Coordination, cooperation, and creativity within harm reduction networks in Iran: COVID-19 prevention and control among people who use drugs

In Iran, the first two cases of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were confirmed on February 19, 2020. By April 19, Iran had the ninth and seventh-highest numbers of infections and deaths in the world, respectively (Johns Hopkins University, 2020). Among people who use drugs (PWUD), numbers of SARS-CoV-2 infections and deaths are unknown; however, the scale of the pandemic and vulnerability of PWUD underscore the need for relevant and timely action, if the threat is to be controlled among this population.

Drug use is a significant public health issue in Iran. In 2013, an estimated 1.6 million people had used drugs in the previous year (Nikfarjam et al., 2016). Since the 1979 revolution, Iran has gradually shifted from zero-tolerance policies towards drug use to adopting harm reduction initiatives in the late 1990s and drug law reforms in 2010s (Alam-mehrjerdi, Abdollahi, Higgs & Dolan, 2015; Ekhtiari et al., 2019). By 2014, opioid agonist therapy and needle exchange programs were available in more than 5000 clinics and nearly 500 centres, respectively (National AIDS Committee Secretariat, 2015). The non-government sector has played a significant role in this trajectory, in promoting a sharper focus on harm reduction vs punitive/criminal justice approaches, and in providing access to care among the most marginalised PWUD (Ghiabi, 2020b). In recent years, the harm reduction infrastructure has been utilised to scale-up therapeutic interventions among PWUD (Alavi et al., 2019; Mirzazadeh et al., 2019), and is well-positioned for provision of COVID-19 control measures too, given appropriate public health leadership in policy development and allocation of resources. The government has a limited capacity for leading efforts in identifying and corresponding to the specific needs of PWUD during a pandemic (Farhoudian et al., 2020). Years of unilateral economic sanctions imposed by the United States, the rise of socially austere policies within a weakened economy, and ongoing restrictions on humanitarian trade transactions have contributed to significant shifts in priorities and reduced the potential for a comprehensive COVID-19 public health strategy (Ameli, 2020; Kokabisaghi, 2018; Murphy, Abdi, Harirchi, McKee & Ahmadnezhad, 2020; Takian, Raoofi & Kazempour-Ardebili, 2020).

The necessity to act against the pandemic and gaps in COVID-19 public health policy prompted a major non-government organization (NGO) to initiate administrative action and develop the COVID-19 prevention and control Working Group, bringing together a diverse range of representatives from private and public sectors. This Working Group aims to enable greater collaboration between government and non-government sectors and develop an equitable COVID-19 response among PWUD.