As the novel coronavirus sweeps Iran, the government’s response has been opaque and remarkably deficient, favoring political and religious priorities over pragmatic prevention policies. When the virus began to spread in Wuhan, China, other countries took stock of their readiness against the disease. Iran did not prepare. Instead, it continued to export facemasks to China, causing a national shortage when its own hospitals needed masks in February. Iran also refused to restrict travelers from China, its largest trading partner, in all likelihood to avoid any deleterious impact on its already spiraling economy, which has been battered by U.S. sanctions.

Just a month before the country’s first coronavirus cases were reported, Iran’s military had mistakenly downed a Ukrainian jetliner. The handling of the crisis that ensued became an embarrassing display of ineptitude on the part of the country’s leadership. Facing a crisis in public trust after that blunder, as well as worsening economic and political isolation under U.S. sanctions, Iran’s leaders were disinclined to ask for international aid and instead adopted a policy toward the coronavirus outbreak that prioritized the regime’s survival and prestige over the public’s welfare.

Although the circumstances are much different, the pattern is strikingly similar to the Iranian government’s response to repeated bouts of pandemic cholera at the turn of the twentieth century. Iran’s inability to halt the recurrent ingress of cholera across its borders more than a century ago damaged its economy, eroded its sovereignty, and provoked popular protests that forced Iran’s then ruling Qajar dynasty to make major changes. The coronavirus outbreak has set off a similar chain of events: an expanding international travel ban on Iran, the further depreciation of the already struggling Iranian currency, and a growing domestic mistrust of the government. By the same token, the public health reforms that eventually helped smother pandemic cholera in Iran a century ago likely hold the key to containing the coronavirus outbreak today.

Denial and Refusal

Iran began reporting coronavirus fatalities in the city of Qom as early as February 19. Travelers from Iran to Canada and Lebanon tested positive for the virus over the next two days, signaling a much larger outbreak than Tehran was willing to admit and prompting neighboring Afghanistan, Armenia, Pakistan, and Turkey to close their borders with Iran.

Although President Hassan Rouhani dismissed the domestic concern surrounding the pandemic as unwarranted hysteria, a whistle-blowing parliamentarian from the city of Qom accused the government of covering up the crisis, claiming that 50 of his constituents had succumbed to the contagion. Iran’s credibility suffered an even more severe blow earlier last week when the country’s deputy health minister and the head of its coronavirus task force was forced to admit that he was infected with the pathogen after appearing visibly ill at a press conference. By Thursday, two members of parliament and one of Iran’s vice presidents also had known infections. The government’s latest official report of 54 fatalities out of 978 cases nationwide surpasses the single-digit mortality rate in China, suggesting that the outbreak in Iran is either much wider than previously reported or unusually lethal.

Tehran’s policy response to the outbreak has been even more concerning than its lack of transparency.

Tehran’s policy response to the outbreak has been even more concerning than its lack of transparency. Since detecting the disease’s presence in Qom, the ministry of health has refused to establish quarantines in or around the city, wrongly characterizing the measure as outdated. The administration has failed to adequately identify, isolate, and treat people who have come in contact with the virus, and the infection has consequently spread to other parts of the country. The health ministry did request closing Qom’s religious landmarks, including the Fatima Masumeh Shrine, but religious officials refused. A surrogate of Supreme Leader Ayatollah Ali Khamenei concurred with that decision, declaring that any attempt to restrict access to the shrine promotes a nefarious plot by the United States to make the holy city appear to be unsafe. Hundreds of pilgrims and visitors congregate in close proximity to one another at Qom’s religious sites on a daily basis, providing further opportunity for the virus to spread.

First as Tragedy

While the coronavirus is new to Iran, the country’s response to the pandemic is arrestingly familiar. In 1904, a pandemic wave of cholera reached Iran on the heels of Shiite pilgrims from Iraq. Tehran first attempted to stop the contagion by restricting pilgrimages to holy shrines. But the most esteemed grand ayatollah of that time resisted such efforts and accused officials of furthering the aim of Western “infidels” to prevent the Shiite faithful from fulfilling their religious duties. Much like the current Rouhani government, the weakened prime minister and his cabinet lacked the power to oppose the religious establishment. And so they allowed caravans of infected pilgrims to bypass government quarantines and further disseminate the disease. Then as now, the government feared a general panic. It concealed the cholera outbreak from the country’s population—and even from the reigning monarch—until the growing mortality made it impossible to hide.

Keeping the spread of cholera a secret and doing little to contain it served to magnify the demographic and economic shock the illness caused. The cholera epidemic touched off double-digit inflation, which in turn sparked widespread protests calling for government reform. The result, in 1906, was the movement known as the Constitutional Revolution, which established a parliamentary system and brought about a short pause in Iran’s long history of absolutism. The Iranian government’s failure to keep cholera from entering the country and the resulting economic free fall also forced Iran to cede control over its eastern and southern frontier quarantine establishments to Russia and the British Empire, making those countries masters of Iran’s major overland and maritime cross-border traffic.

In the second decade of the twentieth century, Iran established a secular system of governance and a public health administration that began to bring pandemic cholera outbreaks under control. Essential to ending the recurrence and severity of the pandemics was the adoption of a microbiological understanding of infectious disease, and hence, the retreat of religious and political obstacles to empirically informed approaches to disease control, prevention, and treatment.

The current leadership in Iran appears to have forgotten these hard-earned lessons, including the secular approach to medicine that transformed the country’s infectious disease landscape in the past century. Unless Iran’s leaders rapidly adopt a more transparent and robust approach to stopping the contagion, the full arc of history is likely to repeat itself, as a growing coronavirus outbreak will irreversibly erode the legitimacy of clerical rule.

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  • AMIR A. AFKHAMI is an Associate Professor of Psychiatry, Global Health, and History at George Washington University and the author of A Modern Contagion: Imperialism and Public Health in Iran's Age of Cholera.
  • More By Amir A. Afkhami