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Background: Vaccination has played a pivotal role in reducing the burden of COVID-19. Despite numerous studies highlighting its benefits in reducing the risk of severe disease and death, we still lack a quantitative understanding of how varying vaccination roll-out rates influence COVID-19 mortality. Methods: We developed a framework for estimating the number of avertable COVID-19 deaths (ACDs) by vaccination in Iran. To achieve this, we compared Iran's vaccination roll-out rates with those of eight model countries that predominantly used inactivated virus vaccines. We calculated net differences in the number of fully vaccinated individuals under counterfactual scenarios where Iran's per-capita roll-out rate was replaced with that of the model countries. This, in turn, enabled us to determine age specific ACDs for the Iranian population under counterfactual scenarios where number of COVID-19 deaths are estimated using all-cause mortality data. These estimates covered the period from the start of 2020 to 20 April 2022. Results: We found that while Iran would have had an approximately similar number of fully vaccinated individuals under counterfactual roll-out rates based on Bangladesh, Nepal, Sri Lanka, and Turkey (~ 65–70%), adopting Turkey's roll-out rates could have averted 50,000 (95% confidence interval: 38,100–53,500) additional deaths, while following Bangladesh's rates may have resulted in 52,800 (17,400–189,500) more fatalities in Iran. Surprisingly, mimicking Argentina's slower roll-out led to only 12,600 (10,400–13,300) fewer deaths, despite a higher counterfactual percentage of fully vaccinated individuals (~ 79%). Emulating Montenegro or Bolivia, with faster per capita roll-out rates and approximately 50% counterfactual full vaccination, could have prevented more deaths in older age groups, especially during the early waves. Finally, replicating Bahrain's model as an upper-bound benchmark, Iran could have averted 75,300 (56,000–83,000) deaths, primarily in the > 50 age groups. Conclusions: Our analysis revealed that faster roll-outs were consistently associated with higher numbers of averted deaths, even in scenarios with lower overall coverage. This study offers valuable insights into future decision-making regarding infectious disease epidemic management through vaccination strategies. It accomplishes this by comparing various countries' relative performance in terms of timing, pace, and vaccination coverage, ultimately contributing to the prevention of COVID-19-related deaths. [ABSTRACT FROM AUTHOR]

The Zayandeh-Rud River Basin in the central plateau of Iran continues to grapple with water shortages due to a water-intensive development path made possible by a primarily supply-oriented water management approach to battle the water limits to growth. Despite inter-basin water transfers and increasing groundwater supply, recurring water shortages and associated tensions among stakeholders underscore key weaknesses in the current water management paradigm. There was an alarming trend of groundwater depletion in the basin's four main aquifers in the 1993–2016 period as indicated by the results of the Mann-Kendall3 (MK3) test and Innovative Trend Analysis (ITA) of groundwater volume. The basin's water resources declined by more than 6 BCM in 2016 compared to 2005 based on the equivalent water height (EWH) derived from monthly data (2002–2016) from the GRACE. The extensive groundwater depletion is an unequivocal evidence of reduced water availability in the face of growing basin-wide demand, necessitating water saving in all water use sectors. Implementing an integrated water resources management plan that accounts for evolving water supply priorities, growing demand and scarcity, and institutional changes is an urgent step to alleviate the growing tensions and preempt future water insecurity problems that are bound to occur if demand management approaches are delayed. [ABSTRACT FROM AUTHOR]

The anthropogenic impacts of development and frequent droughts have limited Iran's water availability. This has major implications for Iran's agricultural sector which is responsible for about 90% of water consumption at the national scale. This study investigates if declining water availability impacted agriculture in Iran. Using the Mann‐Kendall and Sen's slope estimator methods, we explored the changes in Iran's agricultural production and area during the 1981–2013 period. Despite decreasing water availability during this period, irrigated agricultural production and area continuously increased. This unsustainable agricultural development, which would have been impossible without the overabstraction of surface and ground water resources, has major long‐term water, food, environmental, and human security implications for Iran. Plain Language Summary: Given the heavy reliance of the agricultural sector on water availability, it is important to examine if Iran's agriculture has been impacted by water availability changes in recent decades. The investigation of the long‐term impacts of natural water availability changes on agricultural activities in the country during the 1981–2013 period revealed that the agricultural sector in Iran continued to expand regardless of decreasing water availability in the country. This expansion was facilitated by the excessive use of nonrenewable water resources which has significant environmental and socioeconomic implications. Key Points: Trends in Iran's agricultural production and area did not follow natural water availability changes due to meteorological variabilityIran's agricultural production continuously increased despite water availability reduction during 1981–2013The unsustainable growth of Iran's agriculture has important water, food, environmental, economic, and human security implications [ABSTRACT FROM AUTHOR]

Lake Urmia in northwest Iran, once one of the largest hypersaline lakes in the world, has shrunk by almost 90% in area and 80% in volume during the last four decades. To improve the understanding of regional differences in water availability throughout the region and to refine the existing information on precipitation variability, this study investigated the spatial pattern of precipitation for the Lake Urmia basin. Daily rainfall time series from 122 precipitation stations with different record lengths were used to extract 15 statistical descriptors comprising 25th percentile, 75th percentile, and coefficient of variation for annual and seasonal total precipitation. Principal component analysis in association with cluster analysis identified three main homogeneous precipitation groups in the lake basin. The first sub-region (group 1) includes stations located in the center and southeast; the second sub-region (group 2) covers mostly northern and northeastern part of the basin, and the third sub-region (group 3) covers the western and southern edges of the basin. Results of principal component (PC) and clustering analyses showed that seasonal precipitation variation is the most important feature controlling the spatial pattern of precipitation in the lake basin. The 25th and 75th percentiles of winter and autumn are the most important variables controlling the spatial pattern of the first rotated principal component explaining about 32% of the total variance. Summer and spring precipitation variations are the most important variables in the second and third rotated principal components, respectively. Seasonal variation in precipitation amount and seasonality are explained by topography and influenced by the lake and westerly winds that are related to the strength of the North Atlantic Oscillation. Despite using incomplete time series with different lengths, the identified sub-regions are physically meaningful. [ABSTRACT FROM AUTHOR]

Iran is currently experiencing serious water problems. Frequent droughts coupled with over-abstraction of surface and groundwater through a large network of hydraulic infrastructure and deep wells have escalated the nation's water situation to a critical level. This is evidenced by drying lakes, rivers and wetlands, declining groundwater levels, land subsidence, water quality degradation, soil erosion, desertification and more frequent dust storms. This paper overviews the major drivers of Iran's water problems. It is argued that while climatic changes and economic sanctions are commonly blamed as the main drivers of water problems, Iran is mainly suffering from a socio-economic drought—i.e. "water bankruptcy," where water demand exceeds the natural water supply. In theory, this problem can be resolved by re-establishing the balance between water supply and demand through developing additional sources of water supply and implementing aggressive water demand reduction plans. Nevertheless, the current structure of the water governance system in Iran and the absence of a comprehensive understanding of the root causes of the problem leave minimal hope of developing sustainable solutions to Iran's unprecedented water problems. [ABSTRACT FROM AUTHOR]

Within river basins different social, economic, political and physical subsystems interact. When making decisions, policy makers should be aware of such interactions as any new policy will affect more than one subsystem. To determine the adequacy of a specific management policy, an integrated study is needed of a complicated water management system in the basin considering major physical, social, economic and political aspects. The Zayandeh-Rud river basin, in central Iran with a semi-arid climate and large agricultural, industrial and domestic water uses, is an example of a complicated watershed system where the lack of complete knowledge about all the interacting subsystems has led to failure of the policymakers in addressing the water shortage in the basin. Although water shortages occur fairly soon after completion of each new water source, transbasin water diversion is still the major policy of water planners to address ongoing shortages. System dynamics provides a unique framework for integrating the disparate physical, socio-economic and political systems important to watershed management. This approach is used to comprehend the interactions of different drivers of the problem and to convey the experiences, lessons learned, and perceptions gained during the model development process. A simulation model, built based on causal loop diagrams of the problem, shows that transbasin diversion is not the best and only solution to the problem. The results of the model for different scenarios suggest that various options of demand management and population control can be more effective in addressing the water crisis of the basin when combined with transbasin water diversions, increasing water storage capacity and controlling of groundwater withdrawal. [ABSTRACT FROM AUTHOR]

This paper presents the first groundwater‒energy‒food (GEF) nexus study of Iran's agronomic crops based on national and provincial datasets and firsthand estimates of agricultural groundwater withdrawal. We use agronomic crop production, water withdrawal, and energy consumption data to estimate groundwater withdrawal from electric-powered irrigation wells and examine agronomic productivity in Iran's 31 provinces through the lens of GEF nexus. The ex-post GEF analysis sheds light on some of the root causes of the nation's worsening water shortage problems. Access to highly subsidized water (surface water and groundwater) and energy has been the backbone of agricultural expansion policies in Iran, supporting employment in agrarian communities. Consequently, water use for agronomic crop production has greatly overshot the renewable water supply capacity of the country, making water bankruptcy a serious national security threat. Significant groundwater table decline across the country and increasing energy consumption underscore dysfunctional feedback relations between agricultural water and energy price and groundwater withdrawal in an inefficient agronomic sector. Thus, it is essential to implement holistic policy reforms aimed at reducing agricultural water consumption to alleviate the looming water bankruptcy threats, which can lead to the loss of numerous agricultural jobs in the years to come. [ABSTRACT FROM AUTHOR]

Highlights: [•] Assessment of water transfer as a solution to water shortages in central Iran. [•] Developing a system dynamics model for the Zayandeh-Rud River Basin. [•] Understanding the casual relationship between different components of the problem. [•] Identifying the main driver of water shortages in the basin. [•] Providing policy insights based on the Fixes that Backfire system archetype. [Copyright &y& Elsevier]

Abstract: This study evaluates climate change impacts on crop production and water productivity of four major crops (wheat, barley, rice, and corn) in Iran''s Zayandeh-Rud River Basin. Multi-model ensemble scenarios are used to deal with uncertainties in climate change projections for the study period (2015–2044). On average, monthly temperature will increase by 1.1 to 1.5°C under climate change. Monthly precipitation changes may be positive or negative in different months of the year. Nevertheless, on the annual basis, precipitation will decrease by 11 to 31% with climate change. While warming can potentially shorten the crop growth period, crop production and water productivity of all crops are expected to decrease due to lower precipitation and higher water requirements under higher temperature. Out of the four studied crops, rice and corn are more vulnerable to climate change due to their high irrigation water demand. So, their continued production can be compromised under climate change. This finding is of particular importance, given the locally high economic and food value of these crops in central Iran. [Copyright &y& Elsevier]

Understanding the complexity and feedbacks among food, energy, and water (FEW) systems is key to making informed decisions about sustainable development. This paper presents qualitative representation and quantitative system dynamics simulation of the water resources system in the Qazvin Plain, Iran, taking into account the energy intensity of water supply and interconnected water use sectors (e.g., urban, industrial, and agricultural). Qazvin Plain faces water resources challenges that are common to arid/semi-arid areas, including frequent droughts, declining surface water and groundwater, and increased urban and agricultural water demand. A system dynamics model is developed using historical data (2006–2016) to investigate the effects of anticipated dynamics of integrated water and energy sectors in the next two decades. The results of policy scenarios (2020–2039) demonstrate that the continuation of the existing management policies will cause severe damage to the water and energy sectors, pushing the system towards water resources limits to growth. An annual groundwater table decline of nearly 1 m is anticipated, indicating significant overshoot of the plain's natural recharge capacity, which may lead to the depletion of recoverable groundwater in the plain within the next three decades. The groundwater table decline will cause energy consumption of water supply to increase by about 32% (i.e., 380 GWh) to maintain irrigated agriculture. It is critical to implement a combination of water demand and supply management policies (e.g., net agricultural water savings and recycling treated wastewater) to delay the problem of water limits to growth in the region. • We present a system dynamics of model integrated water and energy sectors in an agricultural region. • The model facilitates evaluation of water management policies using a food-energy water nexux approach. • Policies that facilitate net agricultural water savings and water reuse can delay groundwater depletion. [ABSTRACT FROM AUTHOR]

Understanding the climatic and direct human drivers of abrupt drying of lakes in many parts of the world is a high research priority, particularly for water resources management and restoration. Lake Urmia, a shallow endemic lake in north-west Iran and one of the major saltwater bodies on earth, has undergone a dramatic decline in its water level (WL) in the past decades, resulting in about 80% of loss in the lake's water content. Different explanations have been discussed regarding the primary cause of this WL decline, including climate change, and regional human-driven land- and water-use changes. This paper reports a comprehensive study of the possible primary drivers of the lake's desiccation. Using classical exploratory statistical methods, the analysis accounts for the relationships between climate change (precipitation P, temperature T), land-surface and hydrological evolution (soil moisture SM, and WL), and vegetation cover (VC) change in the region. The latter includes human-driven changes of irrigation and expansion of agricultural lands. Observations over the period 1981-2015 indicate that the observed variability in P, T, and SM cannot explain the sharp decline in the lake WL since 2000. Instead, land-surface analysis shows VC was nearly doubled after 2000 in the Lake Urmia watershed, indicating that the WL decline is mainly associated with human-driven agricultural increase of VC. The expansion of agricultural activities in the watershed has led to increasing transpiration and hence, total evapotranspiration, decreasing the runoff during the increase in VC (inherently including irrigation, storage, and water diversion). Our results are consistent with similar cases around the world identifying human activities and interventions as the main driver of hydrologic changes, while climate change will likely increasingly contribute to such changes and their impacts in the future. [ABSTRACT FROM AUTHOR]

Global groundwater assessments rank Iran among countries with the highest groundwater depletion rate using coarse spatial scales that hinder detection of regional imbalances between renewable groundwater supply and human withdrawals. Herein, we use in situ data from 12,230 piezometers, 14,856 observation wells, and groundwater extraction points to provide ground-based evidence about Iran's widespread groundwater depletion and salinity problems. While the number of groundwater extraction points increased by 84.9% from 546,000 in 2002 to over a million in 2015, the annual groundwater withdrawal decreased by 18% (from 74.6 to 61.3 km 3 /y) primarily due to physical limits to fresh groundwater resources (i.e., depletion and/or salinization). On average, withdrawing 5.4 km 3 /y of nonrenewable water caused groundwater tables to decline 10 to 100 cm/y in different regions, averaging 49 cm/y across the country. This caused elevated annual average electrical conductivity (EC) of groundwater in vast arid/semiarid areas of central and eastern Iran (16 out of 30 subbasins), indicating "very high salinity hazard" for irrigation water. The annual average EC values were generally lower in the wetter northern and western regions, where groundwater EC improvements were detected in rare cases. Our results based on high-resolution groundwater measurements reveal alarming water security threats associated with declining fresh groundwater quantity and quality due to many years of unsustainable use. Our analysis offers insights into the environmental implications and limitations of water-intensive development plans that other water-scarce countries might adopt., Competing Interests: The authors declare no competing interest., (Copyright © 2021 the Author(s). Published by PNAS.)

Being the second-largest country in the Middle East, Iran has a long history of civilisation during which several dynasties have been overthrown and established and health-related structures have been reorganised. Iran has had the replacement of traditional practices with modern medical treatments, emergence of multiple pioneer scientists and physicians with great contributions to the advancement of science, environmental and ecological changes in addition to large-scale natural disasters, epidemics of multiple communicable diseases, and the shift towards non-communicable diseases in recent decades. Given the lessons learnt from political instabilities in the past centuries and the approaches undertaken to overcome health challenges at the time, Iran has emerged as it is today. Iran is now a country with a population exceeding 80 million, mainly inhabiting urban regions, and has an increasing burden of non-communicable diseases, including cardiovascular diseases, hypertension, diabetes, malignancies, mental disorders, substance abuse, and road injuries., (Copyright © 2019 Elsevier Ltd. All rights reserved.)