In advance of World Health Day on 7 April and over two years since the start of the pandemic, ARTICLE 19’s research, including a survey completed by over 800 people in Iran, shows that Iran’s management of the health crisis has been characterised by violations of the right to access information, lack of transparency and corruption.

ARTICLE 19 urges the Iranian authorities to conduct an independent, transparent and public inquiry into their handling of the COVID-19 pandemic. There must be accountability for the authorities’ actions and omissions, which have placed the lives and health of millions of people at grave risk, as well as full transparency on the state’s ongoing public health response to coronavirus, in particular its domestic vaccine development.

The outbreak of COVID-19 and its tragic consequences took the world by surprise. After China, Iran was one of the first countries where the crisis unfolded. While the novelty and gravity of the crisis the virus caused meant that many countries around the world were unequipped and unprepared to deal with the situation, sometimes catastrophically so, the level of corruption, deception and concealment of the truth demonstrated by the Iranian authorities also showed their utter disregard for the rights of people, including their right to life and health. The failure to show transparency and respect the right to information has allowed individuals and bodies responsible to be shielded from any consequences while, consistent with the broader patterns of harassment of individuals seeking truth and justice in Iran, those demanding accountability have been subjected to persecution.

“With the acceleration and expansion of the vaccination programme globally, snippets of life prior to the pandemic caused by COVID-19 are returning to many parts of the world, including Iran. Yet, we must not forget that there must be accountability for the Iranian authorities’ failures and violations that have cost lives, placed healthcare workers under extreme pressures and exposed to serious dangers, and left some of the most vulnerable sectors of the society, including its prison population, without protection,” said Saloua Ghazouani, Director of ARTICLE 19 Middle East and North Africa Programme.

In 2021, as part of its ongoing research into the Iranian authorities’ compliance with their international obligations to uphold the right to access information and transparency, ARTICLE 19 carried out an online survey in order to gain a better understanding of the ways in which the state shared necessary information about the pandemic with the public, including with regards to prevention, treatment, and the vaccination programme. The survey further tried to identify the extent to which they relied on official and semi-official sources from the Islamic Republic of Iran, and the extent to which they turned to other sources, such as Persian-language media based outside the country. Where people did rely on state institutions, the survey sought to establish whether they found this information reliable, sufficient, and accessible.

Due to the survey’s limitations and scope, its findings cannot be simply generalised. However, the data it obtained is consistent with the broader findings by ARTICLE 19, other human rights organisations and reports by journalists pertaining to the failure of the Iranian authorities to provide timely, sufficient, adequate and accessible information regarding various aspects of the health crisis, as well as their failure to be transparent, including about the number of daily infections, deaths and the country’s vaccination programme.

“It comes as no surprise that the public’s level of reliance on and trust in the information the Iranian authorities disseminate at times of crisis is rather minimal. Only a negligible percentage of the research participants in ARTICLE 19’s survey have found the information provided by state institutions to be reliable, sufficient, and accessible. The Iranian authorities have persistently resorted to misguided and ill-interpreted notions of reputation and national security to restrict people’s human rights, including their right to freedom of expression and access to information. It is high time that they cease concealing and distorting the truth and prioritise people’s health and lives,” said Saloua Ghazouani.

ARTICLE 19 highlights that the welcomed and long-awaited improvements in the situation following nearly two tragic years do not mean that the violations that have marked Iran’s response to the crisis are matters of the past. It remains pertinent to seek transparency and accountability about the state’s continued public health response, including through vaccine procurement and development, and as COVID-19 continues to claim lives. Moreover, the right to know about past and present human rights violations, including those that pertain to the state’s management of the COVID-19 health crisis, is a human right that should be enjoyed by people in Iran and fully respected by the authorities. There cannot be any accountability for violations committed by the state without full transparency, access to information and respect for the right to truth.

Concealing the truth at the cost of life

On 19 February 2020, Iran’s Ministry of Health officially announced the first COVID-19 cases in the country. According to some reports, however, the outbreak started much earlier, with some stating that it began as early as 22 January. Iranian authorities’ initial reaction in the face of the new virus was to deny and suppress independent reporting. Well into February 2020, and as reports of infections in the cities of Qom and Tehran in particular emerged, Iranian authorities resorted to arrests, forced confessions and concealment tactics in order to cover up the spread of the virus. On 7 February 2020, Iran’s state TV aired the ‘confessions’ of a man who had been arrested following the release of a video in which he talked about the hospitalisation of individuals infected with the virus in Kurdistan. A Cyber Police official interviewed in the same TV programme described the man’s comments about COVID-19 infections as ‘lies’ and ‘falsehoods’ that had disturbed public opinion. Another TV programme recorded in the city of Qom and aired prior to the parliamentary elections in February similarly referred to reports of an outbreak in the city as manufactured rumours aimed at preventing people from participating in the elections. On 26 February and even after the official acknowledgment of the outbreak, Hassan Norouzi, the spokesperson for Parliament’s legal and Judicial Commission, stated that ‘the spread of false news about the coronavirus …. had brought the country to a halt’. Journalists and media workers who reported on the outbreak faced harassment and questioning and the weeks that followed saw the announcement of at least hundreds of arrests and the opening of criminal cases against individuals for what the authorities described as spreading lies and rumours.

Leaked documents and information investigated by journalists and human rights organisations demonstrate that, even after the acknowledgment of the outbreak, the authorities continued their policy of concealment regarding other aspects of the crisis. In late July 2020, Amnesty International stated that it had reviewed four leaked letters dated between 29 February 2020 and 5 July 2020, signed by officials at Iran’s Prisons Organisation, which falls under the auspices of the judiciary, to the Ministry of Health, raising the alarm over serious shortages of protective equipment, disinfectant products, and essential medical equipment in Iran’s prisons. These letters, as well as investigations by Amnesty International and the Abdorrahman Borumand Center for Human Rights in Iran, show the state’s appalling failure to protect prisoners stood in stark contrast with the authorities’ claims that prisoners in Iran enjoyed ‘better standards of health care and sanitation than they would in society’. A few days later, in August 2020, an investigation by the BBC – based on details it had received regarding daily admissions to hospitals across Iran, including names, age, gender, symptoms, date and length of periods spent in hospital – revealed that, despite having a record of all deaths, the Iranian authorities were reporting significantly lower daily numbers.

The Iranian authorities’ decisions to deny, conceal and deceive people in Iran contravened its human rights obligations, including with regards to the right to information, health and life. Under the guise of protecting national security and the public, authorities censored information, shut down independent reporting and silenced critical voices. These measures have had a devastating impact on the ability of peoples to access accurate and timely information to protect themselves and their communities amid a global health crisis. In his January 2022 report, the UN Special Rapporteur on the situation of human rights in Iran referred to ‘the absence of any inquiry into excessive deaths caused by the government’s pandemic response’ as an example of an absence of accountability and called for the launch of a national and public inquiry into the handling of the pandemic.

How do people in Iran judge the government’s performance?

In April 2021, ARTICLE 19 designed an online survey with the aim of collating primary statistical data on the Iranian government’s sharing of COVID-19-related information with the public. The survey was made available between 12 and 19 May 2021 via Psiphon, an Internet censorship circumvention tool commonly used by people of different genders, ages, and ethnic and socio-linguistic backgrounds in Iran. It consisted of 10, primarily multiple choice questions. In addition to information about the participants’ details such as their gender, ethnicity, mother tongue, and whether they had a disability, the survey gathered data about what sources of information the participants accessed, including internal officials sources (such as the Ministry of Health), external sources (such as Persian-language media outside the country) and informal sources (such as unofficial pages on social media platforms). It asked which of these three categories of sources the participants used most frequently and the issues they had while accessing information about the health crisis, including COVID-19 symptoms, personal and public hygiene measures, testing services, the number of people infected with the virus, the number of people who had been hospitalised and died as a result of it, and vaccination-related information such as doses purchased, the country of origin of vaccines, the prioritisation of vaccine roll-outs, and side-effects.

A total number of 850 people participated in the survey, although the vast majority left at least one question unanswered. The majority of the participants identified as Persian-speaking men and women residing in Tehran. As stated earlier, the fact that the majority of survey respondents belonged to a certain demographic – that is Persian-speaking individuals residing in Tehran without any disabilities – means that the responses provided by them cannot necessarily be attributed to other sectors of the society or generalised. Nonetheless, the information provided by the participants is revealing, given that the demographics to which the majority of respondents belong may arguably face fewer barriers presented by the absence of information in minority/national languages and accessible formats.

Based on the responses provided by the participants, the majority (30%) of respondents answering the question¹ Less than 50% of the participants answered the questions regarding their main source of information; the reasons for which remain unknown. The pilot study for f the survey questionnaire did not demonstrate possible language and/or format difficulties that would have negatively affected the process. on whether and which internal official sources they use for COVID-19-related information said they did not rely on any of these as a main source of information. Instead, Persian-language news agencies based outside of Iran have been the main source of information on COVID-19, with 35% stating that they rely on external sources as their main source of information. Following these sources, the second- and third-most used sources were the World Health Organization and Iran’s Ministry of Health. The data thus indicates that despite the importance of internal official sources in disseminating government’s information and advice, there exists little public trust in the information the Iranian authorities share via official domestic sources.

Ultimately, the survey asked participants whether they found the information they accessed via internal official sources reliable, sufficient and accessible. While a large number of participants did not respond to this question, the responses of those who did, provided an answer that were consistent with the findings of the previous questions regarding the extent to which respondents relied on internal sources of information when it comes to the pandemic. Of the total respondents (850), only 36% chose one of the internal official sources as their first choice, 42% of which found their COVID-19-related information reliable; 32% said it was sufficient and 46% considered it accessible. As low as 7% and 3% of the participants chose one of the internal official sources as their second and third priority respectively. In total, therefore, less than 50% of the participants identified these sources as having any primacy. This is consistent with the findings in the previous section, noting that overall, the participants – whose first to third choice of source was one of the internal official sources – reported less than 45% satisfaction with their levels of reliability, sufficiency, and accessibility.²It is worth emphasising that only 36% of the respondents answered the questions on reliability, accessibility, and sufficiency of COVID-19-related information, the reasons of which are unknown.

Vaccination programme shrouded in corruption and secrecy

Whether Iran has complied with international human rights law when carrying out its COVID-19 vaccination programme, including procurement of vaccines from other countries and the development of domestic vaccines, requires a detailed investigation that falls outside the scope of this statement. Nonetheless, a brief study of the authorities’ decisions pertaining to COVID-19 vaccines clearly demonstrates a dangerous failure by the state to adhere to the principles of transparency, both in vaccine development and procurement processes. Furthermore, decisions taken by high-ranking state officials including supreme leader Ali Khamanei with regards to the timely procurement of vaccines exhibited a total disregard for people’s rights to health and life.

Right to information standards require states to be transparent with regards to public procurement, including when it comes to contracts between governments and pharmaceutical companies for the purchase of vaccines. Similarly, development of medications, which includes vaccines, including research, clinical trials, and the individuals and institutions involved, as well as funding, must also adhere to principles of transparency. Guaranteeing the right of all people to access information about such important public health-related issues can help prevent corruption, conflict of interest and disinformation, all of which pose a risk to people’s right to health. It will further enable individuals to seek accountability and justice when their rights are violated.

The Iranian officials’ policy from the early days of the outbreak of COVID-19 has been geared towards development of domestic vaccines. Over the past two years, the development of multiple vaccines has been announced. In fact, the authorities’ emphasis on the production of domestic vaccines continued as the country was hit by consecutive waves of COVID-19 without respite. On 8 January 2021, Iran’s supreme leader, Ali Khamenei, stated in a speech that ‘import of [the COVID-19] vaccines made in the US and UK are prohibited.’ He further, in a tweet, claimed that vaccines made in the US or the UK are ‘completely untrustworthy’ and it was ‘not unlikely they would want to contaminate other nations.’ He further stated that in light of the country’s ‘experience with France’s HIV-tainted blood supplies, French vaccines aren’t trustworthy either.’ The next day, the head of the humanitarian organisation the Iranian Red Crescent Society announced that plans to import 150,000 doses of the Pfizer vaccine donated by an US charity had been cancelled.

Despite this, Iran’s vaccine development has been shrouded in secrecy. Little information, including on all individuals and institutions involved, clinical trials, and funding, is available on the various vaccines that have been and are being developed in the country. For example, significant state funding appears to have been granted to vaccine developers. In October 2021, Hassan Jalili, the director of the Barekat Vaccine project, told a journalist working for the domestic media that the Hassan Rouhani administration had granted three Iranian pharmaceutical companies each a fund of $40 million for the development of the vaccine. Yet, there has been no transparency on the contracts between the state and vaccine developers and the manner in which state funding has been spent.

This lack of transparency is even more alarming given the nature of some of the state institutions and entities involved in vaccine developments: Noora vaccine, one of the few domestic vaccines, is being developed by Baqiyatallah University of Medical Sciences, which is under the auspices of the Islamic Revolutionary Guards Corps (IRGC). The armed force, according to detailed documentation conducted by human rights organisations and UN experts and bodies over the past decades, has systematically and persistently engaged in committing gross violations of human rights, including the rights to life, freedom from torture and other ill-tratment, truth and justice, and crimes under international law. The Execution of Imam Khomeini’s Order (EIKO), an opaque organisation under the direct control of the supreme leader that lacks transparency and evades accountability, is the parent of the pharmaceutical company which has developed Iran’s Barekat vaccine.

In his January 2022 report, the UN Special Rapporteur stated: ‘concerns have been raised that the policy of reliance on the production of local vaccines rather than urgent import of available vaccines was guided by the financial self interest of State-owned business enterprises rather than public health concerns.’

Individuals affiliated with the state of Iran have acknowledged the lack of transparency of Iran’s vaccine developers with regard to their research, generally blaming it on the sanctions imposed on the country. In November 2020, Dr Alireza Bihlari, the head of the Pasteur Institute of Iran, a medical research institute affiliated with the Ministry of Health, stated that the reason behind the lack of public information about the companies involved in vaccine development was a concern that they would come under sanctions. In August 2021, Kayhan Azadmanesh, the head of the virology research division at the Pasteur Institute and an advisor to the government, reiterated this in his response to Nature’s questions as to why Iranian researchers were reluctant to publicise their work internationally: ‘This could be another side effect of the sanctions. Researchers in Iran might not want to draw too much attention to their work in case they put potential partnerships in jeopardy before they have achieved a final product, or they run the risk of losing access to raw materials and technologies they need for vaccines.’

Transparency in clinical trials helps to prevent data and statistical manipulation, selective and partial reporting, and other forms of distortion and is crucial for protecting the safety of trial participants and all those who eventually use the medicines. It will allow governments to make evidence-based determinations as to whether a new medicine is safe and should be granted a licence, and for healthcare professionals to decide on the best treatment for their patients.

A similar lack of transparency has governed Iran’s procurement and import of COVID-19 vaccines. In August 2021, amid a fifth wave of the virus, the failure of domestic developers to deliver the vaccines, and growing and widespread criticisms, Iran’s supreme leader announced that vaccines should be procured in every possible way, including through importing them. The authorities did not show any accountability with regards to the supreme leader’s previous ban on importing vaccines from the UK and the US, which contributed to the slow rate of vaccination and the high death rate.

ARTICLE 19 has not been able to access the contracts signed between Iran and pharmaceutical companies for the purchase of vaccines, including those sourced from Russia and China, as they do not appear to have been made public. Generally, most information available on the country’s vaccination programme has been made available through media reports and sporadic statements made by officials.

With warnings about a looming seventh wave of the coronavirus to begin following the New Year holiday period, it is high time for the Iranian authorities to, once and for all, end their policies of concealment and cover-ups and abide by their human rights obligations to guarantee the rights to freedom of information, health and life.

Recommendations

ARTICLE 19 calls on the Iranian authorities to:

• Respond to the calls of the UN Special Rapporteur on Iran by conducting an independent and public inquiry into the handling of the COVID-19 pandemic, including decisions pertaining to the development, procurement and distribution of COVID-19 vaccines;
• Immediately cease the targeting of critical voices, including journalists, media workers, medical professionals, human rights defenders and lawyers reporting on the government’s COVID-19 measures, seeking transparency and accountability;
• Immediately and unconditionally release all individuals arrested for exercising their human rights, including their rights to freedom of expression and access to information; and to drop all charges and overturn all convictions arising from such activities;
• Ensure the right of all to have unhindered and easy access to credible, reliable, objective and evidence-based information about all aspects of the COVID-19 pandemic, including disaggregated data on the number of individuals infected with the virus, hospitalised and those who have died as a result since the start of the pandemic;
• Adopt and enforce legislation to ensure that all vaccine developers make public their summary results as well as their clinical trial protocols and full reports;
• Make public all contracts pertaining to the procurement and development of COVID-19 vaccines;
• Ensure fair access to COVID-19 vaccines for all and publish vital information about the national vaccination rollout including disaggregated data about individuals who have received the vaccines to date.

• 1
  Less than 50% of the participants answered the questions regarding their main source of information; the reasons for which remain unknown. The pilot study for f the survey questionnaire did not demonstrate possible language and/or format difficulties that would have negatively affected the process.
• 2
  It is worth emphasising that only 36% of the respondents answered the questions on reliability, accessibility, and sufficiency of COVID-19-related information, the reasons of which are unknown.