The newly elected Iranian government led by President Ebrahim Raisi is facing demands to broaden its sources of vaccines as the country becomes engulfed by its fifth and most deadly wave of Covid-19. The supply of vaccines is said to be close to exhausted in Isfahan and Tabriz, as well as provinces including Gilan, Khuzestan and Mazandaran. Bahram Einollahi, the proposed minister of health in the Raisi administration, said he did not expect Iran to be fully vaccinated until next February, a slower timetable than once predicted by Raisi. He told the confirmation hearings in front of the Iranian parliament that this would require 120m doses of vaccine. Einollahi said the total number of delivered vaccines – predominantly Chinese – has reached 23 million people, but only just over 6 million have been vaccinated twice. Iran has a population of more than 85 million people, leaving the proportion of Iranians vaccinated way below other countries in the region, but Einollahi said 85% of the factors that affected health were outside the control of his ministry. He called for localisation of the management of the disease. The death toll in Iran has now reached 102,648, with a further 610 deaths announced on Monday, down from an all-time record of 684 on Sunday. New infections over the previous 24 hours slipped back from a record 50,228 on 17 August to 38,657 on Monday, but this fifth wave, under way since late June, is three or four times more deadly than anything that has afflicted the country before. This reflects the virulence of the Delta variant, the exhaustion of the Iranian people and the lack of vaccines. The daily death toll has at times reached the level of the Iran-Iraq war of the 1980s. Human Rights Watch in a report this week accused Iran of serial mismanagement. “Iranians are expressing their anger at the authorities’ incompetence and lack of transparency in controlling the Covid-19 pandemic, which is costing an Iranian life every few minutes,” said Tara Sepehri Far, Iran researcher at Human Rights Watch. “Public trust is a crucial factor in managing the public health crisis, yet Iranian authorities’ track record of repeated failure is happening again.” An attempt by human rights groups within Iran to take the government to court for mishandling the crisis has been blocked, and some of the instigators arrested. But in a speech to mark Iran “Doctor’s Day”, Mohammad Reza Zafarghandi, the head of the Iranian medical organisation, a non-governmental licensing body, criticised the slow vaccination process. “We are not in good shape. We would be better off today if we had vaccinated sooner and more widely,” he said. Part of the delay has been caused by the Iranian ban on the use of western vaccines, such as AstraZeneca, leaving Iran to wait for a domestic vaccine or supplies from Russia and China. By June it was clear that the Russian and Chinese supplies were not arriving in time. In February, the then health minister Saeed Namaki boasted that within two to three months Iran would be one of the most important centres for vaccine production in the region, a promise that is far from being met. There have also been generalised allegations of corruption inside the ministry of health, including how money set aside for a domestic vaccine – COVIran Barekat – had been spent. Hossein Salami, commander-in-chief of the Revolutionary Guards, continued to defend the government’s handling of the crisis, including the ban on western vaccines. “We don’t trust them … This is while they use biological weapons against our people, and we act based on principle of independence,” he said. He also said economic sanctions were making it difficult to purchase medicines. Kianoush Jahanpour, head of the health ministry’s public relations, was forced to deny on Monday reports that Iran was about to import 40m doses of vaccine through the UN-administered Covax scheme. He said on Twitter that Iran’s quota from the Covax mechanism was closer to 17m doses, adding that only 2.2m had been delivered. Critics of the government such as Zafarghandi have complained about the absence of deterrent fines on those who breach restrictions or quarantines, but Iran, faced with heavy US sanctions, argues that it is not in a position to restrict its workforce, who are desperate for income. Referring to the disputed published totals of coronavirus deaths in Iran, Zafarghandi said: “Patients [who] die without taking a test are not included in the statistics.” This leads to a difference between the official and hospital-derived statistics, he said. Health officials insisted the latest trend was downwards and predicted that the outbreak may be brought under control within 12 days. However, there are concerns that the Lambda strain, first reported in Peru, is reaching Iran. The head of the Corona Disease Management Operations Headquarters in Tehran, Dr Alireza Zali, warned that it was more infectious than other variants, probably more resistant to vaccines, and more virulent among children.