When the HPV Vaccine Disappeared

Iran relies on India — “which is easy to get to” — for its supplies of chemical molecules, which get around sanctions more easily than finished products. After winding their way through an obstacle course, they are finally assembled. In this way, the Iranian pharmaceutical industry tries to reconstitute the finished goods that it now only imports in dribs and drabs.

Is the government succeeding in softening the brutality of the sanctions? For ordinary medicines, a collapse has been avoided. In other cases, the picture is less rosy. Ali details the different classes of products in acute shortage: “Antibiotics for rare diseases, anticancer drugs, vaccines against certain sexually transmitted infections.” Among these, he mentions “papillomavirus, the prevalence of which is increasing at an alarming rate. It takes seven molecules to produce a vaccine; we only have two.

Several studies have established a correlation between the intensification of sanctions and the deceleration (or even stagnation) of healthy life expectancy for sick Iranians. Similarly, the diseases that are abnormally lethal in Iran according to World Health Organization figures — especially cardiovascular diseases — are precisely the ones whose treatment requires medicines that are in short supply due to the financial embargo. An article from Global Health in 2016 — i.e., before Donald Trump’s new salvo of sanctions — suggests that “ongoing challenges to importing life-saving medicines, supplies, and medical raw materials . . . have resulted in an estimated 6 million Iranian patients who lack access to essential treatment needed to address highly prevalent communicable and non-communicable diseases (NCDs) within the country”.

According to one Iranian NGO, the financial embargo has been responsible for the deaths of 650 people with thalassemia since 2018, while 10,000 have to live with “serious complications,” out of the 23,000 affected. This hereditary disease causes a shortage of hemoglobin and generates anemia that can only be warded off by regular consumption of pharmaceutical products — the very products that have been banned from reaching Iran for the past six years.

In addition to the direct deprivation they cause in various sectors, sanctions are also putting a strain on the country’s macroeconomic performance. A dollar was exchanged for 43,000 rials in 2016; today a greenback is sold for over 430,000 rials. Iran’s GDP, halved in the wake of Donald Trump’s election, has still not returned to its previous level. Inflation approached 50 percent for calendar year 2023, with no significant increase in wages to offset it.

But the most profound impact of sanctions in Iran lies elsewhere. Since 1979, an entire mode of production has been shaped in response to US sanctions — and is now reaching its limits, as the country’s most precious resource is running out.

The Contaminated Waters of Khuzestan’s Furnace

On a small island in Lake Shadegan in central Khuzestan, on the border with Iraq, leafless palm trees stretch as far as the eye can see. “This used to be a lush landscape. Today, as the marshes dry up, the trees are dying.” In this remote fishing village, where Arabic is spoken more than Persian, the waters are slowly receding. “Day by day, the diversity of species diminishes. For decades, we have been careful to preserve our ecosystem. We only fished a limited amount, adapted to the rate of the fish’s reproduction.”

Muhammad, a boatbuilder, continues: “Today, poachers are rampant. Since they use electric fishing, they eradicate all living species from the areas they cover.” These illegal fishermen don’t come out of nowhere. Under pressure from drying waters, they resort to desperate methods, which only further degrade their fishing environment.

In Khuzestan, the progress of drought is a major cause for concern, both in the marshy areas of Shadegan and in its industrial capital, Ahwaz. In summer, scorching winds sweep across the region, and a screen of orange dust covers the atmosphere, forcing residents to take refuge in their homes for days on end. When it recedes, an equally acute problem remains: the shortage of drinking water. As a result, the water supply has reached “2850 milligrams of total dissolved solids per liter of water (mg/L).” As we watch, Soraya, owner of a luxury apartment in Ahwaz, measures the toxicity of tap water. At 500 mg/L, water is no longer considered drinkable. A six-filter machine is used to purify it.

Who can afford such a machine? “Everyone I know has this machine. But not everyone in the region does,” admits Soraya. Euphemism: as soon as you leave the affluent center of Ahwaz, it’s impossible to find one. “The cost would be exorbitant,” as Jawad, a resident of the small town of Hamidiyeh, puts it. “We have to buy bottled water, which is a heavy burden on our income. This is one of the major causes of emigration.”

The exodus from this region has already begun. These drought migrants are taking refuge in more salubrious areas of the country, where they swell the ranks of the unemployed and informal workers who are already reaching a critical mass on the outskirts of the big cities.

Khuzestan is one of the regions most affected by global warming. But water stress is not primarily due to climatic causes. The main cause is not the shrinking of surface rivers, but the plundering of groundwater.

Sovereignty, Pistachios, and Drought

This has its origins in the development model implemented following the 1979 revolution, which led to the establishment of the Islamic Republic. While its religious component was undeniable, the revolution primarily targeted a “comprador” bourgeoisie with incestuous ties to the United States, pampered by Mohammad Reza Pahlavi. The last Shah of Iran had benefited from invaluable support from American leaders.

So, 1979 was to mark the great divorce from the United States. Anti-imperialist, the revolution was to impose an endogenous production model on Iran, aimed at emancipating it from Western tutelage. And the battery of sanctions that was to fall upon the country would confirm this course, even though the revolutionary fever of the early years had subsided — and the mullahs, representatives of a new ruling class, were busily dismantling the gains made.

The new regime therefore set out to achieve self-sufficiency at breakneck speed. In a sense, it has been a resounding success. The Iranian experience is one of the few successful attempts at state-led industrialization, at a time when the countries of the South were opening up to free trade. In many sectors, however, this came at the price of an unbalanced extraction of natural resources, the consequences of which would prove painful.

Such was the case in agriculture, which today corners 90 percent of the country’s water. In an arid country with thankless soils, securing food sovereignty was to prove arduous. Under the Shah, importing agricultural products gave the country undeniable comparative advantages. But after 1979, it was no longer a time for free trade, but for the Islamic Republic to consolidate its sovereignty, and for Washington to isolate the country.

To boost agricultural yields, Iranian governments have been tapping into the country’s aquifer resources at an unprecedented rate. Groundwater reserves, the main source of drinking water, have paid the price. Iran is the country to have suffered the third-greatest loss of groundwater in recent decades, just behind China and the United States. Tension is also mounting over the country’s other major source of running water: glaciers. The rivers they feed are suffering the consequences.

On the outskirts of the city of Ahwaz, on cracked earth, Jawad points to a thin trickle of water. “When I was a child, I used to play on the banks of the river, which stretched as far as where we’re walking now. In recent years, the waters flowing from the glaciers of the Zagros Mountains have been diverted eastwards, to feed the other part of the country at our expense.” The Karun River, which has its source in the northern mountain ranges, irrigates a large part of Khuzestan, then flows into a delta shared with the Tigris and Euphrates rivers.

Recently, Iranian authorities imposed a detour on the glaciers of the Zagros Mountains to favor the city of Isfahan, further east, whose rivers were drying up. The availability of water in Khuzestan has declined significantly, provoking repeated clashes. Not just its quantity but also its quality worsened: as the flow of pure water from the mountains shrank, the impact of industrial waste discharged into the river increased tenfold. Ultimately, this decision provoked a diplomatic incident with Iraq, whose second-largest city, Basra, depends on the glaciers of the Zagros Mountains and the waters of the Karun River.

This increase in tensions over water cannot be reduced to the financial embargo. Within Iran, a powerful agri-export sector is attached to the status quo for reasons only remotely related to food sovereignty. Pistachio growers, for example, whose crops intensely deplete groundwater, sold 40 percent of their crops abroad between 2016 and 2021. However, the sanctions are preventing any significant change. By hindering food imports, they force Iran to persevere with the self-sufficiency model initiated by the 1979 revolution.

They also compromise technological, logistical, or academic exchanges with foreign countries that could increase the efficiency of water management. In 2018, an article by the Carnegie Endowment for International Peace warned that new US sanctions “are likely to obstruct this necessary exchange of expertise [on confronting Iran’s water problem] even as it encourages the Iranian establishment to pursue self-sufficiency policies more rigorously.”

The Dollar as a Weapon of War

There was a time when the rest of the world refused to blindly apply American sanctions. The European Union, in particular, remained one of Iran’s trading partners. In 1996, the Iranian Sanctions Act adopted under Bill Clinton threatened both American and non-American companies with exclusion from financial markets in the event of illegal transactions. In response, the European Council adopted a series of measures prohibiting European companies from complying with the embargo: fines for those who yielded to it, and monetary compensation for those who suffered as a result. Such a firm stance is hard to imagine today.

Europe’s autonomy vis-à-vis the United States was subsequently to shrink to the bone. As sociologists Grégoire Mallard and Jin Sun explain in a 2022 article, the effectiveness of sanctions stems from US supremacy in global finance. The 2008 crisis marked a turning point. At a time when European banks and companies were in desperate need of liquidity, the United States — via the Federal Reserve and then the European Central Bank — agreed to bail them out, provided they complied with its rules.

European players signed numerous agreements “which required that the entire top management of banking branches would be replaced . . . and that the new management would show a clear willingness to cooperate with U.S. authorities,” Mallard and Sun point out. To demonstrate their good faith, some banks are even recruiting former US regulators. HSBC, for instance, ended up appointing Stuart Levey, ex-director of the Office of Foreign Assets Control (OFAC), the branch of the US Treasury responsible for enforcing sanctions, to head its compliance department.

In 2008, the OFAC took a harder line. It demanded access to the transactions of European players and sanctioned those who traded with Iran — such as BNP-Paribas in 2013, to the tune of $9 billion dollars — or those who refused to lift banking secrecy, such as HSBC in 2012, just before the appointment of Stuart Levey. But OFAC’s most formidable weapon is simply its control of the international reserve currency. In 2008, it banned European companies that violated the US Iran Act from refinancing with the Fed, effectively reducing them to the status of financial market pariahs.

In just a few years, there was a 180-degree turnaround. Fearing the wrath of investors, OFAC, and the Fed, European companies now avoid any direct or indirect contact with Iran. Is it any surprise, then, that the “humanitarian exemptions” provided for by the United States are not being respected?

Neocons and Mullahs: The Best of Enemies?

Donald Trump’s doctrine of “maximum pressure” on Iran, also pursued by Joe Biden, seems strangely incapable of weakening the mullahs’ hegemony. The increasing scarcity of imports clearly strengthens the Iranian regime’s grip on society and perpetuates the profits of the ruling class. “Sanctions and censorship are the two blades of the same scissors,” says the director of an Iranian tech company we meet in Shiraz. “In 2015, when [sanctions] were partially lifted, the Iranian private sector began to bud, allowing it to conquer a certain autonomy from the regime. Subsequently, the reinstatement of the embargo prevented this ecosystem from growing, and tightened its ties with the state.”

Workers in the Khuzestan town of Hamidiyeh strike a very different note. But they also deplore the effects of the sanctions. A few hundred kilometers away, they live in a completely different world: “There’s no future here. Unemployment, inequality, corruption, water pollution, air pollution, stifling heat all year round. . . . We hate this regime, which has been killing our dreams for many years,” says Jawad. The inhabitants of this Arab region, who frequently complain of discrimination, express a particularly strong rejection of the Islamic Republic. But memories of the war with Iraq are still vivid, as is Western support for Saddam Hussein, and identification with the Palestinian cause remains strong. “The embargo has encouraged the development of incredible poverty. It makes the population even more dependent on the state, and on the few crumbs it agrees to pay out.

Cuba, North Korea, Iraq, Venezuela . . . the Islamic Republic of Iran is not the first system which has shown remarkable longevity, seemingly strengthened rather than weakened by US sanctions. If sanctions fail to satisfy neocons’ objectives, they enrich a considerable number of players. American arms companies and private security firms are the most obvious beneficiaries of increased tensions with Iran. Lockheed Martin’s CEO expressed his opposition to the Iran nuclear deal (JCPOA) imposed by Barack Obama — on the grounds that it would reduce his order book.

Beyond this military-industrial interface, with its incestuous links to the American political class, the oil sector booms every time new sanctions against Iran are announced. We can thank researchers Jonathan Nitzan and Shimshon Bichler for highlighting the close correlation between rising tensions between the United States and Middle Eastern oil-producing countries, on the one hand, and rising profits for American oil giants, on the other.

Beyond the inflammatory rhetoric of hawks in Washington, isn’t the real function of sanctions to perpetuate a permanent state of tension with a handful of countries, in order to maintain an economic system that should have expired with the end of the Cold War? Judging by the Iranian example, that’s exactly what we’re dealing with.