A hardline act to follow: Iran’s presidential election

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Hello and welcome to the Intelligence on Economist Radio. I'm your host, Jason Palmer. Every weekday we provide a fresh perspective on the events shaping your world. Some of the trickiest cases of COVID 19 occur in patients who don't produce their own antibodies to lock onto the coronavirus. Now an antibody therapy has been shown to save those lives, suggesting that other seemingly failed drugs need revisiting. And a style of folk music in Norway that had been in terminal decline is experiencing something of a revival. It's not just people getting back to their cultural roots. The pandemic has driven a sense of community that the tunes always provided. But first, Iran's Supreme Leader, Ali Khamenei is imploring citizens to go to the polls tomorrow to vote for their next president. It might seem that they're being offered a real choice, a say in the direction their country goes in. They know better. Hardline clerics are in the ascendant mountain. Moderate or reform minded types are in short supply on the ballot. Mr. Khamenei lambasted what he called the satanic centers of power in the world as the malign force in the election. But it's the consolidation of hardline theocratic power that he himself is engineering that will keep voters at home.

There have never really been free elections in the Islamic Republic since the revolution in 1979.

Nicholas Pelham is the Economist's Middle east correspondent.

Clerics wield ultimate authority and candidates can be disqualified for the flimsiest of reasons. Elections are highly orchestrated affairs. Even by these standards, though, tomorrow's presidential election is shaping up as a farce.

How so? How is this one worse than previous ones?

Well, nearly 600 candidates applied to replace Hassan Rouhani, the current president. The Guardian Council, a group of clerics and lawyers who vet candidates, allowed just seven on the ballot. And that Karl has removed any serious challengers who favour Better economic and political ties with the West. Mr. Khamenei, the supreme leader, could have overruled the council and added more candidates to drum up enthusiasm, but he chose not to. Instead, the regime has put all its effort into making one candidate the president. This is not meant to be an election. In other words, it's rather a coronation.

So who is the one candidate that's essentially going to be crowned?

The favorite is Ibrahim Raisi. He's the head of the judiciary and a staunch hardliner. He helped orchestrate the mass execution of political prisoners back in the 1980s. And at every step of the way, he's been supported by Ayatollah Ali Khamenei, the supreme leader. He was the only plausible challenger to Rouhani's second term back in the 2017 election. Against that, you have a couple of other hardliners who've been around and on the scene for several decades. The only other challenger that you have who can claim to be something of a moderate is Abdel Nasser Hammati. He was governor of the Central bank until just last month. And his claim to fame is really that he's kind of presided over a collapse of the Iranian rial, which has seen Iranian savings plummet. And the only other reformist, Mohsen Mehr Ali Zadeh, withdrew from the race on Wednesday, apparently in order to try and kind of rally support behind Mr. Hammerty and not split the moderate vote.

And how are the Iranian people reacting to what appears to very much be a rigged vote?

I mean, the disillusion this time around, it's really striking. In the past, the regime has been quite successful at kind of getting out the vote by stirring some degree of debate from within the system. They failed to do that this time. Most Iranians have been steadily losing faith in the system, and reformists included. Mr. Rouhani's eight years in office have brought economic decline and scant social change. And many Iranians, I think, are just going to stay at home. And the turnout is likely to be the lowest in Iran's history.

So if Mr. Raisi is elected as expected, what does that mean then, for the regime?

For Iran, it's quite a dramatic shift. In the past, the regime has cared a lot about getting out the vote. It has seen elections in the past as a kind of sign of popular legitimacy. And it likes to present this kind of face to the world of a theocracy with a democracy attached. And I just think there's something so fundamentally shifting this time around, where democracy seems to be less important. You're seeing a shift in some sense away from a sort of Islamic Republic to a more kind of hardcore Islamic government. In the short term, it's going to mean that if Raisi does win, there'll be a break from the reform agenda headed by Rouhani and his foreign minister, Mohammad Javad Zarif. And you're going to see a much more top down system of government, sort of less flexibility in which the Supreme Leader is calling the shots and writing his legacy. I think Iranians are worried about what this is going to mean, for what freedom of expression they have.

Well, that's the point. The mix of democracy and theocracy that Iran has had seems to be at real risk here. The hardliners are very much on the up. What's changed?

I think kind of really when push comes to shove in Iran, you do have a pyramid structure of power. And at the top of that is Ali Khamenei, the Supreme Leader. And this is really his vision, not just for the next kind of four years of the presidency, but for the future of the Islamic Republic. He does see the outside world as a threat. He does believe that ultimately Western powers are working for regime change, whether sort of openly or by stealth. And he is nervous that the nuclear deal is going to kind of open the door to kind of Western influence in Iran. And he's trying to adopt a defensive strategy in which the regime, regime is kind of protected by those he trusts and by his acolytes. I don't think he's risk averse and he wants to ensure that this regime survives his death. At the same time, he knows that economically Iran is in a really bad place. If there is to be a nuclear deal, he wants it to be as controlled as possible. He does want to see an easing of sanctions, but he wants to ensure that the structures of power and those who control the levers of power and the economy remain unchanged.

Well, that said, what would Mr. Wricey's election do on the international scene?

It's likely that his script is going to be written by the Supreme Leader, Ali Khamenei. In the past he has described the west as the enemy. But I think if Ali Khamenei does decide that he wants to have a nuclear deal, then Mr. Raisi will oblige. And I guess you're going to see kind of more tensions with European powers. There is a redness with the Biden administration for the west to try and re engage with Iran. And I think you're going to have people in the presidency who are Much more cautious about that sort of engagement that the west would like to see. So even if you get a deal, it's going to be a kind of a fraught process of implementation.

And what do you think this will mean for the region more broadly? Iran being involved in lots of conflict around the region, proxy wars and so on?

I mean, it was notable that kind of there was outreach under the Rouhani presidency for better ties with Saudi Arabia, particularly towards the end of his term. I just think you're going to see a kind of more defensive presidency, which means that it'll probably double down on what leverage it has militarily in the region. That will mean kind of cementing its positions in the Middle East. It'll mean reinforcing the irgc, the Islamic Revolutionary Guard Corps, and kind of working with groups that Iran likes to call the resistance. So the Houthis in Yemen, its allies in Iraq, with the Assad regime in Syria, with Hezbollah in Lebanon. This is really about seeing kind of the hard line conservative core of the regime ensure its survival internally. And that will mean projecting itself across the region as well.

Nicholas, thanks very much for your time.

Thank you, Jason. Always a pleasure.

What the body needs to fight off pathogens are antibodies, the immune system's soldiers. Each dedicated to a particular foe. The body should produce them when exposed to the coronavirus or to a coronavirus vaccine. The hunt for COVID 19 therapies has included several so called monoclonal antibodies. A shortcut of growing those proteins in the lab and delivering them directly into the bloodstream. But several clinical trials had found scant benefit from such treatments until this week.

Yesterday we heard an antibody therapy from the pharma firm Regeneron improves the survival of some COVID 19 patients in hospital.

Natasha Loder is the Economist's health policy editor and host of our sister show the Jab.

It reduced the chances of death by about a fifth. But this was only in patients who were not raising their own antibodies. And this finding really offers a lot of renewed hope for the treatment of those who are most seriously ill with the disease.

So what exactly is the drug? How does it work?

The drug's called regen CoV and it's actually a combination of two different monoclonal antibodies. Antibodies are proteins. They're immune system components that disable pathogens like viruses. They lock onto them in a very specific place and they prevent the virus from binding into cells and infecting them. And these two antibodies are cooked up in a lab and then used as an infused drug and using Two antibodies reduces the risk of the virus evolving resistance to the treatment. Now, the drug isn't new. President Trump was actually treated in hospital with this drug. But this is really the first evidence that it can be used in hospital to save lives. And the other really useful thing is that it highlights a group of patients that are likely to benefit from these really expensive therapies. And so while we've been exploring monoclonal antibodies for treating Covid for some time, the problem is, is that you often have to give them to lots and lots and lots of people before you see any benefit. And from an economic perspective, that doesn't work.

So you say it's shown to be effective, but how so and for whom?

When you have patients who are not making antibodies to COVID 19 and they turn up in hospital, this drug looks like it's going to sa about one in five of them. Now, these antibody negative patients made up about a third of the 10,000 hospital patients that were in this study. And the study looked at the antibody therapy when it was given alongside standard treatments, that would be either the steroid dexamethasone or for the sickest, an anti inflammatory known as tozalizumab. And people who were given the antibody therapy were compared to people who were just given the standard of care. So they got all the other normal treatments, but they didn't get the antibody therapy. And so that's how they're able to compare the two groups. And they know that 20% more patients survived. And the drug also reduced the median length of hospital stay by four days. And so that was down from 17 days to 13 days. So this drug is well worth having at a number of levels. And then, you know, the question to my mind this all raises is, could we catch some of these patients before they end up in hospital? And so if we have patients who are languishing at home with COVID 19, I do wonder whether it might be worth offering them a cheap lateral flow test to find out which ones are not mounting an immune response kind of earlier in the progress of the disease.

So this is particularly good news then for that subset of people who aren't making antibodies?

Yes, and we can also now look at some of the antibody therapies that have failed in trials and ask whether they were being given to a much more broad set of patients and not being able to demonstrate their benefit. And so Eli Lilly's antibody therapy failed to provide a benefit to hospital patients, but they looked at all hospital patients. And what this study showed us is that it's only the subset that benefit. And then similarly, we heard this week that a drug from AstraZeneca was also disappointing when it was given to everybody who had been exposed to the virus. And so now we know that this is helping the seronegative patients, then this opens up the possibility that there are other antibody therapy drugs that may also work.

And is there anything standing between this drug and it getting around the world into the hands of patients who need it?

Well, in some countries the regulators will need to come up with some kind of emergency authorization for use. That includes Britain. Some countries already have done that, such as America, Brazil and Canada and some others. But even if authorisation follows, access is going to be extremely restricted to this drug globally, and that's even in wealthy countries. Monoclonal antibody therapies are not widely available globally. So if you are in a low income country or a middle income country, you're going to struggle to get any kind of drug that is like this. And that's because they're expensive to make. They're biological products, much like vaccines, as it happens. They're not small molecule drugs like dexamethasone, which can be really cooked up quickly and easily in a vat. So that's why historically these drugs have really been only made and used in wealthy countries. And Regenkov costs many thousands of dollars for and there's not a lot of it in the world at the moment. America and Germany have brought up large supplies earlier this year and if we start thinking about how we can make more of it, that is somewhat challenging given the sort of constraints we have at the moment on vaccine making, which uses a lot of the same equipment.

So do you think those problems can.

Be overcome in the short term? Increasing the capacity to produce this drug and other monoclonal antibodies like it could be constrained. But as we look further into the future, it's possible we could invest now in establishing more facilities around the world and increasing our production of what we need to make them. We can make more of these drugs. It's just a question of investment and having the will to do so. I think what studies like this show is the power of these monoclonal antibody drugs and the need to have factories that are able to make them all around the world at affordable prices is only going to increase as time goes on. So now is a really good time to think about how we can improve access to this class of drugs globally.

Natasha, thank you very much for your time.

You're welcome. Jason.

Satisdal is a winding valley to the north of Kristiansand in southern Norway. It's a verdant place full of tumbling waterfalls and idyllic little meadows. And it's a place of great folk traditions, music, dance and poetry.

Guy Kiddie writes about Europe for the Economist.

The music is characterized by violins, juice, harps, accordions as well. It's the kind of music that people would play at parties and have played at parties and celebrations and any community event for centuries, from birth to death and every step in between. But very sadly, this whole tradition is under threat.

Why is the music under threat?

Well, it's partly to do with population decline. As in many rural areas, young people have grown up and then left and not returned. But it's also the distractions of modernity. First radio, then tv and now the Internet. People basically have far more choice. And the old sitting at grandpa's knee or grandma's knee and learning the tunes just doesn't happen anymore. I spoke to a lady called Anne Bioglin, who is a musician herself. She's a fiddler and a musicologist. And she told me how this whole scene has been in decline and it's in danger of fading away.

Maybe 5 to 10% of the people living in Sitstal know their folk music, and the rest don't have any contact with tradition because there are new people moved in or the time has just went by and it hasn't been delivered to the next generation.

As a result of this great decline, even the United nations have stepped in to try and save it.

How so? What can the UN do?

Well, UNESCO, the UN's culture agency, gave a listing to Satastal in the Intangible Cultural Heritage List. And what this means is that a state that receives this listing must do something within six years to preserve whatever's being lost or in danger of being lost, or it loses its recognition in this cultural heritage list. And that really spurred Setastyle into action.

How so? What did they do?

The plan was in 2020 to make a start on reversing the trend. Clearly that was very difficult given the restrictions that we've all been living under. So, in effect, what's happened over the last year or so is that the Set Astal municipality and people there have been planning the reversal of the trend, and that's going to get underway in a big fashion this summer. There's going to be a festival to celebrate the listing and to celebrate the music and the traditions of Setastyle, but also some really concerted action in schools to start teaching these musical traditions and dance traditions. So Physical education lessons will include dance music lessons will be centred on the folk songs and instrumental skills that will enable people to start to learn these folk culture traditions once again. Anne Bjerg Lien has the job of implementing all of these initiatives and she told me how important it is that this folk revival is an essential part of schooling in Sutterstahl as well as in the wider community.

My goal is to integrate it in the deep structure of the regular school. And the point is that you can go home and talk to your parents and your grandparents and contribute back to the school. You kind of build up a proudness of where you live and where you're from. All these kind of processes will, in a long term, maybe bring back a little bit of the daily life kind of use of this folk music, which was how it all started.

And what has the reception to this revival been like in the community?

Really very positive. There are lots of non natives in Sutterstahl who are quite charmed by the prospect of this becoming a real hotbed of folk culture once again. But even those who do have a long family tradition there are keen, particularly the kids. And it's quite easy to see why, actually, because your typical Satterstal standard tune has a really visceral pulse to it. I mean, it really wouldn't be out of place in the late night at Glastonbury. But also, one observation that Ambjor Glean made was that, like many of us, people in Satterstahl feel a bit cast adrift by the whole coronavirus experience. And this enthusiasm and interest in the folk revival of Sutterstal probably reflects a craving for community and a kind of search for soul and identity once again. People want to feel part of something and they want to feel grounded and at home. And a very strong cultural tradition like this would. Would provide exactly that.

Guy. Thank you very much for your time.

Oh, it's an absolute pleasure.

That's all for this episode of the Intelligence. If you like us, leave us a rating and a review and you can subscribe to the economist@examiner.com intelligenceoffer See you back here tomorrow, Sam.