” and, more recently, “vaccination”. Ayatollah Khamenei issued a Fatwa banning Pfizer, Moderna, and AstraZeneca vaccines on January 8, 2021, and stated: “American and British vaccines are not allowed to be imported; I have said this to all authorities and now I am announcing it to the public that I do not trust the Americans and the British”.
A contribution by Dr. Negar Noori and Robert Van Gasteren L.LM.
Overarching policy and leadership
Fatwas usually refer to the final opinion and decision of a high-ranking Islamic authority, which is based on the Qur'an, the collective opinion of Islamic scholars and reason. This opinion is expressed in the form of five notions: obligatory, forbidden, disliked, recommended, and permissible. The basis for issuing a decree (fatwa) is that, first, there is a necessity and there is no law, or the law is silent in that particular case, or the interests of the regime are at stake. Based on this definition the decree of the Supreme Leader of Iran is an overarching policy that cannot be questioned. On the specific issue of the Corona vaccine, when the Supreme Leader issued a ban on vaccines from the United States and Britain, while Iran was in a state of crisis, many raised the question of the role of science and anti-science in the country’s overarching policies. Critics have argued that the fatwa is a supra-legal power that is incompatible with the principles of jurisprudence. In modern government, the wishes and opinions of no citizen should be above the law, and in fact, legal critics consider the fatwa to be a violation of equal citizenship rights. On the other hand, the proponents of the fatwa banning the import of Pfizer and Moderna vaccines point out that the Supreme leader has no objection to vaccination and even the import of vaccines, and that his will is to maintain the health and protection of the Iranian people. He believed that the Pfizer and Modern vaccines were urgently licensed, and their performance was unreliable. But the question is whether in the case of a human health issue that has become a global epidemic, the basis on which a vaccine's assurance can be determined should be political relations with the countries that produce it?
Governing the pandemic in Iran
The beginning of the pandemic and the beginning of the dangerous situation in Iran was during Rouhani's presidency. As soon as the pandemic was a fact, governments around the world implemented social measures, beefed up hospital capacity, and above all tried to get access to as much protective gear (masks, respirators, etc.) as possible. Before vaccines were even approved, some governments co-financed the development of a vaccine, thereby buying into a potential delivery scheme. Also, they signed large contracts such as the ones the EU signed, thereby limiting the supply to smaller or poorer countries. For stand-alone countries such as Iran it was impossible to play a role due to its smaller size but also it lacked a relevant network of "equals" to source the vaccine at an acceptable price successfully. Iran faced an extra hurdle as the regime does not maintain many friendly relationships with countries other than China and Russia. These two countries have developed their own vaccines but did not have a large surplus, and for a very long time, their vaccines were seen as second-in-class by international medical standards. Iran's government also focused on the development of domestic vaccines and cooperated in the development of vaccines with Cuba. However, due to the government's weakness in negotiations and the establishment of international agreements, Iran's share in the achievements of this cooperation was insignificant, and their Cuban partners failed in their commitment to share generated knowledge. Iran has been working on nine domestic vaccines, of which only three have been approved for usage. Iran unveiled its homegrown Fakhra coronavirus vaccine to much fanfare, but seven months after the launch of the first clinical trials, the production of the vaccine is being discontinued, and they therefore had to ramp up import of foreign inoculations. The unfounded enthusiasm led to allowing only a limited supply of imported vaccines to enter. Purchasing vaccines was a government-to-government action almost all over the world, but because of the overarching policy Iran delegated authority to private companies and made it more complicated. This mechanism caused ambiguities, complications, corruption, and delays in the supply chain.
Another problem related to the government's interaction with citizens in curbing Corona was the lack of transparent information. While the government was convinced that controlling the pandemic was only possible with the cooperation of the citizens and that the key to this is transparency, it could not gain the trust and support of the citizens to accompany this approach. The widespread vaccination program in Iran coincided with the beginning of the new government, the presidency of Raeisi, who is close to the supreme leader in Iran.
Power, Profit, and then People
The approach of the international and humanitarian community and vaccine suppliers to Iran’s vaccine demand
The vaccine sourcing roughly runs through 5 mechanisms: (1) straight from the tier-1 suppliers, (2) through ‘the free market’ (3) and international programs, (4) to developing and producing a new vaccine, and (5) approving and importing class-B vaccines.
Like in any market with supply shortage individual buyers, trading companies and hedge funds stepped in thereby increasing prices to extreme levels but still affordable to many except the poor countries. The Iranian procurement was not capable of being successful as the process was defined by bureaucrats not skilled to act in a trading situation in which the seller defines the rules. Either the bureaucrats set a target price which was unrealistic or were not willing to cooperate in payment procedures necessary for suppliers to be paid. Iran has been banned from the SWIFT banking system and keeps its limited USD funds in China, UAE, Russia and Turkey, hence special arrangements are needed to ensure sellers they are going to be paid.
Iranian entrepreneurs who were delegated with this responsibility also were not capable of being successful out of fear of what failure might do to their reputation or worse their life as an entrepreneur be put under scrutiny of the regime, not to speak about repercussions. It shows that under totalitarian regimes people fear to make mistakes, hence they don’t make decisions and in a market with shortages in supply and fast competition rapid decision making is needed.
Likewise, suppliers from all over the world were not easy to convince that supplying to the authoritarian regime would not be in violation of the international trading boycott and preferred to sell to easy customers.
The international community has responded quickly by putting in place several supply and coordination mechanisms. Unfortunately, like so many international initiatives the set up and roll out takes long due to political debates as well as the well-known overarching bureaucracy of the institutes.
COVAX was created last year to ensure that Covid vaccines are made available around the world, with richer countries subsidizing costs for the poorer nations. Its initial goal was to provide two billion doses of vaccines worldwide in 2021, and 1.8 billion doses to poorer countries by early 2022. COVAX is run by several international organizations, including the World Health Organization (WHO), UNICEF and GAVI. The scheme is based on both contributions in kind as well as funding. Contributors are the USA, UK, Japan and the EU. Since its establishment only 303 million doses have been shipped.
Despite their commitment to deliver vaccines or funds the rich countries also kept gobbling the global supply for their own use. Hence to date the wealthier nations have taken 67% of the available vaccines with a population making up 13% of the global population.
Iran is one of the self-financing countries in the program and received donations per 16th November 2021 through COVAX: 6,7m doses were delivered from its paid allocation and 4,3m donated
According to the most recent available data Iran to-date has been able to roll out almost 112m doses on a population of 85m and 59% of the population received two doses, which considering the above is not a bad result. Iran has been slow in approving vaccines but to date has eleven vaccines approved for use amongst which are Astra Zeneca, Johson&Johnson and Sputnik. But what is striking is the number of vaccines not approved for use in the rest of the world. There are currently another six vaccines under consideration in Iran which have not been approved for use on a global scale. Between February and mid October 2021, the international community provided Iran with 92,9 million doses. China provided 90%. Clearly the Regimes strategy seems to be based on being dependent upon one supplier, the political ally China importing a vaccine which has not been approved for use by a vast majority of countries. It also seems to be gambling on smaller vaccines not approved in and by other countries and thereby not being in competition with other buyers.
Living your life or die
Iranian citizens’ approach in the face of the pandemic
As in all other countries, it was necessary to follow health protocols in Iran during the pandemic. The government was forced to lock the cities down. But these lockdowns in Iran did not mean staying at home for many citizens, and they considered it a holiday and an opportunity to travel, party, etc. Many citizens of large cities like Tehran went on leisure trips to the green and pleasant northern towns, which made the situation in those cities critical. The ban on intercity traffic also did not stop people from traveling, and many videos were published on social media about citizens' disregard for health protocols and lockdown. One of the most viral videos shows a reporter interviewing a man without a mask who works in a crowded market asking him why he does not have a mask. The man firmly answers that he had nothing to be afraid of leaving this world. Citizens' reluctance to accept a new lifestyle and avoid entertainment on the one hand and lack of hope for life and future on the other are the two main reasons for disregarding the protocols. In addition, for economic reasons and the government's lack of support for vulnerable groups during the pandemic, some groups risked their lives to make ends meet.
In conclusion, the facts being made obvious in times of a pandemic indicate that old policy-making procedures, such as centralized government procurement employing bureaucratic processes or global coordination mechanisms from international institutions, and in-house R&D instead of open innovation approaches do not work. Neither does working with entrepreneurs with other local interests as in totalitarian regimes they fear repercussions. What is needed is a flexible approach, executed through capable trading mechanisms and sourcing specialists from abroad, authorized to act on behalf of the government with full powers of attorney. Last but not least, the level of citizens’ trust in government plays a crucial role, and without trust and understanding, they will not voluntarily line up.