The coronavirus pandemic is about to enter a new phase as vaccines become available. Countries in the Middle East are making preparations and here is a round-up of what they are doing.
Some – mostly the wealthier ones – have struck deals with major pharmaceutical companies, often for more than one type of vaccine. Others are relying on the international Covax initiative and some are making use of both methods.
Covax aims to provide "equitable access to safe and effective vaccines" worldwide and is part of the ACT-Accelerator programme. Covax is of particular interest to low-and-middle-income countries which are eligible to receive vaccines at a reduced cost. In the Middle East, Algeria, Egypt, Morocco, Palestine, Tunisia, Sudan, Syria and Yemen fall into that category.
Initially, all the vaccines will be imported, though Egypt is eager to start local production of those developed by other countries and Morocco may do so too. Iran, Israel, Saudi Arabia and Tunisia are also seeking to develop their own vaccines.
Algeria's health minister told a news conference on November 5: “As soon as it is marketed, Algeria will acquire the vaccine to protect its citizens, whatever the cost.”
Algeria doesn't appear to have struck deals with any specific manufacturers but has joined the Covax initiative which aims to provide "equitable access to safe and effective vaccines" worldwide.
Bahrain has begun vaccinating front-line health workers after giving emergency approval to a vaccine developed by the Chinese Sinopharm company. More than 7,000 volunteers in Bahrain have already taken part in Phase III trials of the same vaccine.
Bahrain is reported to have ordered more than a million doses of Covid-19 vaccines – some of them from Pfizer/BioNTech and AstraZeneca as well as Sinopharm.
Egypt has ambitions to become a major local manufacturer of Covid-19 vaccines and a distribution hub for other parts of Africa. With a population of around 100 million it has a large domestic market and that, coupled with its previous experience in vaccine production, makes it an attractive proposition for major pharmaceutical companies.
Russia has agreed to provide 25 million doses of the Sputnik V vaccine once it has been approved by Egypt's health ministry. There are hopes that this will develop further into "a mutually beneficial partnership".
In September, Egypt began trials of two different Chinese vaccines. To encourage volunteers, health minister Hala Zayed was among those vaccinated though she said later that she developed a fever after receiving the first of two shots.
The Egyptian Vacsera company is reported to have a production line ready to start producing Chinese vaccines once it is given the go-ahead.
Egypt is also having talks with a view to obtaining millions of doses of the vaccine developed by researchers at Oxford University in partnership with AstraZeneca and the health ministry says it has it has reserved enough of Pfizer's Covid-19 vaccine to meet 20% of its needs.
Iran has been seeking to develop its own vaccines because of concerns that US sanctions will make importation difficult. So far, five Iranian-made "candidate" vaccines have been put on the World Health Organisation's list.
Although Iran is seeking to obtain other vaccines through the Covax system there have been difficulties with its advance payments. While US sanctions don't prevent it from importing medicines, banks have apparently been nervous about processing the related financial transactions.
Iraq is purchasing its first batch of vaccines through the Covax facility. Payment was approved by Iraq's Higher Committee for Health and National Safety on November 7.
The Israel Institute for Biological Research, which has connections with the defence ministry, has begun trials of a locally-produced vaccine known as Brilife but this is unlikely to be approved for several months. The Phase III trials are not expected until April or May next year.
Israel already has contracts with Moderna and Arcturus for substantial quantities of vaccine when approved and is also negotiating with AstraZeneca.
Prime minister Binyamin Netanyahu said recently that Israel's policy is to “buy as many options as possible from as many companies as possible”. He added that “the cost of throwing money in the trash, if the vaccines are unsuccessful, is minimal compared to not having vaccines.”
Last week Israel also signed an agreement with Pfizer for eight million doses of its vaccine. However, it was later reported that Pfizer has not committed itself to a delivery schedule and is charging Israel $56 for each two-shot dose compared with $39 in the US.
Jordan's health ministry says it has secured enough vaccines for 15% of the population and is seeking to secure a further 5%. The first vaccines are expected to become available in January or February and priority will be given to health workers in contact with infected patients, followed by the elderly and people with chronic diseases.
Kuwait's health ministry says it has ordered a million doses from Pfizer and the first batch of 150,000 is expected to arrive once the US Food and Drug Administration has given the vaccine its approval.
Priority for vaccination will be given to frontline health workers, the elderly and those with chronic diseases.
Pfizer's vaccine needs to be stored and transported at a very low temperature (minus 70 degrees Celsius) and the Kuwaiti health ministry has described some of its plans for dealing with this.
Lebanon has reserved vaccines under the Covax scheme which should be enough for the "most vulnerable" 20% of its population. It also has an agreement with Pfizer to supply vaccines for a further 15% of the population.
The first vaccines are expected to arrive in February next year.
Libya is planning to obtain vaccines through the Covax facility. It has signed an agreement and made an advance payment.
The Libya Observer reports that a budget of $9.6 million has been allocated, though it's unclear whether this includes the cost of distributing and administering the vaccine inside the country.
Given the continuing turmoil in Libya, the World Health Organisation appears to have some concern about the authorities' ability to manage a vaccination programme effectively. In a report last month the WHO said it is supporting them in preparing guidelines and a "readiness assessment tool".
Morocco is expecting to receive about 10 million doses of vaccine. The government has not said which vaccine will be used but there are indications it will be Chinese
In August Morocco signed two cooperation agreements with the China National Biotec Group to carry out Phase III trials and the agreements will also allow for local production of the vaccine once it is available for general use.
The Moroccan authorities appear very confident of their supplies, though they have given no details. They say a large-scale campaign will begin in the next few weeks to raise public awareness about the benefits of vaccination.
It's not clear who will be supplying the vaccine and the health minister has said Oman is seeking to obtain it "from any internationally accredited institution".
Palestine will obtain the Pfizer vaccine through the Covax facility once it has been approved by the World Health Organisation, according to health minister Mai Alkaila.
At the end of October, Moderna announced an agreement to supply Qatar with the vaccine it has been developing. The vaccine is not yet approved and no details have been given of the quantity reserved for Qatar or the likely delivery date.
Qatar has also been in discussions with Pfizer and is said to be "confident" of receiving an initial batch of its vaccine by the end of this year or very early next year, assuming it gets regulatory approval.
● Saudi Arabia
Saudi Arabia has "signed an agreement to receive early supplies of two or three different vaccines that have reached the final stages of their clinical trials," according to a health official quoted by Arab News.
So far, though, the kingdom does not appear to have struck deals with specific suppliers but is relying initially on ACT, the international Access to Covid-19 Tools (ACT) accelerator programme. It has contributed $150 million towards the programme and in return is expecting priority access to some vaccine supplies.
Two Saudi laboratories are also developing vaccines but those projects are still in their early stages.
Sudan is among 92 low-and-middle-income countries eligible to receive vaccines through Covax, with Covax covering at least part of the cost.
Syria, like Sudan is eligible to receive vaccines through Covax, with Covax covering at least part of the cost.
However, Russia has said it hopes to provide vaccines for its closest allies – and the Assad regime is one of them. President Assad has also said he "would love" to be injected with a Russian vaccine.
In August, Tunisia's Pasteur Institute announced that it is developing a DNA-based vaccine which it expects to be ready for use "early" next year.
Tunisia is also eligible to receive vaccines through Covax, with Covax covering at least part of the cost.
The United Arab Emirates has been taking part in clinical trials of Chinese and Russian vaccines and in September the health ministry granted emergency approval for use of a Chinese vaccine on "high risk" frontline workers.
"High risk" appears to have been defined liberally and besides healthcare workers, royalty, senior officials, police officers and teachers have been among those vaccinated. On November 3, the ruler of Dubai was photographed receiving a jab.
This week it emerged that more than 30,000 army personnel have been vaccinated too. This was explained on the grounds that the military have been assisting the UAE's medical efforts in various ways during the pandemic.
Yemen, one of the world's poorest countries, is eligible to receive vaccines through Covax but with two rival governments fighting each other distribution is likely to be problematic.
In May, the Houthis who control much of the north claimed to be working on their own vaccine. Their health minister, Taha al-Mutawakkel, said: "God willing and with the capabilities of our doctors, pharmacists, and laboratory colleagues, we are conducting extensive research and the corona drug will come from Yemen." He added: "There is extensive and promising research and studies – and I stress on the word 'promising'."