As Covid-19 vaccines become more available, here is a country-by-country roundup of the situation in the Middle East and North Africa. While some countries are still waiting for supplies, in others the roll-out is well under way.
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 free of charge or 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 are being imported, though several countries hope to start local production under licence. Iran, Israel, Saudi Arabia and Tunisia are also seeking to develop their own vaccines.
More information about how the pandemic is affecting the region can be found here.
The Algerian government has said it ordered 500,000 doses from Russia, though reports did not indicate how many were delivered in the first batch.
In addition, Algeria is reported to be seeking supplies of Sinopharm and AstraZeneca vaccines.
Bahrain has already vaccinated 10% of its small 1.7 million population. It took part in Phase III trials of a Chinese Sinopharm vaccine and began vaccinating frontline workers early in November, having granted emergency approval before all the checks were completed.
Since then, Bahrain has also approved the AstraZeneca and Pfizer/BioNTech vaccines for emergency use. It received an initial consignment of the AstraZeneca vaccine, manufactured by the Serum Institute of India, towards the end of January.
Egypt is expecting 40 million doses of Sinopharm vaccine and 20 million of the AstraZeneca version, according to health minister Hala Zayed. This would be enough to provide about 30% of the country's population with the required double dose. There are expectations that the Covax scheme will provide vaccines for a further 20% of the population.
In December local media reported the arrival of 50,000 Sinopharm doses on a plane from the UAE. A 50,000-dose shipment of AstraZeneca vaccine arrived on January 31.
Doctors and other healthcare workers are the first to receive vaccinations but Mada Masr website reports that some of them are refusing the Sinopharm vaccine – apparently because they doubt its safety. Medical staff in isolation hospitals are currently prescribed hydroxychloroquine and Ivermectin as a protective measure, though the effectiveness of those medications is disputed.
Supreme Leader Ayatollah Ali Khamenei claimed in January that American and British vaccines are "completely untrustworthy", adding that "it's not unlikely they would want to contaminate other nations."
Regardless of such conspiracy theories, Iran's focus on alternative sources does have a rational basis because of concerns about US sanctions. While the sanctions don't prevent it from importing medicines, banks are said to have been nervous about processing payments.
Iran has been allocated 16.8 million doses of unknown origin for eventual delivery through the Covax scheme and on January 30 the government news agency reported that a contract had been signed with Russia for the purchase and joint production of vaccine. Several batches are expected to arrive this month.
However, Iran seems to be pinning most of its hopes on vaccines developed by three local research institutes – Barekat, Razi and Pasteur. Small-scale trials have begun and fficials are claiming that the Barekat institute's COVIran vaccine is effective against the British and South African variants. Assuming the trials are successful, roll-out of locally-made vaccines could start in late spring or early summer, according to head of the Pasteur institute.
Iraq is expecting about three million doses of vaccine to have arrived by the end of this month.
The National Board for Selection of Drugs (NBSD) has approved Sinopharm, AstraZeneca and Pfizer/BioNTech vaccines for emergency use. Priority will be given to health workers, security personnel, people over 50 years of age and those with chronic diseases, according to the health minister.
More than three million Israelis – a third of the country's population – have now received a first dose of vaccine and almost two million of those have had a second dose. Early signs are that this is slowing the spread of the virus. The level of new infections is still high, however, and the number of people coming forward for vaccination has been falling recently.
Prime minister Binyamin Netanyahu said Israel's strategy was to “buy as many options as possible from as many companies as possible” and in November he negotiated a deal with Pfizer to supply eight million doses of its vaccine – though at a relatively high price.
Israel also has contracts with Moderna and Arcturus, and has reportedly been negotiating with AstraZeneca.
Israel has supplied small quantities of vaccine to the Palestinian Authority in the West Bank but has been criticised for not doing more to help.
Last year the Israel Institute for Biological Research, which has connections with the defence ministry, began trials of a locally-produced vaccine known as Brilife. This is unlikely to be approved for several months as the Phase III trials are not expected until April or May.
So far, 40,000 people are reported to have been vaccinated and the health ministry says it has enough supplies to give them a second dose. A further delivery of Pfizer/BioNTech vaccine is expected this month, along with 41,000 doses allocated under the Covax scheme. Jordan is also said to be negotiating with Sinopharm for "a large quantity" of vaccine. Mass vaccination centres are being prepared in Amman and Irbid.
Kuwait's first batch of Pfizer/BioNTech vaccine – 150,000 doses – arrived on December 23, and roll-out began next day. A second batch arrived in January.
The health ministry has also been talking to other possible suppliers and says it has secured an initial batch of AstraZeneca vaccine for delivery early this month.
Lebanon aims to vaccinate 80% of its population – including refugees and migrant workers – by the end of this year. However, its arrangements so far would provide a single dose for barely half the population.
A deal with Pfizer/BioNTech provides for 2.1 million doses, with deliveries starting this month and spread throughout the year. A further 2.7 million doses of vaccine will be provided through Covax.
Last week the health minister said Lebanon is also negotiating for 1.5 million doses of AstraZeneca vaccine.
Libya has ordered 2.8 million doses through Covax but delivery may be four months away.
The National Centre for Disease Control has ruled out use of the Pfizer/BioNTech vaccine because the ultra-cold storage it requires is not available in Libya.
Given the continuing turmoil in Libya, the World Health Organisation has previously expressed concern about the authorities' ability to manage a vaccination programme effectively.
Morocco aims to vaccinate at least 80% of its population and has ordered 66 million doses. Of those, 25 million will be AstraZeneca vaccine produced by the Serum Institute of India (SII) and Russia’s R-Pharm company.
The remaining doses are expected to come from China. Last August Morocco signed cooperation agreements with the China National Biotec Group to carry out Phase III trials of a Sinopharm vaccine. The agreements will also allow Morocco to produce the Chinese vaccine locally.
Oman has ordered 370,000 doses of the Pfizer/BioNTech vaccine – 27,000 of which had been delivered by the end of January. Further supplies have been delayed by production problems at a factory in Belgium, causing Oman to slow down its roll-out.
In the meantime, India has donated 100,000 doses of the AstraZeneca vaccine produced at its Serum Insititute and as a result of this a new vaccination campaign is due to begin in Oman on Sunday, targeting people over the age of 65.
The Indian donation is seen as token of the close between the two countries. Oman has a large Indian expatriate community and many Omanis have Indian ancestry.
The Palestinian Authority has begun vaccinating medical staff using Moderna vaccine from Israel. A hundred doses arrived in the West Bank in January, followed by 2,000 more this week. Altogether, Israel has promised 5,000 doses.
As far as vaccine for the general population is concerned, the Palestinian Wafa news agency reported this week that a batch of 50,000 doses is expected in mid-February and an additional shipment towards the end of the month. These will come from a variety of sources, including the World Health Organisation and Covax.
It is unclear when the first vaccines will arrive in Hamas-controlled Gaza.
Qatar has signed agreements with Pfizer/BioNTech and Moderna.
Since December 21 it has received several small shipments from Pfizer/BioNTech and larger deliveries are expected from early March.
The first delivery of Moderna vaccine – "a very limited quantity" – is due soon. Larger quantities are expected from the beginning of March.
● Saudi Arabia
Saudi Arabia began vaccinations on December 17, using the Pfizer/BioNTech vaccine.
Supply problems have caused some delays in administering a second dose. On Wednesday, however, the health minister announced that the kingdom would be rolling out "huge quantities of Covid-19 vaccines received from various suppliers" during the next few days. Details are unclear but it's likely these new supplies are AstraZeneca vaccine from India.
Sudan is among 92 low-and-middle-income countries eligible to receive vaccines through Covax, with Covax covering at least part of the cost.
In December the health ministry said it aims to provide 8.4 million doses of vaccine to high-risk groups, including health workers. The ministry said this is planned to take place during the first quarter of 2021, depending on availability of supplies.
In mid-January it was reported that the United Arab Emirates would be providing Sudan with "considerable quantitites" of vaccine, though the number of doses was not mentioned.
Syria is eligible to receive vaccine free of charge through the Covax scheme, Akjemal Magtymova, the World Health Organisation's representative in Syria said on Tuesday. However, she added that the timing and the quantities this would depend on availability and initial supplies might only be enough for 3% of the population.
It's unclear how this will affect areas outside the Assad regime's control. A report by Human Rights Watch says:
"On January 21, the Syrian health minister said that among the most important conditions for Syria’s procurement of the vaccine is to ensure that it does not 'impact Syria’s sovereignty'. That suggests that the government is unlikely to have included the northeast – which it does not control – in its plans.
"Governing authorities in most of northwest Syria told Human Rights Watch that they too have submitted a formal proposal to Covax for areas under their control. These plans have not been made public. Northeast Syria, though, currently has no arrangement to obtain vaccines independently."
A surge of new infections in January put Tunisia's health services under great strain, making the need for vaccines more urgent. As a result, Tunisia (along with Palestine) will be first in the Middle East and North Africa to receive free vaccines through Covax. Tunisia expects to receive four million doses, starting this month.
In August, Tunisia's Pasteur Institute announced that it was developing a DNA-based vaccine which it expected to be ready for use "early" in 2021.
The UAE has been at the forefront of vaccination efforts in the Arab countries. Last year it took 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 were among those vaccinated. On November 3, the ruler of Dubai was photographed receiving a jab.
In mid-November it emerged that more than 30,000 army personnel had been vaccinated too. This was explained on the grounds that the military were assisting the UAE's medical efforts in various ways during the pandemic.
The UAE reportedly plans to start manufacturing Sinopharm vaccine under licence later this year.
Yemen is due to receive vaccines through Covax, but probably not until April or May. Internal distribution of vaccines is likely to be problematic as the country is in turmoil, with two rival governments fighting each other.
Last year 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'."