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Two of Iran’s 32 provinces – Alborz, close to capital Tehran, and Ilam to the west of the country – have been confirmed by the country’s health ministry to be facing a fourth wave. Seven more, including Tehran, are on the verge, it said.

“If we don’t have the necessary considerations, we might face this wave in other provinces as well. So we need to be careful,” President Hassan Rouhani said during a televised session of the national anti-coronavirus task force on Saturday.

Iran has reported more than 1.9 million coronavirus cases since it announced its first in February last year. About 63,000 people have died in what is the worst COVID-19 death toll in the region.

The resurgence in the cases, which health officials say will soon be accompanied by a spike in hospitalisations and deaths, comes two weeks after Nowruz, the Iranian new year, on March 20.

Even as health officials said they opposed travels this year, people were officially allowed to visit hundreds of cities across the country that were not classified as “red” or “orange” on a colour-coded scale denoting the severity of outbreaks.

Alireza Raeisi, a spokesman of the national anti-coronavirus task force, said on Saturday that road travel during Nowruz experienced a 100 percent increase compared with last year.

Shortly before Nowruz, Roads Minister Mohammad Eslami predicted that a whopping 33 million people will travel during the holidays, with at least 7.8 million people using public transport to move around the country.

According to the health ministry, at least 15,000 people who knew they were infected with COVID-19 after testing positive at registered labs, travelled during Nowruz.

Official figures also show 47 cities are now classified “red” while 126 have been bumped to “orange”.

A further 247 are “yellow” while only 14 are classified as “blue”, experiencing the lowest transmission rates.

Iran, has administered  about 161,000 doses of coronavirus vaccines to people in vulnerable groups, as per the latest figure announced by officials last week.

Iran expects more doses from Russia, China, and India, while three local vaccine candidates are undergoing human trials and are expected to head for mass production in the next few months.

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Unlike the US or UK, Russia approved its vaccine — called Sputnik V — before conducting phase 3 trials. These late-stage trials typically evaluate a medical treatment in tens of thousands of people to determine how well it works, ensure that it’s safe, and uncover any side effects.

When Russia approved Sputnik V for distribution, only 38 people had received the vaccine in clinical trials. All of them produced antibodies, and side effects were mostly mild — including elevated temperatures and headaches. That research had not undergone peer review, though.

As Sputnik V was distributed to frontline healthcare workers in December, medical experts warned that the data was insufficient to determine whether the vaccine was safe and effective. Some scientists suggested that the vaccine approval may have been rushed for political reasons.

But Russia’s risk seems to be paying off. An interim analysis of phase 3 trials published in The Lancet on Tuesday suggests that Sputnik V is 91.6% effective at preventing symptomatic COVID-19.

“I think everything has been done perfectly and this moment is in some ways a vindication moment,” Kirill Dmitriev, CEO of the Russian Direct Investment Fund (RDIF), told Insider in an exclusive interview on Tuesday. The RDIF is one of the world’s largest sovereign wealth funds and has overseen and financed the development of Sputnik V.

Dr. Julian Tang, a consultant virologist at the UK’s University of Leicester, told Insider the nation’s risky approach “has been justified to some extent now.”

Sputnik V is given in two doses. Each dose relies on a different adenovirus — relatively harmless viruses associated with the common cold — to deliver a gene that codes for the coronavirus’ spike protein, which helps it attach to and invade cells. In theory, this should train the immune system to produce antibodies that ward off symptomatic disease.

The Gamaleya Institute in Moscow and the Russian Ministry of Defence developed the vaccine in tandem.

Russian President Vladimir Putin announced on August 11 that the country’s health agency had approved the new vaccine following phase 1 and 2 clinical trials. Some virus experts feared that any severe side effects missed in those early trials could undermine public trust in other vaccines, too.

“This is a reckless and foolish decision. Mass vaccination with an improperly tested vaccine is unethical. Any problem with the Russian vaccination campaign would be disastrous both through its negative effects on health, but also because it would further set back the acceptance of vaccines in the population,” Francois Balloux, a geneticist at University College London, said in a statement distributed by the UK Science Media Centre.

Despite these concerns, Russia’s health ministry began producing batches of the vaccine in August. By December, the country was offering its first doses to essential workers like teachers and healthcare professionals.

“We registered it in August why? Because we know it’s a safe human adenoviral platform tested for decades. It’s very different from an mRNA vaccine that has not been tested long term at all,” Dmitriev said. “So we do it and we give it only to high-risk personnel who wants to take it. And therefore already in September, we were able to save people, protect lives, and to create this basic safety net of some of the high-risk personnel.”

Phase 3 trials were ongoing at the time, but it would be months before they produced reliable results.

In November, Russia announced that preliminary data from phase 3 trials showed that its vaccine was 92% effective at preventing COVID-19. But the data was based on just 20 confirmed COVID-19 cases, split between the group of participants that had been vaccinated and the group that had received a placebo, according to a press release. It had not yet undergone peer review.

The peer-reviewed analysis published Tuesday, however, was based on a group of nearly 15,000 people who received the Sputnik V doses. Of that group, only 16 people had confirmed COVID-19 cases 21 days after their first dose, compared to 62 out of 4,902 people in the placebo group. None of the vaccinated people had moderate or severe symptoms.

The phase 3 trial relied on participants to self-report any symptoms to test and identify new cases post-vaccination. But researchers still don’t know how effective Sputnik V is at preventing asymptomatic infection or transmission. The US is missing the same data for both the Pfizer and Moderna vaccines.

“The development of the Sputnik V vaccine has been criticized for unseemly haste, corner-cutting, and an absence of transparency,” British virologists Ian Jones and Polly Roy wrote in an editorial accompanying the new study on Tuesday. “But the outcome reported here is clear and the scientific principle of vaccination is demonstrated, which means another vaccine can now join the fight to reduce the incidence of COVID-19.”

Ashish Jha, dean of the Brown University School of Public Health, called the results “good news.”

“We need all the safe effective vaccines we can get,” he wrote on Twitter.

Sixteen foreign countries or sovereign states have already approved Russia’s shots: Belarus, Argentina, Bolivia, Serbia, Algeria, Palestine, Venezuela, Paraguay, Turkmenistan, Hungary, United Arab Emirates, Iran, Guinea, and Tunisia.

Dmitriev said he expects Sputnik V to be registered in 25 nations by the end of next week, but applying for regulatory approval in the US and UK isn’t a priority.

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The ambassador also noted that although Tehran had declared the launch of the first phase of testing the first Iranian vaccine on humans, the Republic was still considering all vaccines being produced, including the Russian.

The first phase of the clinical trial of a COVID vaccine developed by companies under the Execution of Imam Khomeini Order (EIKO) kicked off on December 29.

Senior managers of EIKO and the daughter of Mohammad Mokhber, the head of EIKO were among the 56 volunteers for injection of the vaccine.

Russia also announced shortly before the official start of the corona vaccine test on its citizens.

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The region of 450 million people has secured contracts with a range of suppliers for more than 2 billion vaccine doses and has set a goal for all adults to be inoculated during 2021.

While Europe has some of the best-resourced healthcare systems in the world, the sheer scale of the effort means that some countries are calling on retired medics to help out while others have loosened rules for who is allowed to give the injections.

With surveys pointing to high levels of hesitancy towards the vaccine in countries from France to Poland, leaders of the 27-country European Union are promoting it as the best chance of getting back to something like normal life next year.

“We are starting to turn the page on a difficult year,” Ursula von der Leyen, president of the Brussels-based European Commission coordinating the program, said in a tweet.

“Vaccination is the lasting way out of the pandemic.”

After European governments were criticized for failing to work together to counter the spread of the virus in early 2020, the goal this time is to ensure that there is equal access to the vaccines across the entire region.

But even then, Hungary on Saturday jumped the gun on the official roll-out by starting to administer shots of the vaccine developed by Pfizer and BioNTech to frontline workers at hospitals in the capital Budapest.

Countries including France, Germany, Italy, Austria, Portugal, and Spain are planning to begin mass vaccinations, starting with health workers on Sunday. Outside the EU, Britain, Switzerland, and Serbia have already started in recent weeks.

The distribution of the Pfizer-BioNTech shot presents tough challenges. The vaccine uses new mRNA technology and must be stored at ultra-low temperatures of around -80 degrees Celsius.

France, which received its first shipment of the two-dose vaccine on Saturday, will start administering it in the greater Paris area and the Burgundy-Franche-Comte region.

Germany, meanwhile, said trucks were on their way to deliver the vaccine to care homes for the elderly, which are first in line to receive the vaccine on Sunday.

Beyond hospitals and care homes, sports halls and convention centers emptied by lockdown measures will become venues for mass inoculations.

In Italy, temporary solar-powered healthcare pavilions will spring up in town squares around the country, designed to look like five-petalled primrose flowers, a symbol of spring.

In Spain, doses are being delivered by air to its island territories and the North African enclaves of Ceuta and Melilla. Portugal is establishing separate cold storage units for its Atlantic archipelagos of Azores and Madeira.

“A window of hope has now opened, without forgetting that there is a very difficult fight ahead,” Portuguese Health Minister Marta Temido told reporters.

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Gerresheimer’s vials are made of borosilicate glass — highly prized in pharmaceuticals, heavy industry and kitchenware production for its robustness and resistance to thermal shocks. It was developed in the 19th century in the German city of Jena by the founder of today’s Schott.

In the early summer, when health officials first raised the alarm about potential bottlenecks in the production of packaging, Schott and Gerresheimer teamed up with Italian rival Stevanato to issue an unusual joint statement, assuring the world that they could meet increased demand.  “The good thing is that all the big glass and packaging providers invested huge amounts in expanding production even before the pandemic,” said Salvatore Ruggiero, a Schott spokesman. Schott alone unveiled a $1bn investment programme for its pharma division last year — the biggest in its history. The company expects to provide containers for some 2bn doses of the vaccine. German companies not only dominate the market in glass vials — they also make the specialist containers that will be critical for distributing the new vaccine. The messenger RNA technology used in Pfizer-BioNTech’s shot requires ultra-cold storage, which means it must be stored at temperatures of minus 70C or below — a tall order for countries in Africa, Latin America and Asia. Va-Q-Tec, based in the Bavarian city of Würzburg, says it has the solution. It produces “thermo-boxes” made of “vacuum insulation panels” which it says are up to ten times more effective than traditional thermal insulation materials like polystyrene and fibreglass. Demand is expected to soar: a recent study by DHL said that 15m coolers would be needed to transport 10bn doses of the Pfizer-BioNTech vaccine worldwide.

Joachim Kuhn, Va-Q-Tec’s founder and chief executive, said the company was involved in more than a dozen different vaccine projects globally, many of which would need to be stored at very low temperatures. “Demand is strong, and we are working at full blast to meet it,” he said. Maintaining production, let alone increasing it, was a struggle at a time when the companies had to protect their factories from outbreaks of the same pandemic their products aim to quell.  Gerresheimer, with 37 plants around the world, formed a crisis committee to manage and study the pandemic’s impact on each factory — from navigating lockdowns that blocked truck shipments in India, to testing 600 employees in one day at a plant in Germany. The company learnt how to isolate teams to protect them from outbreaks, while at the same time increasing shifts and staffing. Old machines meant to be replaced by newer lines were instead kept on, boosting production for the anticipated vaccine. “We are working 24 hours a day, seven days a week,” he said.

He expects that Gerresheimer will provide 2.5 to 3bn extra vials for the coronavirus vaccine, roughly a third of global demand. Gerresheimer has received orders from all the potential coronavirus vaccine producers, Mr Siemmsen said, and he anticipates that another vaccine candidate could emerge in the coming months. Already expanding before the pandemic, both Schott and Gerresheimer now look set to grow even faster. Schott has opened new production lines in India and China and is also investing in facilities in Germany and the US. Gerresheimer aims to invest more than €80m in further glass forming lines next year. Schott, Gerresheimer and Va-Q-Tec are rare examples of companies that have gained a boost from a pandemic that has plunged other sectors like aerospace and travel into crisis. Va-Q-Tec saw a big increase in sales of its containers earlier this year because they were ideal for shipping coronavirus test kits. “In the spring we transported more than half of all the test kits that were distributed internationally,” said Mr Kuhn. “We sent more than 20m of them to Brazil alone.” As a result, the company’s revenues grew by 13 per cent to €53m in the first nine months of 2020, and its share price has risen fivefold since the pandemic began. Va-Q-Tec is a typical example of the Mittelstand — the small and medium-sized companies that are the backbone of Germany’s economy, often making specialised products that enjoy huge export success. Progress on the vaccine front, Mr Kuhn said, has given a huge boost to business confidence in Germany. “It shows just how innovative the German Mittelstand is.”

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