Identifying strategies to reduce the COVID-19 burden in Iran: insights for future preparedness

The COVID-19 pandemic exposed critical gaps in healthcare systems and underscored the need for effective strategies to mitigate its burden. Understanding lessons learned from local experiences can inform future pandemic preparedness. This study aimed to explore context-specific strategies implemented in Iran to reduce the impact of COVID-19 and provide insights applicable to future health emergencies. A qualitative study was conducted between July 2023 and February 2024 in five major Iranian cities (Tehran, Shiraz, Isfahan, Mashhad, and Kerman). Data were collected through 28 semi-structured interviews with healthcare managers, hospital administrators, frontline workers, policymakers, and infectious disease specialists, recruited using purposive sampling with maximum variation. Interviews were audio-recorded, transcribed verbatim, and analyzed using conventional content analysis based on Graneheim and Lundman. MAXQDA 2022 software supported data management and coding. Trustworthiness was ensured through credibility, transferability, dependability, and confirmability criteria. Analysis revealed eight main themes and 38 subthemes encompassing a broad range of pandemic mitigation strategies. These included preparedness planning (e.g., early risk assessment, vaccination readiness), organizational coordination (e.g., interdepartmental collaboration, crisis task forces), resource management (e.g., ICU optimization, supply chain efficiency), communication strategies (e.g., transparent reporting, public awareness campaigns), workforce support (e.g., mental health interventions, recognition programs), community engagement (e.g., volunteer mobilization, home care support), policy adaptation (e.g., flexible regulations, cross-sector collaboration), and innovation (e.g., telemedicine, mobile testing, digital health tools). Illustrative participant quotes highlighted both successes and challenges in implementation. Findings demonstrate that a multifaceted, coordinated approach, integrating preparedness, effective communication, community participation, and innovation, is essential to mitigate pandemic burden. Insights from this study can inform evidence-based policy, strengthen health system resilience, and guide strategic planning for future public health emergencies.