Report

Postcards From the End of the Pandemic

In China, workers go first. At a Moscow clinic, every time slot is available. And some New Zealanders think they could do without. A regular check-in on the state of the world’s COVID-19 vaccine rollout.

covid-19-global-vaccine-rollout-sebastian-thibault-illustration-foreign-policy

Sébastien Thibault illustration for Foreign Policy

Sébastien Thibault illustration for Foreign Policy

With a cumulative death toll of over 400,000, the United States exceeds any other country’s overall COVID-19 mortality: near double what Brazil has recorded, and four times the death count in the United Kingdom. Now, the United States has gone all in on vaccines, and it is doing considerably better on distributing them than on handling the pandemic itself. At the current rate, a majority of Americans will be protected in six months. That’s not as efficient as in Israel, where this week even 30-somethings became eligible for their shots, and it’s not even comparable to the U.K., which is projected to reach an immunized majority in half the time of the United States, but it is considerably faster than most of Europe.

Living in the United States right now, scrolling through social media posts of elderly relatives and health care workers brandishing Band-Aids on their shoulders, it’s possible to feel a glimmer of hope—to sense we are, at the very least, nearing the beginning of the end. We at Foreign Policy asked our contributors to tell us how the vaccine rollout felt in other countries. (If you’re looking for numbers, our analytics team has compiled everything you need on COVID-19 responses around the world here.)

Not everyone everywhere is counting the days to immunity. In Australia, a federal politician recently peddled baseless conspiracy theories and reignited debate over the effectiveness of hydroxychloroquine for COVID-19 patients. (“Not scientifically based,” countered the country’s chief medical officer.) The government of Madagascar has refused to participate in the COVAX global vaccine initiative and is instead pushing a botanical treatment. And in France, as in much of the United States and elsewhere in the West, a crisis of trust in the state and its representatives has contributed to sluggish uptake, as Emile Chabal wrote for Foreign Policy.

Many others don’t have the choice to feel optimism. Infection rates of immigrants held in Immigration and Customs Enforcement detention centers in the United States are 13.4 times higher than those of the general population, and yet, as Eillen Martinez and Zackary Berger wrote, most states have failed to prioritize this group in their planning. Vaccine distribution everywhere has mirrored existing inequality, with just 16 percent of the world’s population buying up 60 percent of the world’s vaccine supply—an indefensible “vaccine nationalism,” World Health Organization Director-General Tedros Adhanom Ghebreyesus wrote in Foreign Policy, bound to create a vicious cycle of further deaths, faster spread, and more mutations.

Still, there are good news stories—injections of optimism—from all corners of the globe. Cuba is developing its own vaccine, with two contenders already in clinical trials. It plans to distribute the winner throughout the region as part of its longtime health diplomacy efforts. (FP’s Latin America Brief covers responses from other countries in the region.) Guinea is leading the way among low-income countries, with its president vaccinated in late January. South Africa is experimenting with clinics in shipping containers in order to reach more remote communities. (Read more in this week’s Africa Brief.) And—let’s not forget—in the ongoing race to develop, trial, and bring more vaccines to market, all five vaccines with public results have eliminated COVID-19 deaths.

Jump to country:
China  |  India  |  Iran  |  New Zealand  |  Russia  |  South Korea  |  Thailand 


New Zealand: ‘Sealed in a Bubble, One You Can See Through but Not Pierce’

Quarantined people take in the view from a rooftop terrace at the Grand Mercure Hotel, used to isolate returning New Zealanders during coronavirus quarantine protocols, in Auckland on Oct. 29, 2020.

Quarantined people take in the view from a rooftop terrace at the Grand Mercure Hotel, used to isolate returning New Zealanders under coronavirus containment protocols, in Auckland, New Zealand, on Oct. 29, 2020. Lynn Grieveson/Newsroom via Getty Images

By Jenna Sauers

“We should close it,” said the man. “We don’t need to let any more of them in.” I was checking out at the supermarket, and behind me, on the phone to someone else, was a white New Zealander in his 60s, dressed in an embroidered polo shirt, shorts, and sandals. His use of “them” made me start as I passed a box of tea over the scanner.

In New Zealand, where I grew up and where I completed my mandatory 14-day hotel isolation shortly before Christmas, I’ve noticed people don’t talk about the COVID-19 vaccine much. They talk, instead, about the border. The isolation and quarantine system, which takes place in a network of hotels across the country, is overseen by the armed forces and open only to citizens returning home. It’s fully booked through the next five months—as far out as the calendar is open—and everyone has both a relative overseas desperate to come home who can’t get an allocation and an opinion about how the system is being managed.

Where I normally live and where I spent the first eight months of the pandemic, New York City, we pinned our hopes since the earliest days of the first lockdown to the prospect of a vaccine. But faced with COVID-19, New Zealand pursued a different strategy—elimination—and with good governance and a measure of luck, that strategy has worked. There are effectively zero cases of the virus here. Normal life has resumed, except instead of tourists, there’s an ever-swelling population of expats like me. It’s the border controls that keep the country safe, and there simply isn’t the same urgency around the vaccine as there is in the United States or the United Kingdom, because New Zealand doesn’t need it as much.

Whatever the ethical considerations, vaccine distribution here is, at this point, entirely theoretical.

The New Zealand government has contracted to purchase four different vaccines, in a sufficient quantity of doses to vaccinate the population three times over. There is a debate over whether it even makes sense for New Zealand—a country where the last COVID-19 death was in September 2020 and the total toll for the pandemic stands at 25 people—to undertake a mass vaccination program when, elsewhere in the world, refrigerated body trucks are reappearing outside hospitals. Some of New Zealand’s vaccine supply has been pledged to smaller Pacific island nations, which have more fragile health systems and greater need. But whatever the ethical considerations, vaccine distribution here is, at this point, entirely theoretical. No vaccine has yet been delivered to New Zealand, and the local pharmaceutical regulator has not yet approved any vaccine, though the government is building an infrastructure of super cold freezers and mobilizing thousands of retired health care workers to deliver the shots.

When the vaccine comes, first in line to receive it will be the health care workers, soldiers, and hotel staff who have been working in the quarantine system: about 4,000 people, working in 32 facilities. Prime Minister Jacinda Ardern predicted in one of her recent livestreams on Instagram that vaccinating those people would take just two to three weeks, but it’s hard to know if that’s realistic, or when it will begin. Although no politician wants to say it, New Zealand is a small country at the mercy of international pharmaceutical companies and their delivery schedules. The government just pushed back its earliest estimate for the first vaccinations from March to April, and indications are it won’t be available for the general population until the second half of 2021 at the earliest.

When I emerged from the hotel where I’d been kept by the army for two weeks, I had the sense that I was entering managed isolation on a countrywide scale. New Zealand feels like it is sealed in a bubble, one you can see through but not pierce. The reality is New Zealand probably won’t reopen its borders until the rest of the world does, too. I have a feeling that won’t be for some time.

Jenna Sauers is a writer who splits her time between Brooklyn and New Zealand.


Russia: ‘All I Had to Do Was Call My Local Clinic and Ask for a Shot of Sputnik V’

A nurse prepares a Sputnik V coronavirus vaccination at a clinic in Moscow on Dec. 5, 2020.

A nurse prepares a Sputnik V coronavirus vaccination at a clinic in Moscow on Dec. 5, 2020. KIRILL KUDRYAVTSEV/AFP via Getty Images

By Alexey Kovalev

I consider myself lucky. In another country where vaccines are already available, a healthy middle-aged man like me would probably have to wait a year or longer until it’s his turn. Here in Moscow, all I had to do was call my local clinic and ask for a shot of Sputnik V.

It was during the initial phase of the rollout of Russia’s first vaccine in December, when only certain categories of front-line workers such as doctors and teachers were eligible. After seeing reports of very low turnout, I called the clinic. I was told they didn’t care who I was—all time slots were available for my choosing. Not only that, but the clinic then called me and asked if I could come sooner than scheduled, at half an hour’s notice. Since one vial of Sputnik V contains five doses, patients are corralled in groups of five before a vial is unfrozen. If one of the five doesn’t show up, a dose is wasted—so I was called to jump in.

The first dose only gave me a mild fever that lasted a few hours. But the second three weeks later really did me in.

The first dose only gave me a mild fever that lasted a few hours. But the second three weeks later really did me in: I had a severe fever and terrible chills for two nights, and slept most of the day. I heard from others who had no side effects at all, while some suffered worse after the first dose. I haven’t had an immunity test yet, but those who have and were vaccinated before me have already developed antibodies. A late-state trial published this week showed Sputnik V to be more than 91 percent effective—so if you have the chance, get vaccinated with it.

But I’m also lucky because I live in Moscow. In Russia’s regions, the vaccine rollout has been painfully slow. There are still no credible statistics on how many people have been vaccinated across the country. Argentina, the first country outside Russia that authorized Sputnik V for emergency use, and which received its first batch in late December, had already vaccinated more people by mid-January than all of Russia outside Moscow—and did so with more transparency. A common grievance on Russian social media is the claim that their government chose to ship vaccine to Buenos Aires in order to score propaganda points instead of St. Petersburg, where they are sorely needed.

But even when supplies are plentiful, Russians’ trust in vaccines has declined. In an Ipsos poll conducted in January, Russia was the only country among the 15 surveyed where a majority of the population was opposed to being vaccinated. This attitude may also have something to do with the fact that Russian President Vladimir Putin, a public advocate of Sputnik V, hasn’t let himself be vaccinated. A lot more Russians would trust the vaccine if the president got his shot on national television, but so far his spokesman has only offered vague excuses and distractions. 

Alexey Kovalev is an investigative editor at Meduza.


China: ‘It Wants to Prove Its Strategy Is Superior’

Chinese workers, including security guards, wait to receive a COVID-19 vaccine jab at a mass vaccination center for Chaoyang District in Beijing on Jan. 15.

Chinese workers, including security guards, wait to receive a COVID-19 vaccine jab at a mass vaccination center for Chaoyang District in Beijing on Jan. 15. Kevin Frayer/Getty Images

By James Thorpe

One year since the world’s first coronavirus lockdown, China faces new pressure at home and abroad over its pandemic response. Although its success in keeping the infection rate down is undisputed, China’s approach to vaccines is on less stable ground.

China has produced two COVID-19 vaccines: one from Sinovac and one from Sinopharm. The country started giving shots to limited groups, including students going abroad, even when the data was still in the early stages, but subsequent trials, largely observed in developing countries, have been disappointing. In Brazil, which produced about 6 million doses of Sinovac’s vaccine, the efficacy rate fell from a first reported 78 percent to 50.4 percent.

In spite of this, Beijing has locked in a strong market for the vaccine. Turkey has received around 9.5 million doses of the Sinovac vaccine, while the Philippines has arranged for 25 million doses. The United Arab Emirates, Egypt, and other countries in the region have also pushed ahead with use of Sinopharm doses. At least two other Chinese vaccines are in development.

FP INSIDER'S COVID-19 INDEX outlines major bottlenecks affecting the global vaccine roll-out and profiles actions governments are taking around the world to manage the ongoing crisis.

FP INSIDER’S COVID-19 INDEX outlines major bottlenecks affecting the global vaccine rollout and profiles actions governments are taking around the world to manage the ongoing crisis.

Chinese authorities have gone further than just shipping out their own vaccines. They have also tried to undermine faith in Western-produced ones. The Global Times, a state media outlet, recently published a piece that claimed, without evidence, that the technology used by the Sinovac and Sinopharm vaccines was safer than the technology used by Pfizer.

Chinese officials have spread disinformation on Twitter. The Chinese Foreign Ministry spokesperson Zhao Lijian recently retweeted a post from Liu Xin, a state-media TV presenter, who posted photos implying a causal link between Pfizer vaccines and deaths in Germany.

China also wants to prove its strategy is superior. Unlike other countries such as the United Kingdom and United States, which are focusing their efforts on vaccinating the elderly and clinically vulnerable first, China has prioritized working-age groups it sees as at a high infection risk.

That risk is growing, and the government has rushed to halt a surge in cases, which are at their worst levels since March 2020. In the city of Tonghua, China—the focus of the latest lockdown—local officials publicly apologized for shortages that left some residents short on medicine and food. The country can’t afford for its vaccine deployment to be sluggish.

It also has a problem of scale. According to Xi Chen, a professor at the Yale School of Public Health, the logistics infrastructure needed to reach China’s population, especially in remote rural areas, will be a major challenge. Existing networks are poorly suited for a mass vaccination campaign that would need to penetrate far beyond the cities that are the target market for conventional distribution efforts, such as e-commerce.

This partly explains why China’s vaccination rate for other diseases is so low. Around 2 percent of the population in China was vaccinated against the flu in 2019, compared with 50 percent in the U.S.

China also needs to scale up production. Sinopharm Chairman Yang Xiaoming recently acknowledged domestic supply of vaccines is currently insufficient for 1.4 billion people. Foreign-made vaccines are likely to help overcome this shortfall. On Tuesday, the Chinese firm BioKangtai announced it had finished building a production site that has capacity to make 400 million doses of the AstraZeneca vaccine each year. Beijing may not be pushing its disinformation campaign as aggressively at home as it is abroad, but distrust stoked by the government and state media may soon have to be replaced by a public health campaign that encourages trust in Western-produced vaccines.

Many Chinese people will eventually receive Western-made vaccines, Yale’s Xi said. The public still remembers the 2018 scandal in which a Chinese drugmaker was found to have fabricated its production records, leading to more than 215,000 children being injected with faulty vaccines. China may be proud of its COVID-19 record, but consumers often see Western medicine as the gold standard.

James Thorpe writes about law and politics.


India: ‘In a Situation Unlike Almost Anywhere in the World: Producing More Vaccine Doses Than There Are People Willing to Take Them’

An employee works on an assembly line for manufacturing vials of Covishield, AstraZeneca-Oxford's COVID-19 vaccine at India's Serum Institute in Pune, India, on Jan. 22.

An employee works on an assembly line for manufacturing vials of Covishield, AstraZeneca and Oxford’s COVID-19 vaccine, at India’s Serum Institute in Pune, India, on Jan. 22. PUNIT PARANJPE/AFP via Getty Images

By Rukmini S

In many ways, the rollout of India’s COVID-19 vaccination program has been emblematic of both the best and worst of its pandemic response. The innovation is world-class, and government action is impressive, particularly for a middle-income country—but a faint whiff of impropriety and a thick wall of opacity make celebration difficult.

India detected its first COVID-19 case on Jan. 30, 2020, and since June, when its strict lockdown began to lift, hospitals in its biggest cities were overrun. People died waiting for intensive care beds. But now, for reasons not yet fully understood, the peak appears to have passed.

Since September 2020, new cases have steadily declined, and the country now reports roughly 10,000 new cases each day. A waning pandemic, combined with relatively high levels of immunity in the population, should have set the stage for a wildly successful vaccine rollout. Instead, India is falling far behind its own vaccination targets.

It’s not for lack of scientific achievement. For more than a century, India has manufactured vaccines domestically, and Indian exports now account for 60 percent of the world’s vaccines. Vaccine development against COVID-19 kicked off early during the pandemic in India. By May 2020 there were already 30 vaccines in development in the country. Among globally leading candidates, the Oxford-AstraZeneca vaccine currently being distributed in the United Kingdom is being produced by the Serum Institute of India (SII), the world’s largest manufacturer of vaccines, based in Pune, India. The institute will also produce the Novavax vaccine, whose U.K. trials produced encouraging results.

On Jan. 3, the Indian government approved two vaccines for use in the country: Covishield, the Oxford-AstraZeneca vaccine being produced by the SII, and Covaxin, which is produced by Hyderabad-based Bharat Biotech with the Indian Council of Medical Research.

The trials were not without controversy. A participant in the Covishield trial said he suffered an “adverse event” as a result of the trial and, unhappy with the official response to his complaint, sued SII. The incident was not disclosed, unlike comparable events in other trial sites around the world, and only came to public attention through news reporting of the legal notice. The company’s response was to threaten to countersue, a move that advocacy groups characterized as intimidatory.

Bharat Biotech, meanwhile, has been criticized for recruiting participants from poor and marginalized communities who were not entirely sure what they were signing up for; after a trial participant from Bhopal, India, died, his wife said that her late husband believed he was being given an approved vaccine and did not realize he was participating in a trial.

Granting approval for the two vaccines was not straightforward, either—more so in the case of Covaxin. Covishield had completed both safety and efficacy trials in the U.K. and other trial sites but has yet to complete its efficacy trial in India. Covaxin is much further behind in the scientific process. The company completed the first two phases of the trial—testing for safety and immunogenicity, but its third phase, which tests for efficacy, is ongoing.

“It is highly unusual to approve a vaccine candidate for which efficacy data is not yet available,” said Anant Bhan, a researcher in public health and bioethics.

“It is highly unusual to approve a vaccine candidate for which efficacy data is not yet available, particularly when the same Indian government committee that approved the vaccine for use in January had asked the company in an earlier meeting to come back with efficacy data,” said Anant Bhan, a researcher in public health and bioethics. Explanations around its decision-making process have not been forthcoming from the drug regulator.

India began its COVID-19 vaccination drive on Jan. 16 with both Covishield and Covaxin, and it has since administered doses to more than 2 million people, most of them doctors and other health care workers. The numbers are impressive but well below India’s own targets, partly on account of administrative glitches, as well as, more worryingly, hesitancy on the part of intended recipients worried about being given vaccines that are not yet safe or efficacious. This now places India in a situation unlike almost anywhere in the world: producing more vaccine doses than there are people willing to take them, forcing urgent exports before the vaccines expire.

Things could turn around yet. Covaxin’s phase 3 data could well turn out to be positive, and developers report that their candidate responds well to the variant of the coronavirus first discovered in the U.K. Four other candidates are awaiting approval: the Pfizer, Moderna, Novavax, and Sputnik V vaccines for which trials are ongoing. India does not have an anti-vaccination movement, and faith in scientists and the government is generally high. India also has a large public health machinery accustomed to mass vaccination. But this may be one of the first times India confronts the pitfalls of ruling by diktat.

Rukmini S is an independent journalist in Chennai, India.


South Korea: ‘The Strategy Has Been to Wait and See … and Correct Course if Necessary’

A woman walks past a poster depicting the coronavirus as a bomb at the City Hall in Seoul on Dec. 28, 2020.

A woman walks past a poster depicting the coronavirus as a bomb at the City Hall in Seoul on Dec. 28, 2020. JUNG YEON-JE/AFP via Getty Images

By Max S. Kim

South Korean health authorities announced on Jan. 28 that they would begin rolling out COVID-19 vaccines in early February, with the aim of inoculating 70 percent of the population and achieving herd immunity by November.

South Korea’s vaccination drive comes almost two months behind those of countries like the United States, Mexico, and Britain. Riding on the country’s early and aggressive containment measures, which allowed it to avoid the worst of the pandemic, health authorities have taken a more conservative approach with vaccines, warning against the idea that South Korea needs to be the first in the world to get vaccinated. Instead, the strategy has been to wait and see whether any complications emerge in early-inoculation countries and correct course if necessary.

Under the current plan, vaccines will be distributed for free to all citizens and foreign residents enrolled in South Korea’s mandatory national health insurance program. Front-line medical workers and residents of nursing homes will be the first to be vaccinated, followed by adults 65 and older, disabled or homeless people, and employees of high-risk workplaces. The remaining adults will be vaccinated beginning in July. For the time being, pregnant women and minors have been excluded, although this may change when more clinical data becomes available.

The government has so far secured enough doses for 56 million people—more than its population of 52 million—from AstraZeneca (10 million), Moderna (20 million), Janssen (6 million), Pfizer (10 million), and the COVAX Facility, the World Health Organization-led global vaccine procurement and distribution initiative (10 million). A purchase agreement for another 20 million people’s worth from Novavax is also nearing finalization.

While some have criticized the relatively late start as unnecessary foot-dragging, public opinion seems to back the government’s reasoning.

While some have criticized the relatively late start as unnecessary foot-dragging, public opinion seems to back the government’s reasoning. According to a poll of 1,094 South Korean adults conducted by public health researchers at Seoul National University last month, 67.7 percent responded that they would prefer to wait to be vaccinated, while just 28.6 percent hoped to get vaccinated as soon as possible.

Although South Koreans’ trust in vaccines is generally high, with the country’s child vaccination rates among the highest in the world, there were confidence-shaking problems with the country’s annual flu vaccination program last year. In October, following a temporary suspension of flu vaccinations due to a cold-chain failure, one manufacturer recalled around 600,000 doses of its vaccines after some of the shots were found to be contaminated. Numerous reports of unusual side effects and a total of 108 deaths initially thought to be linked to flu shots stoked further public anxiety around vaccines. Medical authorities have since concluded that these deaths were unrelated. In order to assuage public anxiety, South Korean President Moon Jae-in recently promised that the government would assume full responsibility for any vaccine complications and compensate those affected.

Max S. Kim is a writer and journalist based in Seoul. His reporting on South Korea has appeared in the New Yorker, MIT Technology Review, the Atlantic, and elsewhere.


Thailand: ‘A Fiercely Defensive Government Has Unleashed the Most Fearsome Weapon in Its Legal Arsenal’

Thanathorn Juangroongruangkit gestures as he leaves a news conference in Bangkok on Jan. 21 after he was accused of contravening Thailand's strict royal defamation laws by posting a video criticizing the government's COVID-19 vaccine strategy.

Thanathorn Juangroongruangkit gestures as he leaves a news conference in Bangkok on Jan. 21 after he was accused of contravening Thailand’s strict royal defamation laws by posting a video criticizing the government’s COVID-19 vaccine strategy. LILLIAN SUWANRUMPHA/AFP via Getty Images

By Tyler Roney

As Thailand experiences a resurgence in COVID-19 cases, all eyes are on the vaccine distribution plan, which uses more than one supplier but relies heavily on manufacturing the AstraZeneca vaccine locally and distributing it across Southeast Asia. Already under pressure from protesters, a fiercely defensive government has unleashed the most fearsome weapon in its legal arsenal: the law against lèse-majesté, or defaming the monarchy, which can carry a sentence as high as 15 years.

Thanathorn Juangroongruangkit, the billionaire darling of progressive politics in Thailand, criticized the government’s rollout of the vaccine on a Facebook Live video titled “Royal Vaccine: Who Benefits and Who Doesn’t?,” in which he said the government’s policy was overly reliant on Siam Bioscience, a company owned by the Crown Property Bureau. Thanathorn said Siam Bioscience lacks experience in creating vaccines.

Two days later, the Ministry of Digital Economy and Society issued lèse-majesté charges under the controversial Section 112 of the Thai Criminal Code, which was revived as a weapon against protest leaders to put down the largely peaceful protests in Bangkok in 2020.

Thanathorn, leader of the extra-parliamentary Progressive Movement group, which was set up after the dissolution of the opposition Future Forward Party, was quick to point out that he supported the government’s policy of negotiating for several vaccine sources, but he says the vaccines procured are only enough for 21.5 percent of the population, citing the 26 million supplied from AstraZeneca and 2 million from Sinovac. It was announced late last month that 50,000 of the AstraZeneca doses will be shipped in February.

Part of the key to the government’s rapid response is having the vaccine manufactured by Siam Bioscience, which is owned and controlled by the royal family.

Part of the key to the government’s rapid response is having the AstraZeneca vaccine manufactured by Siam Bioscience, which is owned and controlled by the royal family and King Maha Vajiralongkorn via the Crown Property Bureau. Siam Bioscience received a $20 million government subsidy to increase its capacity so it could produce AstraZeneca’s COVID-19 vaccine for distribution across Southeast Asia.

The Crown Property Bureau, and by extension Siam Bioscience and banks such as Siam Commercial Bank, came under renewed pressure with the Royal Assets Structuring Act of 2018, in which the king himself gained control of the bureau’s assets, essentially meaning there was no longer a distinction between the royal family’s holdings and state assets. Both the Crown Property Bureau and Siam Bioscience headquarters were the site of protests last year.

The charges against Thanathorn for criticizing the vaccine plan come as a surprise both due to his high profile and because he barely mentioned the monarchy in his Facebook Live video. “I questioned whether the scheme benefited one single company or not. It just happened that the shareholder of the company is the king himself,” he told Reuters in an interview.

Thanathorn joins a long list of citizens recently charged with lèse-majesté, including two dozen protest leaders, a 16 year old child, and rappers. The government’s new willingness to use the charge took an even more chilling turn last months, when the courts issued their longest ever sentence for lèse-majesté of 87 years over 29 charges to a 64-year-old woman, shortened to 43 for her guilty plea. Her crime was sharing audio clips from an anti-monarchy podcast.

Tyler Roney is a journalist in Thailand.


Iran: ‘Politicizing Health Care by Making It Harder to Procure Medical Supplies’

Rasoul-e-Akram hospital personnel attend a funeral for a 25-year-old colleague who died from COVID-19 to mark his efforts in protecting people those infected by the disease in western Tehran on Dec. 9, 2020.

Rasoul-e-Akram Hospital personnel attend a funeral for a 25-year-old colleague who died from COVID-19, to mark his efforts in protecting people infected by the disease, in western Tehran on Dec. 9, 2020. Morteza Nikoubazl/NurPhoto via Getty Images

By Anchal Vohra

In the battle between the government of Iran and the Trump administration, Iranians’ health became collateral damage. Both sides blamed the other for politicizing health care by making it harder for Iranians to procure basic medical supplies to manage the coronavirus crisis. The question now is whether the conflict will carry over to the Biden administration.

Iran was among the worst affected by the coronavirus in the Middle East. It has so far reported 1.45 million infections, more than 58,000 of whom have died (although Iran has long been suspected of deliberately announcing a lower number of deaths than the actual tally, to contain public anger and prevent public protests). Yet Iranian Supreme Leader Ayatollah Ali Khamenei has avoided fully embracing vaccines as a solution.

Khamenei has banned the purchase of vaccines manufactured in the United States and the U.K., insinuating that Iranians might be used as guinea pigs by western companies to test their vaccines. “Importing vaccines made in the U.S. or the U.K. is prohibited. They’re completely untrustworthy,” he tweeted on Jan. 8. “It’s not unlikely they would want to contaminate other nations.” The ayatollah’s tweet was deleted by Twitter for spreading “false or misleading information” about coronavirus vaccinations.

The decision by the Iranian government to ban the world’s most credible vaccinations also caused outrage among Iranian and international human-rights activists. Human Rights Watch (HRW) and Iranian human-rights activists in exile accused Iran’s government of politicizing its vaccine policy and urged it to rely on science and medical evidence. They called on the ayatollah to rescind his order and “allow Iranians to purchase any safe and effective vaccines as soon as they are available, regardless of their country of origin,” said the joint statement. Kamran Ashtary, the director of Arseh Sevom (Third Sphere), a non-governmental organization promoting democracy and human rights in Iran and one of the signatories on HRW’s appeal, described the ayatollah’s ban as “pure political paranoia” that was costing Iranian lives.

Iranian President Ali Rouhani has indicated that a domestically produced vaccine might be available to Iranians by the spring. Iranian firms have also partnered with Cuba, another country hit by a range of American sanctions, to co-manufacture a vaccine called Soberana 02. Activists conceded that both options might eventually come to fruition but pointed out that neither can yet be counted on to save lives.

It’s not yet clear if Iran’s ban on western treatments will extend to the tranche of vaccines it is set to receive through COVAX, an international consortium set up by the World Health Organization (WHO). In any case, the procurement through COVAX won’t be enough for the whole population. “With WHO’s COVAX plan guaranteeing 20 percent vaccine coverage in poorer countries, there will still be a need for alternatives, no matter what,” Kamran told Foreign Policy. “Many Iranians are starting to feel that they will live with COVID for a long time to come.”

Collective pressure against the ayotallah’s decision seems to have had some effect. According to local media reports, Iran’s state medical council, which had vehemently opposed the vaccine ban, announced its plans to buy the Oxford-AstraZeneca vaccine from its India partner. The rationale seems to be that, although the vaccine was developed in Britain and the company itself is Swedish, there’s no problem purchasing it from the company’s Indian partner, because India and Iran have traditionally been close.

Iranian activists and the Iranian medical council agree that U.S. sanctions are partly responsible for the health crisis.

Iranian activists and the Iranian medical council agree that U.S. sanctions are partly responsible for the health crisis by complicating the country’s efforts to import protective equipment and, potentially, vaccines. Both groups have called on the international community to urge the United States to end or ease sanctions even if temporarily. “Viruses do not discriminate, nor should humankind,” said the Iranian Healthcare Professionals’ Petition to António Guterres, the Secretary-General of the United Nations.

American sanctions first made it harder for Iranians to procure personal protective equipment (PPE) needed to fight COVID-19 and are now limiting its ability to purchase the vaccines from whoever it sees fit. Technically, the Trump administration exempted the export of humanitarian goods to Iran, including medicine. But these exemptions have been so confusing that they have deterred companies and banks from using fearful of incurring sanctions and legal action.

Mohammad Marandi, an Iranian political analyst, claimed that the U.S. sanctions are making it impossible for Iranians to produce their own vaccines and added: “They attempt to block Iranian attempts to purchase vaccines by blocking financial transactions.”

American sanctions have also been criticized by some U.S. lawmakers. In March, Senator Bernie Sanders called on former Secretary of State Mike Pompeo together with almost three dozen other legislators to suspend sectoral sanctions on Iran during the public health emergency. Many Iranians are waiting to see if President Joe Biden will now practice what others in his party have preached. In the meantime, they are resigned to the ongoing neglect of their lives, both by the hardliners in their own government and a new U.S. administration that claims to be a torchbearer of human rights.

Anchal Vohra is a Beirut-based columnist for Foreign Policy.

More from Foreign Policy

The Taliban delegation leaves the hotel after meeting with representatives of Russia, China, the United States, Pakistan, Afghanistan, and Qatar in Moscow on March 19.

China and the Taliban Begin Their Romance

Beijing has its eyes set on using Afghanistan as a strategic corridor once U.S. troops are out of the way.

An Afghan security member pours gasoline over a pile of seized drugs and alcoholic drinks

The Taliban Are Breaking Bad

Meth is even more profitable than heroin—and is turbocharging the insurgency.

Sviatlana Tsikhanouskaya addresses the U.N. Security Council from her office in Vilnius, Lithuania, on Sept. 4, 2020.

Belarus’s Unlikely New Leader

Sviatlana Tsikhanouskaya didn’t set out to challenge a brutal dictatorship.

Taliban spokesperson Zabihullah Mujahid

What the Taliban Takeover Means for India

Kabul’s swift collapse leaves New Delhi with significant security concerns.