Throughout history, many political changes have been deeply influenced by medical crises.  Consider the beginning of Homer’s Iliad, where a plague threatened King Agamemnon’s  leadership.¹ In the Middle Ages, plagues overthrew sovereign powers of Islamic civilization.² In  19th-century Iran, a cholera pandemic had a devastating impact on the Qajar state.³⁴ As Hormoz  Ebrahimnejad argues, the necessity for controlling epidemics led to the institutionalization of  modern medicine in Iran, along with vaccination and sanitary councils,⁵ which ultimately gave rise  to new political institutions such as a parliament during the Persian Constitutional Revolution.⁶ 

The recent COVID-19 pandemic had similar impacts on Iran’s politics. Shortly after the pandemic’s  deadliest peak⁷, the Mahsa Amini protests (also known as the Zhina movement) broke out in Iran on September 16, 2021. After Mahsa Amini (Zhina) died during her arrest by the morality police  for allegedly violating hijab laws, a widespread revolt against Iran’s state started and lasted for months. While these protests have been extensively analyzed from political and social  perspectives, the role of the pandemic as a contributing factor has been largely overlooked. 

Even before the pandemic, Iranians were deeply dissatisfied with their government, but the crisis  further intensified their discontent with both its domestic and foreign policies. While many  governments were vaccinating their populations, Iran lagged in importing vaccines. Although sanctions may have contributed to the delay⁸, many viewed them as a consequence of the government’s misguided foreign policies. In addition, domestic policies further restricted access to vaccines—for example, in January 2021, some Iranian authorities publicly opposed importing vaccines from developed countries.⁹ Although domestically produced vaccines were approved in June 2021¹⁰, their efficacy and safety remained controversial in public opinion.¹¹ Thus, the Iranian government failed in its basic Hobbesian duty: not only by delaying vaccine imports but also by mismanaging the crisis, ultimately failing to protect its people from death.¹² 

During the deadliest peaks, the state’s inability to manage the crisis fostered a collective sense  among the people that they shared the same fate with their inept government. This failure also  sparked growing interest in libertarian political philosophy. Many Iranians actively promoted  reducing the size of government and criticized big states as the root of all economic problems. Two weeks before the Zhina movement began, Ludwig von Mises’s Liberalism (1927) was printed for the fifth time in just one month.¹³ While people in other countries sought to expand government support for healthcare, many Iranians argued that only the free market could effectively produce and distribute vaccines. 

Over the course of the pandemic, as most people studied and worked from home, the state lost its  control over personal lifestyles in workplaces and universities. The Iranian government temporarily retreated from interference, unintentionally creating a “negative freedom” in Berlin’s sense of the term.¹⁴ As a result, many became accustomed to not wearing hijab while attending online classes or working from home. When quarantine ended, the government resumed strict hijab enforcement, but these restrictions now felt more oppressive than ever, making people less willing 

to comply. Additionally, increased exposure to diverse perspectives on social media led many with  traditional mindsets—who had once supported mandatory hijab—to shift toward supporting  women’s freedom of choice. 

Many people also developed empathy through caring for sick family members at home throughout the pandemic. When they saw pictures of 22-year-old Mahsa Amini in a coma, lying in a hospital  bed due to head trauma, they deeply empathized with her—not as someone suffering from a viral  disease, but as a victim of state oppression. 

Due to quarantine, many had not gathered publicly for two or three years. When the protests  erupted, people were eager for collective action. Many publicly expressed solidarity with the  movement. Even doctors and nurses who did not join the protests in the streets supported it by  treating injured protesters in their homes. Additionally, the widespread use of face masks (initially  for health reasons) became a practical tool for protesters, allowing them to hide their identities  from the police, further encouraging participation. 

These factors suggest that the pandemic acted as an accelerating agent for the Zhina movement in Iran. The logic of linking medicine with political movements can also help explain other uprisings in the Middle East. For instance, in the Arab Spring, Egyptian doctors played significant roles in  both the 2011 and 2016 revolutions.¹⁵ Future studies could re-examine other revolutions, analyzing  the roles of medical crises, healthcare professionals, and medical knowledge in shaping them.  Given current trends, the next revolution in Iran may begin with a shortage of essential drugs and  the collapse of the national healthcare system. 

Endnotes: 

1 “Zeus’ son and Leto’s, Apollo, who in anger at the king drove the foul pestilence along the host,  and the people perished.” Homer. The Iliad of Homer. The University of Chicago Press, 1951, p.  59. 

2 “Along with other unfavorable demographic factors, plague helped to destroy the most abundant  resource of the Mamluk Sultanate.” Dols, Michael W. The Black Death in the Middle East.  Princeton UP, 1977, p. 282. 

3 Floor, Willem. Public Health in Qajar Iran. Mage, 2004. 

4 Nategh, Homa. “The Social and Economic Impact of Cholera in Qajar Iran” [in Persian]. Tarikh,  vol. 1, no. 2, 1977, pp. 30–62. 

5 “In 1867, when a plague epidemic spread among Iraqi cities bordering Iran, the Ottoman Pasha  of Baghdad established quarantine to prevent the movement of pilgrims… Later, sanitary councils 

trained medical officers (hâfez al-sehheh), who were sent across the country. At the beginning,  their duties consisted of informing the central Sanitary Council in Tehran, but gradually they  formed the nucleus of health centers in each province” p. 102. Also: “This medical modernization  was embedded in political, administrative and institutional transformations mainly aimed at  military reform. As a result, conceptual transformation in medicine took place within the  framework of institutional and political reforms” p. 163. Ebrahimnejad, Hormoz. Medicine in Iran:  Profession, Practice and Politics, 1800-1925. Palgrave Macmillan, 2013, pp. 102 & 163. 

6 Heydari, A. The Inverted Reading of Iranian Despotism [in Persian]. Mania Honar, 2019, p. 165. 

7 August 2021 was the deadliest month for COVID-19 in Iran, with a peak in daily fatalities.  However, Since September 2021, the number of deaths began to decline, signaling a significant  reduction in the severity of the pandemic. “Coronavirus in Iran.” Worldometers, https://www.worldometers.info/coronavirus/country/iran/. Accessed 12 Mar. 2025. 

8 Heidari, Mohammad, and Hamid Jafari. “Challenges of COVID-19 Vaccination in Iran: In the  Fourth Wave of Pandemic Spread.” Prehospital and Disaster Medicine, vol. 36, no. 5, 2021, pp.  659-660. 

9 Wintour, Patrick. “Iran Bans Importation of Covid Vaccines from the US and UK.” The  Guardian, 8 Jan. 2021, https://www.theguardian.com/world/2021/jan/08/untrustworthy-covid vaccines-from-us-and-uk-banned-by-iran. 

10 COVIran Barekat.” Wikipedia: The Free Encyclopedia, Wikimedia Foundation, https://en.wikipedia.org/wiki/COVIran_Barekat. Accessed 12 Mar. 2025. 

11 Torbati, Yeganeh. “Amid Covid Surge, Iran Cut Corners to Approve Yet-Unproven Vaccine.” The Washington Post, 20 Aug. 2022, https://www.washingtonpost.com/world/2022/08/20/iran covid-vaccine-approval/. 

12 In Leviathan, death is a metaphor for civil war, and the main reason for constituting a state is to  prevent it. Hobbes, Thomas. Leviathan. Oxford UP, 2008, p. 7. 

13 Tadayoni, M. “The Fifth Edition of the Book Liberalism [in Persian].” 31 Aug. 2021. Accessed  9 Feb. 2025, https://t.me/tarikhandishi/2110. 

14 Berlin, Isaiah. Liberty. Oxford UP, 1969, p. 169. 

15 Bayoumi, Sherine, and Sherine Hamdy. “Nationalism, Authoritarianism, and Medical  Mobilization in Post-Revolutionary Egypt.” Culture, Medicine, and Psychiatry, vol. 47, no. 1,  2023, pp. 37–61.