TEHRAN – Iran is benefiting from strengths in fighting against the coronavirus epidemic, including strong primary health care system, production surge in a reasonable time, and multisectoral response, WHO Representative in Iran, Dr. Christoph Hamelmann, said in an exclusive interview with the Tehran Times.

Looking back to the early days of the outbreak, the virus was almost unknown and there were not quite successful experiences worldwide, however, Iran was among the few countries with a self-sustaining plan in the fight against the epidemic, after China and South Korea, Dr. Hamelmann said.

“On February 19, the first two cases of coronavirus were confirmed in Iran, but in a short period, Iran developed the right concept asking for China’s experience and WHO’s support through the country office and a special international WHO expert mission which visited the country in early March. 

At that time, we were aware of only a few symptoms and ways to stop the transmission, for instance, we knew that diagnostic tests must be conducted at a large scale to detect infected people very early because hospital capacities were limited and there would have been medical equipment shortages, he explained.

So, one of the very important early achievements in Iran was the rapid establishment of a decentralized laboratory testing for Covid-19,” he explained.

A good experience

On the other hand, Iran, to a certain degree, is a good experience to learn from by other countries due to the strong primary health care system, which focuses on promoting healthcare in rural areas, he added.

The second strength of Iran was a surge in the production of essential commodities needed for the Covid-19 response, as well as all protective tools for health workers in clinics, while the global market is still dealing with shortages, he highlighted.

Thanks to the experience of dealing with the sanctions Iran has made a very early decision on production of the needed items trying to be self-sustained and resilient in the health sector, he stated, adding, the country has rapidly identified how to scale up existing products and produce new ones.

Hamelmann further emphasized that Iran was one of the few countries in the world which developed test kits as soon as possible despite problems such as licensing and evaluation. The government also had a really strong focus on increasing production and innovation.
The multi-sectoral response was another strength of Iran, as the government increased the health ministry’s authority, all the ministries got involved, and armed forces supported certain areas and communities, he noted.

Iran’s health system a great strength

Setting up health houses in villages [with two Behvarz (healthcare providers) for each who were tasked with tracking the population, providing health services, and also vaccinating the people and newborns, as well as offering postpartum care], made a difference, Hamelmann said.

Many other countries in the region or even some high-income countries do not necessarily have a well-coordinated and structured primarily healthcare system, he added.

Iran has established a national electronic health record (EHR) system in which every citizen is registered with the national ID number, he highlighted.

So, the PHC system, health houses, environmental health offices (responsible for environmental safety in the community), and all related organizations were involved as soon as the epidemic started, he said.

The health networks started early detection of infected cases by calling the citizens and questioning them about the symptoms, and the vast majority of community members with a focus on the most vulnerable were screened and prevented from referring to the hospital in cities, he added.

Iran could soon control transmission

“Although comparing the countries is always complex because all the aspects including different timing of epidemic phases must be considered, Iran did very well compared to some other countries in establishing a comprehensive national plan and campaign to control the epidemic. 

Italy was very close to Iran in terms of new cases and mortality in the early days, other countries like Russia are still fighting to flatten the curve; so there was a lot to learn from each other, also from some of the intensive experiences in Iran,” Hamelmann noted.
Emphasizing that each country has its own health system and tackling program, he said that China, in comparison to Iran, announced a lot more quarantining, isolation and restrictive measures, and for a longer period than Iran.

Countries like Sweden had hardly announced any restrictive measures, only social distancing, but not full-scale lock-down measures. Therefore, differences in crisis response allow us to learn and enrich our knowledge.

He further pointed out that many of the public health measures taken are not simply the final solution, so it is essential to stay very close to the data, and to check how efficient were the previous measures, then take the next step, or even go backwards to more restrictions if necessary.

He went on to note that these days we have many meetings with ministries of health from various countries through video conferencing to exchange experience, so countries should be collaborative and friendly to overcome the pandemic, he added.

Iran could efficiently adapt despite sanctions

Referring to the unilateral U.S. sanctions, Dr. Hamelmann said that it has been two years that we are working with the ministry of health to first identify and quantify the impact of sanctions on the health sector.

“Although it has been repeatedly said by all parties that there are no direct sanctions on health commodities, we are all aware in practice that there is an impact, particularly on banking transactions, to import essential items. Certain medicines were not available in sufficient volume and some laboratory equipment has been difficult to maintain.

Besides, some of the suppliers are refusing to continue business with Iran, which to a certain degree is over compliance on their side, he said, adding, so when Covid-19 started, the health system in Iran was already stressed through this impact.

So, it affected the treatment and diagnosis processes, but on the other hand, some improvements can be seen during emergency situations such as the coronavirus crisis in terms of the urgent need for collaboration and solidarity, and the strategy of further strengthening a resilient health system in Iran plays also a very important role.

Covid-19 may accompany us for years

Pointing to the virus eradication possibility, Dr. Hamelmann said: “Initially the assumptions were that the virus is preventable and manageable but after a while, more experts concluded that things may never return to the same normality as before the COVID-19 pandemic started.

So, there is a probability that the virus will not be eliminated. At the moment and in addition to all the preventive public health measures, we should pay great attention to reduce its impact through medicines with proven effectiveness and by developing a vaccine that can be provided to everybody on a global scale.

Usually, vaccine development and mass application takes 4-5 years or longer

“We have witnessed long periods for a vaccine to be developed, but usually the vaccines were made to prevent particular diseases for a certain target population, for example, children, or the elderly.

However, the Covid-19 vaccine will not only be used for a certain part of the population, but eventually, all susceptible populations in the whole world should most likely be vaccinated, and mass-production of the vaccine on such a great scale and distribution of it in the world is very time-consuming in itself, he said.

We may face vaccine shortages in the beginning, and also there will be difficulties to determine who gets the vaccine first.

WHO and other key international bodies have started already with great effort to develop and agree on concepts on how to distribute a vaccine when it is available very fast among the most vulnerable groups and in the most equitable way to the broader public, within countries and globally,” he stated.

He went on to highlight that the whole process takes a considerable amount of time and money, but the positive aspect is that we are not only working on one single candidate for the vaccine, but a multitude on different approaches and basic research and trials are already ongoing in a number of countries.

Usually, the development of a vaccine and mass-vaccination can take 4-5 years or even longer, sometimes without success like in the search for an HIV vaccine which is ongoing for decades, he added. Or sometimes the vaccine is not of high efficacy, provides only partial immunity against infection, or reduces the likelihood of severe disease or death.

But in an optimistic forecast, in such an emergency situation, there is a very high commitment to fasten processes and to invest substantial amounts for the vaccine development. Nevertheless, it is very unlikely that this year we can have a vaccine that can already be used on a larger scale, he suggested.

World must prepare for new viruses

Referring to the risk of newly-emerging viruses in the world, Dr. Hamelmann said facing the risk of newly emerging infections is not a new threat at all. What needs to be new is that we make preparations to face new epidemics much more seriously, including much better implementation of the International Health Regulations. 

“After the peak of the emergency, we need to take stock and should look back and see what went well or what went wrong to prepare and protect ourselves better in the future, to determine how much money from national budget should be earmarked for preparedness against the threat of the newly-emerging diseases, what hospital capacities we need, what do we need to have on the stock of essential commodities, what capacities for immediate scale-up of production of essential commodities is needed, how to improve national health information systems and what coordinating structures with other sectors dealing with health crisis management are needed – these are only some of the points that need to be reviewed and decided on. And very importantly: What can we do more and better for the many frontline workers in epidemic situations, in the hospitals, but not only there. Many of them are our heroes today – but we should not forget it tomorrow and also keep in mind that we acted too late and too little to protect them, that is one of the most unifying lessons learned in all countries. And we will this stocktaking with a much better understanding that a health crisis impacts on all parts of life, on the whole social and economic fabric of countries and during pandemics of the whole world. 

No evidence yet to discover coronavirus origin

In my professional career, most of the things I have read about the origins of new infectious agents were just theories, like HIV for which it is still not clear where it comes from,  Dr. Hamelmann lamented.

“Most likely we will never be 100 percent sure about the exact origin of the COVID-19 although many research centers are working on it and might publish their theories.

WHO is communicating with member states, and of course especially with China where the virus was first discovered. I am sure we will hear many stories, some more interesting than others until the very details about the origin of the virus have been fully brought to light ” he concluded.

FB/MG