Aid and human rights organizations fear that the COVID-19 vaccine could become a tool for governments, rebel groups and other fighters involved in conflicts in the Middle East to advance their own goals.
Using vaccines this way "is a form of indirect, passive biological warfare," Annie Sparrow, a public health expert at the Icahn School of Medicine at Mount Sinai, in New York, told DW.
Tt has happened before and it was very deliberate.
Near the beginning of the Syrian civil war, in 2013, a disease the world had mostly eradicated broke out in Deir ez-Zour. The country officially eliminated polio in 1995. But medical researchers say that in 2012, Bashar al-Assad's government deliberately excluded the area, controlled by fighters who oppose it, from earlier routine vaccination drives.
"This was a man-made outbreak," Sparrow wrote at the time.
There are fears the same sort of thing might happen with COVID-19 vaccines.
Human Rights Watch is also concerned about the politics of supplying vaccines to Syria.
"We have significant concerns for several reasons," Sara Kayyali, a Syria expert at Human Rights Watch, said. Kayyali explains that current and potential closures of border crossings nearest opposition-held areas, where millions of civilians still live, mean that international aid agencies will need permits from the al-Assad government to bring vaccines in. If they can get permits, they will most likely have to travel through Damascus. And this, Kayyali noted, "involves significant restrictions. The Syrian government is being difficult to make sure that there is dependency on them," the researcher explained. "This is no surprise. We have seen them use aid to really punish people before."
A 2020 report by the US organization, Physicians for Human Rights, on healthcare in the Syrian region of Daraa, noted that the al-Assad government kept blacklists, whereby aid was denied to families considered disloyal to the government.
Elsewhere in the Middle East, other groups in disputes are also using the COVID-19 vaccine for their own ends.
Healthcare as a victim of, or tool in, conflict is nothing new, said Leonard Rubenstein, a professor at the Johns Hopkins Bloomberg School of Public Health in Baltimore. "It's just that more attention is being paid to it now," Rubenstein told DW. "One of the examples is what is happening in Israel."
Israel has been the fastest in the world to vaccinate its population. It has sent COVID-19 doses hundreds of kilometers to illegal Israeli settlements in the West Bank but has refused to help vaccinate over 2.7 million Palestinians living around them. Instructions were given in the Israeli prison system that Palestinian prisoners were not to be vaccinated either. The Oslo Accords also contain a phrase that says the two parties should cooperate to combat "epidemics or contagious diseases." Additionally, international humanitarian law says that an occupying power must take responsibility for the healthcare of the occupied.
In Yemen, COVID-19 vaccines will arrive in April or May. The amount delivered may only cover 20% of the population but the government says it will distribute doses in areas controlled by the rebel Houthi organization, with whom it is fighting, too. The Houthis control the most populated central and northern parts of Yemen. However, the Houthi rebels have been antagonistic toward aid organizations. Blockades of vaccination campaigns and disinformation are thought to be responsible for a late-2020 polio outbreak in Houthi-controlled areas. Religious leaders have told locals not to use "vaccines made by Jews and Christians".
Public health expert Sparrow doesn't doubt that different parties to various regional conflicts might try to use the COVID-19 vaccine to advance their own agendas. "I don't think that you can have any naivete about how governments will use these vaccinations," she told DW. "But what is stupid is that by not giving people a shot in the arm, governments are shooting themselves in the foot. You cannot actually protect your country unless you vaccinate everybody, at the same time."
Sparrow explains that the more a population remains unvaccinated, the more opportunity a virus has to mutate. Those mutations may eventually be able to re-infect people who have already been vaccinated if the virus isn't taken out of circulation, she said.
"The virus doesn't care whether you are Palestinian or Israeli," Sparrow concludes. "It's only job is to infect and evolve."
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