Study results: SPRP of Pillars 1 to 8 in August 2020 and Pillars 9 and 10 in February 2022^a.

Pillar 1. Country-level Coordination, Planning, and Monitoring
Step		Actions to Be Taken	Responses and Plans
1	1	Activate multi-sectoral and multi-partner coordination mechanisms to support preparedness and response	National COVID-19 management HQ was established in early May 2020.
	2	Engage with national authorities and key partners to develop a country-specific operational plan with an estimated resource Requirements for COVID‑19 preparedness and response, or preferably adapt, where available, an existing Influenza Pandemic Preparedness Plan	-A new program for COVID-19 was drafted by the office of disease control -Human resources management was applied through repositioning the health system and rapid recruitments.
	3	Conduct initial capacity assessment and risk analysis, including mapping of vulnerable populations	Based on previous national guidelines of the Ministry of Health (MoHb), at-risk populations were defined readily.
	4	Begin establishing metrics and monitoring and evaluation systems to assess the effectiveness and impact of planned measures	-The Communicable Diseases Unit continuously received data through the SIBc online platform. -Daily Excel forms from primary health centers were being gathered in regional Communicable Diseases Units
2	5	Establish an incident management team, including rapid deployment of designated staff from national and partner organizations, within a public health emergency operation center (PHEOC) or equivalent, if available	In late April 2020, a national task force for COVID-19 was formed, but later on, with the formation of COVID-19 management headquarters as of early May 2020 task force was disbanded.
	6	Identify, train, and designate spokespeople	Changes were made as of June 2020 by the introduction of the official COVID-19 spokesperson for MoHb. Previously the public affairs chairman of the MoH handled announcements.
	7	Engage with local donors and existing programs to mobilize/allocate resources and capacities to implement an operational plan	Basij forces were arranged to help speed up the screenings.
	8	Review regulatory requirements and legal basis of all potential public health measures	The Governor’s Office, the Provincial Governor, the Municipality, the and Iranian Medical Council performed a review.
	9	Monitor implementation of the CPRP based on key performance indicators in the SPRP and produce regular situation report	Seven sessions were held until August 2020.
3	10	Conduct regular operational reviews to assess implementation success and epidemiological situation and adjust operational plans as necessary	Epidemiological monitoring of the pandemic took place in the COVID-19 management HQ on a national level based on daily observatory reports.
	11	Conduct after-action reviews in accordance with international health regulations (IHR-2005) as required	Checklists were developed although they were not strictly based on IHR.
	12	Use the COVID-19 outbreak to test/learn from existing plans, systems, and lesson-learning exercises to inform future preparedness and response activities	We implemented learned lessons from the Influenza program and a COVID-19 re-evaluation for secondary waves preparedness was also drafted.

^aHQ, headquarters; COVID-19, coronavirus disease-2019; IHR, international health regulations; SPRP, Strategic Preparedness and Response Plan, NGO, nongovernmental organization, WHO, World Health Organization; MOH, Ministry of Health; HSE, health, safety, and environment; RT-PCR, real-time reverse transcription–polymerase chain reaction; IUMS, Iran University of Medical Sciences; IPC, infection prevention control; PPE, personal protective equipment; DIC, drop-in center; DCP, disease commodity package, SOP, standard operating procedure; ToRs, term of references; AEFI, adverse events following immunization; AVSS, active vaccine safety surveillance; UNICEF, United Nations International Children's Emergency Fund; NITAG, a national coordinating committee at country, provincial, and regional levels; RITAG, regional immunization technical advisory groups; NCC, national development plan; NDVP, national development, and vaccination plan; HR, human resource; UN, united nation; DIC, drop-in center; ID, identity. ^bMoH, Ministry of Health; NRA, national regulatory authority EPI, expanded programme on immunization; MAH, marketing authorization holder. ^cSIB, an acronym that translates to [Uniform Health Platform]—an online patient history platform used in primary care. ^dAkhavan Center (Article 16) are rehabilitation centers for addiction. ^eDrop in centers are organized shelters for the homeless.