As COVID-19 continues to ravage low- and middle-income countries, Iraq struggles to manage the pandemic within its borders. It continues to have one of the lowest vaccination rates in the Middle East: to date, only about one million people have been fully vaccinated, representing less than two percent of a population of approximately 40 million.
Iraq has secured Pfizer, AstraZeneca, and Sinopharm vaccines in recent months, including 1.25 million doses of the AstraZeneca vaccine through COVAX, the global vaccine distribution effort back by the World Health Organization. However, many of these doses have gone unused and some might have even expired, said an official with the Iraqi Ministry of Health who granted an interview with Physicians for Human Rights (PHR) in July 2021 on the condition of anonymity. Many Iraqis say that they do not trust that the COVID-19 vaccines will be safe or effective, leaving them uninterested in or unwilling to get vaccinated. This COVID-19 vaccine hesitancy stems from a combination of factors, including an immensely traumatized population and the longstanding dysfunctionality of public services.
The Iraqi public’s deep mistrust in their government, coupled with misinformation about the coronavirus and the vaccine, continues to thwart efforts to protect the population against the virus.
This viewpoint has started to shift somewhat now given the Delta variant’s recent deadly surge across the country, but not quickly enough. The Iraqi public’s deep mistrust in their government, coupled with misinformation about the coronavirus and the vaccine, continues to thwart efforts to protect the population against the virus.
The Pandemic Hits a Weakened Health System
For decades, conflicts, internal strife, dictatorship and dysfunctional governments, and a weakened health system have left the Iraqi people vulnerable and without adequate health care.
When COVID-19 first struck Iraq in late February 2020, its impact was devastating. The virus subsequently spread so widely that it seems as if nearly every Iraqi knows someone who has contracted COVID-19. Johns Hopkins University estimates that more than 1.7 million Iraqis have contracted COVID, making Iraq one of the hardest hit in the region. Officially, the government reports more than 19,000 Iraqis have died from COVID-19, though due to limited testing and poor data tracking, the true number of deaths is likely far higher.
This summer, according to the Iraqi Ministry of Health, the number of COVID-19 cases and deaths have significantly increased. It reported that 87 people died on August 6, 2021, making it the deadliest day since the pandemic began in Iraq in February 2020. Due to the increase in deaths, the Ministry also reports that the daily vaccination rate has increased by more than threefold in recent weeks, to approximately 80,000 per day. While this recent uptick is promising, Iraq’s vaccination rates are still far below other countries in the region. According to Dr. Nabeel Ibrahim, an internist in Medical City Hospital in Baghdad, the country’s current vaccination rate is so slow that Iraq will need years to vaccinate 70 percent of its population. At that rate, and in the context of emerging variants, it is unclear whether such a drawn-out effort would be protective.
Deadly Outcomes of Mistrust and Misinformation
Initially, the ubiquity of the disease meant that some Iraqis viewed COVID-19 as minor illness. As vaccines eventually became available, there was a low level of demand. Ahmad Abbas, a military officer from southern Iraq, told me, “In my unit and among my family, no one wants to be vaccinated. It is not worth it; [COVID-19] is not a big deal.”
The initial COVID-19 surge nearly toppled Iraq’s fledgling health services infrastructure and the country has struggled to find enough doctors, beds, or oxygen to help those sickened by the virus.
Government and health officials have struggled to improve upon a lack of educational and promotional information about the value of the COVID-19 vaccines, with limited success. Numerous government authorities have been vaccinated on TV to promote its safety, and public health authorities have outlined the benefits of getting vaccinated. On July 8, the Ministry of Health issued a statement to media outlets and via social media emphasizing that only vaccines can help break the cycle of infections in the country. Prominent Shi’a cleric Muqtada al-Sadr was vaccinated on national television and instructed his thousands of followers to get vaccinated.
Hagob Yakouf, a 50-year-old man from Kurdistan, said, “How can I trust that I will (get) the vaccine I want, one that it is not expired or improperly frozen. I do not have faith in health workers and facilities.” There is no evidence that Iraqi health officials have mishandled any vaccine shipments, but the initial COVID-19 surge nearly toppled Iraq’s fledgling health services infrastructure and the country has struggled to find enough doctors, beds, or oxygen to help those sickened by the virus. Two recent fires in COVID-19 wards have killed scores of Iraqis, most of them patients. This has further cemented doubts about the health system.
“I do not trust any vaccine,” said Mohammed Khalaf, a 72-year-old resident of Baghdad who has diabetes, when asked why he wasn’t vaccinated yet. Seeing that more Iraqis are now opting to get vaccinated, Mr. Khalaf is considering getting the vaccine but remains unsure. He is far from the only one who feels that the vaccine might be harmful. Another Baghdad resident, who is 62 and suffers from asthma and preferred to remain anonymous, remains unconvinced, “I have heard vaccines are not useful.”
Iraqis’ deep distrust of their government extends to a lack of confidence in its ability to properly handle the COVID-19 vaccines.
The official with the Ministry of Health concedes that the government’s efforts to date have not had much impact. “In general,” he said, “people do not much trust any government approach.” Research shows that Iraqis do not believe that the Iraqi government has their interests in mind. Iraqis’ deep distrust of their government extends to a lack of confidence in its ability to properly handle the COVID-19 vaccines.
While some of these efforts have succeeded, they have confronted constant competition from other voices focused on the vaccine’s negative side effects, including some health care workers who have taken to social media to discourage people from getting vaccinated, arguing that any vaccine takes years to be proven safe and effective. Recently, the Iraqi Medical Association rescinded the medical license of a doctor who has repeatedly taken to YouTube and Facebook to advise the public against getting vaccinated. However, these kinds of arguments have continued to circulate widely in a country of 25 million social media users (a figure that increased by 19 percent between 2020 and 2021 as many people turned to social media outlets for information during the pandemic).
Further complicating matters, some Iraqis who are willing to get the COVID-19 vaccine have strong preferences for specific brands. The AstraZeneca vaccine is the primary type distributed by COVAX, but the AstraZeneca vaccine has been met with concerns over associated blood clots that emerged in March 2021. Demand is high for the Pfizer-BioNTech vaccine, but supply is limited (Iraq signed a contract with Pfizer to purchase 12 million doses, but only 500,000 have been received thus far). Iraq also received about 500,000 doses of the Sinopharm vaccine, but it is less trusted by some people.
Luay Hassan, a 53-year-old from Baghdad, said, “I will not take the Chinese vaccine because I do not trust it, I will wait for Pfizer. This applies to almost all of my family and friends.” In March, Iraq signed an agreement with Russia to import one million doses of the Sputnik V vaccine, but no shipments have arrived yet.
Looking Ahead
In the face of widespread resistance, the government has taken to trying to force its large civil service sector to get vaccinated through employment-based mandates, a potentially risky move given their past heavy-handedness in dealing with positive COVID-19 cases. On June 8, the Iraqi government issued an order that all public sector employees be vaccinated by October 1, 2021 or be prohibited from returning to work. Likewise, the country’s national security advisor recently made COVID-19 vaccination compulsory for all members of the security and armed forces.
As Iraq enters a third COVID-19 surge with the emergence of the Delta variant, the country is in desperate need of a more robust vaccine strategy to fight the pandemic.
At least some companies have also mandated vaccinations for their employees. According to Hassan Auda, a nurse in charge of vaccination in Almshrah, a town in southeastern Iraq, “The people of my town are not interested in getting the vaccine. Most who have been vaccinated are working with Chinese oil companies where it [vaccination] is mandatory.”
Starting in October 2021, no Iraqi will be able to fly internationally without proof of vaccination status. These government mandates do not seem to include accommodations for those who are unable to get vaccinated for medical or other valid reasons. How the government intends to enforce these edicts – and how effective these measures will be – are open questions.
As Iraq enters a third COVID-19 surge with the emergence of the Delta variant, the country is in desperate need of a more robust vaccine strategy to fight the pandemic, including more active promotion of the benefits of the vaccine and a comprehensive media campaign that better leverages local and religious leaders as trusted voices. Sufficient resources must be allocated to set up localized vaccine drives in residential neighborhoods and to explore effective types of incentives to increase vaccination rates. The Iraqi government must work with COVAX to ensure that the country secures sufficient vaccine supply. These steps will be critical to help Iraq get on the right path and alter its current trajectory.