Iran domestic vaccines a feather in the nation's cap

We began the previous Persian year with the corona virus at our doors, and we end it with the coronavirus raging anew, as precautions taken for prevention and studies conducted for cure or immunization yield results. 

And the first Iranian covid-19 vaccine is expected to come out in days in its 100s of 1000s. Phase 1 of the trial period is behind us and we’re going onto phase 3.

Let us delve into how well Iran has done in the corona crisis and what problems the country still faces.

Phase 3 of the COVIran Barekat vaccine has been administered but must yet prove itself. Although it may be too soon to speak for the layman, the doctor managing trial administrations, Dr Mohsen Malekhosseini, of Imam Hossein Hospital, appears confident.

The trials are held at Tehran’s Hotel Eram where trial jabs are administered, and subjects are supervised for safety.

In phase two, in a larger population of several hundred people, we still focus on antibody production in addition to safety. That is, we want to see how much antibody is produced and to what extent that immunity is achieved by memory cells, a notion that’s called cellular immunity. These are measured using different methods, for instance with different proteins and various CD markers. In this phase, we assess them to realize what an immune response we could get in a lab setting. In phase three, as you mentioned, we will make sure we have a safe vaccine, and that it produces antibodies.

Dr Mohsen Malekhosseini,  Phamacist, Imam Hossein Hospital

Thus far, finalized versions administered to the population have been foreign vaccines, beginning with the debated Russian jab Sputnik V. Iran’s President Hassan Rouhani said the vaccination program will reach a “remarkable” level before the Iranian year beginning March 20, with the delivery of other shipments of vaccines purchased from abroad.

Naturally, the existing sanctions slowed down the efforts at all stages, especially in the industry sector. I’m not aware of the full extent of the problems, but those whose line of work is in the industry sector, with whom I have the honor to do clinical work, know that procuring much of resources and equipment have been extremely hard due to these unfair conditions. Of course, on the other hand, we can assume that such conditions push people to try to work more seriously.

Dr Mohsen Malekhosseini,  Phamacist, Imam Hossein Hospital

Iran bought 2 million doses of Russia’s Sputnik-V vaccine, according to the Food and Drug Administration. And the first shipment arrived in Tehran on February 4… The health minister’s son is known to have received the first Russian jab to prove its safety, as it is yet to be approved by the World Health Organization or the European Medicines/Drug Agency.

Dr. Motevallian is a surgeon and Vice President of Baqiatallah Hospital University.

Health experts still are uncertain about the stability of the Pfizer vaccine, the well-known vaccine made in the Western world, because that can only be established over time. This stability test is not such that it can be guessed or assumed that its effect is permanent. A vaccine’s stability and safety can’t be measured before 18 months have passed since the first and second administrations. We can’t just say in the form of a slogan that one or two doses of the vaccines we’ve developed can achieve anything. Anyone who’s done scientific work knows that this is just words.

Dr. Ebrahim Motevallian, Vice Chancellor, Baqyatolah University of Medical Science

Nearly 100 members of the board of Iran’s Medical Council signed a letter addressed to President Rouhani saying purchasing Sputnik V before international approval could be “dangerous

But… Iran’s health minister Saeed Namaki said Sputnik V was bashed for “economic interests”.

And… President Hassan Rouhani’s chief of staff, Mahmoud Vaezi, said:… “If the vaccines were to be purchased recklessly and without expert evaluation, the process wouldn’t have taken this long,” … Iran could have accessed the vaccine much earlier due to its good relations with Russia.

Sputnik V was developed by the Russian Direct Investment Fund. That’s the country’s sovereign wealth fund, and it has been given regulatory approval in 16 countries, as of March 16, and is awaiting emergency use approval by the WHO, the World Health Organization.

Manufacturers of the Russian vaccine say they have received requests for vaccinating more than 1.2 billion people from more than 50 countries.

The matter of numbers always counts in administering cure or prevention, and deciding its extent.

I also agree that the real number of those who’ve contracted and recovered is much higher. The 60-70-thousand death toll that we’ve reported, considering the toll in the villages and how much access they had to medical facilities, I think is a relatively acceptable statistic compared to that of the rest of the world.

Dr. Ebrahim Motevallian, Vice Chancellor, Baqyatolah University of Medical Science

The vaccine must be administered in two separate doses 21 days apart.  Following Minister Namaki’s son, the medical staff at 635 hospitals across Iran was the first group to get the Russian vaccine.

Mutually beneficial cooperation

A joint scheme between Iran and Russia was scheduled for late March, to mass produce Sputnik V just before Year’s-End in Iran on March 20^th.

But with the Persian vaccine out, to be mass administered by late April and early May, what need there was for a Russian line, especially as the first batches of the Russian vaccine to be mass administered will also be available in late April?

The fact that different institutions are working on vaccines is valuable in and of itself because ultimately, the practical benefits of such attempts will be recorded and reserved in the country. But we know that some teams are more likely to succeed than others. That’s why we predict that in this process of experimentation and development, a few can get to the production phase. Both timing and the volume of the production are significant.

Dr Mohsen Malekhosseini, Pharmacist, Imam Hossein Hospital

 Doctors foresee a need for 120 million doses of the anti-corona COVID-19 vaccine, to inoculate 60 million of Iran’s 85 million-strong population with 2 jabs each.

But vaccine production and mass administration is a slow process everywhere, and this country is among the few to have even attempted the feat; and attempted it has, with success.

And that is in spite of US sanctions against this country.

The vaccine production has passed stage one. The next stage of the production is the semi-industrial phase, which we hope will provide several hundred thousand doses a month, given the efforts that are being made. We expect that in the final stage, which according to our company’s main goal is scheduled for June, we can produce 10 million doses.

Dr Mohsen Malekhosseini, Pharmacist, Imam Hossein Hospital

The Iran and Russia vaccine production will take place at the facilities of an Iranian pharmaceutical company.

The two countries will be producing between 36 million and 40 million doses of Sputnik V in Iran within the next 12 months.

They jointly decided Iran would host the operation, mainly to increase supplies of the jab to countries in the Middle East or West Asia.

As an epidemiologist, I believe that many of our neighboring countries aren’t reporting valid data. We’ve always been witnessing cases being under-reported for all kinds of diseases, and especially COVID-19. What I’m trying to say is that we’re in much better shape concerning diagnosis and treatment compared to many other nations.

Dr. Ebrahim Motevallian, Vice Chancellor, Baqyatolah University of Medical Science

Having said quite a bit on the Iran-Russia project, I have to say a word on the Iran-Cuba vaccine which was in the spotlight before anything else. Cuba being a country sanctioned by the US, like Iran, it joined forces with this country, so that the two together, that’s Iran’s Pasteur institute and Cuba’s Finlay institute produce a vaccine jointly. This is not to forget Cuba’s present Cuban vaccine is among the foreign vaccines Iran should be administering, having participated in its trial period.

So far with regard to ready vaccines, Iran has imported several consignments of vaccine from Russia, China and India. … and this country has also set its sights on the AstraZeneca vaccine from South Korea.

… As for Iran’s singular projects, three homegrown vaccines have undergone clinical trials in this country.

Over 10 Iranian centres and startups applied to produce a vaccine. Iran is looking forward to 4 to 5 homegrown vaccines as things stand at present.

In Iran, 12 or 13 different projects are being implemented on different platforms, which are production methods in the research and development stage. Of course, because some companies undertake several projects simultaneously, the number of firms that are working on the vaccines is less than this number. Some of the companies, like the Barekat Pharmaceutical Complex, are working on 3-4 projects at the same time. The vaccine types being developed are different too. Two to three of them are the inactivated type, two to three others are the sub-unit type. Some of the companies are working on M-R-N-As and the others are working on recombinant models.

Dr Mohsen Malekhosseini, Pharmacist, Imam Hossein Hospital

Short term goals

Officials say Tehran will receive around 16 million doses of vaccines through the World Health Organization's COVAX program. It will import more than 25 million doses from abroad. And it will produce 25 million other doses inside the country.

Therefore, a different variety of vaccines that we have heard about in the world are being researched and developed in Iran, and some of them are still in the laboratory stage. Some of them, fortunately, have gone through the animal stage, and as we speak, 3 of these vaccines have reached the human trial stage.

Dr Mohsen Malekhosseini, Pharmacist, Imam Hossein Hospital

But the vaccine is not everything. In the case of COVID-19 prevention is most definitely better than cure as there is no cure but only medicine to ease symptoms, and vaccines with an effect lasting only months so far. Does that mean it is not worth the effort to make vaccines? It certainly does not. Mass vaccine production and administration would break the chain of transmission, and render the virus controllable. That is why masks and social distancing have been recommended and ENFORCED.

Many in our medical staff aren’t willing to take the vaccines because of all the uncertainty around them. We can’t force them to take the shots. We can only do that after we develop the vaccine and people trust that it doesn’t have any side effects. It’s not possible at this point, as we haven’t yet established the vaccines are free of complications.

Dr. Ebrahim Motevallian, Vice Chancellor, Baqyatolah University of Medical Science

Iran’s potential in production is praiseworthy. Authorities boast: every medicine which was said to be effective on the coronavirus, was produced inside the country within less than 3 months. Test kits and ventilators were also produced and the vaccine only came after.

We started plasma therapy here at the Baqiyatallah University of Medical Sciences around late March last year. We have very professional specialists. They knew that when there was an antibody, the patient's plasma and blood serum could help cure the disease. We took it and tested it with caution from those who recovered from COVID-19 and had high levels of antibodies in their blood, which was successful. Then the Americans started doing the same by using our published articles.

Dr. Ebrahim Motevallian, Vice Chancellor, Baqyatolah University of Medical Science

Mobile field hospitals in Iran

We’re here at a military bus and mobile hospital site. It boasts state of the art medical equipment and facilities. Facilities that you would expect to see in a well-equipped hospital with roots in the ground. But then that is what makes it unique in West Asia.

One of the drugs we had trouble procuring, especially during the second wave of the coronavirus outbreak, was Remdesivir. The 100 mg vials of this drug were very rare, so much so that patients had to purchase them at 8-million tomans per vial through black markets. Thankfully, we have no shortage right now. Remdesivir was prescribed for COVID patients who are in critical conditions. The other drug given to cases who are experiencing a less severe form of the disease and are staying at home is Favipiravir. We have enough supplies of this medicine at our hospital and aren't experiencing any shortage.

Dr Mohsen Malekhosseini,  Phamacist, Imam Hossein Hospital

High up in the IRGC land forces chain of command, Mr Akhavan is on the mobile hospital’s committee. He summed up his pride in the project, which was inaugurated March 14 with the Health Minster, in the few minutes he had with us on site.

Establishing field hospitals for COVID-19 patients require special infrastructure. They need mobile CT scans, oxygen generators, and mobile PCRs. Intensive care units, especially mobile ICUs, require better ventilation with more suitable spaces, and many other features. This field hospital here is a specialized unit with 128 beds. One of its characteristics is speed: this entire unit can be moved to any point in the country very fast.

Brig. Gen. Ahmad Akhavan Mahdavi, Commander, IRGC Ground Forces Health Centre

Who can blame the doctors and nurses and pharmacist for savouring a brand new experience, in terms of the scale of field hospital work?

I can almost say that in the past, we were successful in 40 to 50 percent of the cases, considering the equipment we had back then but now; with the new hospital, we have been able to help people 90 to 100 percent of the time.

Zhaleh Parvartabar, Operating Theatre Technician, Imam Hossein Hospital

The fact is that we used to provide health care to deprived areas in tents. But now, thank God, we have almost everything. The order that you see and the cleanliness that you observe and the comfort of the staff is really very important. Because if the staff does not get tired, there is no other problem. One of the problems we had in the tents was the disorganization of the tents, the hot and cold weather that was out of control. But now, thank God, this problem has been solved.

Dr Mohsen Malekhosseini,  Phamacist, Imam Hossein Hospital

The staff under stress

Speaking of the difficulty of our work, take me for example. I have two children who are not very old, one is 7 years old and the other is 9. My husband is also in the military and has a job that’s like mine. We have been here since the weekend, and we may have to stay until the end of the week if no problem comes up, God willing. If needed, we have to stay here longer. This causes problems in our personal lives. Living like this for a mother with two kids is difficult.

Zhaleh Parvartabar, Operating Theatre Technician, Imam Hossein Hospital

Preventative measures prevail, even if at times in a haphazard fashion, given Iran’s cultural and economic conditions. “Travel to cities coded orange and red have been prohibited. Those are cities with horribly high rates of transmission. The government left its final announcement for new year travel bans or easing of travel restrictions to 15 th March. That’s under a week to the 13-day new year holidays.

Evaluation of efforts by the national coronavirus headquarters

We have imposed night-time restrictions for several months but haven’t enforced them too seriously. There have been countries that imposed 5 PM to 6 AM lockdowns all of a sudden and their death toll reduced to as low as 10 people. Social distancing is of paramount importance at this point. No tool is as effective as distancing, even facemasks, because, in my opinion, masks are signs that we need to maintain our distance.

Dr. Ebrahim Motevallian, Vice Chancellor, Baqyatolah University of Medical Science

Iranians, who ttraditionally make hundreds of thousands of domestic New Year trips annually, have been urged not to plan trips to contagious regions, as “The country’s healthcare system has a limit …”

“The public should maintain last year’s lifestyle for another year,” the President himself stressed.

Iran is set to vaccinate enough people by the end of 2021 to reach herd immunity.

The country is working on expanding all corona-related services:

So far, we have deployed 200 mobile hospitals in different parts of the country in various geographical areas. The units provided services for a week to some 4 million people. A memorandum of understanding is being reviewed between the Ministry of Health and the Ground Forces to bring 10 similar units to different military bases across the country.

Brig. Gen. Ahmad Akhavan Mahdavi, Commander, IRGC Ground Forces Health Centre

International borders have been under strict control, with the coronavirus mutating and travelling at will. Iran began suspending flights to London in December 2020 over concerns about a surge in coronavirus cases and a new COVID variant in the UK.

Also the country in February closed five crossing points with Iraq to prevent the spread of the UK variant of the coronavirus, again. Border customs offices however, remained open to commerce WITH traders and businesspersons from both countries presumably observing health protocols, of course.

Everyone was confused at the beginning of the outbreak and even some countries like the United States said there was no problem at all. I think the health and treatment condition of our country is unique, due to the separation of the Health Ministry and the Science ministry, something which exists in almost no other country. Until 1985, we had a Ministry of Science that trained all medical, paramedical, and nursing students. We also had a Ministry of Health. Several hospitals were under the supervision of the Ministry of Science to educate students while some others provided health services. The initiative in the Islamic Republic, which I think was an appropriate one, brought together the Ministry of Health and the Ministry of Education. In my opinion, the universities that provide health services too have been very successful in controlling and preventing COVID-19.

Dr. Ebrahim Motevallian, Vice Chancellor, Baqyatolah University of Medical Science

As implied earlier, what has kept the country going with the coronavirus mutating and jumping borders is basic hygiene, masks and social distancing, paired with health workers tireless efforts and hospitals braving anything thrown at them.

Hospitals have had to manage both their own resources and volunteers demanding they be trained to help.

Conventional, fixed location hospitals however, aren’t the only ones with something to say for themselves.

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