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Thanks to its health system and its logistical capacity, among other factors, Israel is today the country that has administered the most doses of vaccines to its population. The process can help answer a number of key questions, though it does have a big mole: its indifference to the Palestinians.
You don’t have to look in great detail at the following chart to see what is happening in Israel. Today it is the country that has administered the most doses of vaccines against COVID-19 to its population. As of January 21, it had put 38 doses per 100 inhabitants, managing to reach almost 30% of them, a record much higher than any government can hold. There, in addition, some 550 thousand people have already received the second dose.
“The Israeli miracle” is the way some media have described it. Since that country began receiving the first Pfizer / BionTech vaccines on December 19, the eyes of scientists and health professionals have been attentive to the process for two main reasons. The first is because that process will help clear up various questions about vaccines. The second is due to the lessons that the organization can leave and the logistical complexity that immunization requires.
There is also a third inescapable reason: Israel has decided to exclude nearly 5 million Palestinians from vaccination. Being the protagonist of this discrimination has triggered many criticisms from international organizations. This violates the values of the medical profession, Mustafa Barghouthi, who is part of the Palestinian health committee for COVID-19, pointed out a few days ago in The New York Times.
“As Israel conducts an unprecedented vaccination campaign, millions of Palestinians living under Israeli control in the West Bank and Gaza Strip will either not receive any vaccines or will have to wait a long time to receive them,” replied Saleh Higazi, Amnesty regional director. International in the Middle East and North Africa. Not even, Barghouthi recalled, they do so much to the thousands of Palestinian prisoners. “In medical care there should be some patients less worthy of treatment,” he said.
With this in mind, there are several reasons that can help understand why Israel is the leader in vaccination.
Vaccinate in record time
Journalist Danny Zaken tells the newspaper Globes, one of Israel’s main newspapers, that last year, among the discussions that experts and government officials were having about how to access a vaccine, an idea emerged: to offer data to pharmaceutical companies on the result of vaccination much earlier than other countries. It would be a way of persuading them to become one of the first nations to be vaccinated.
The idea, Zaken points out, didn’t go bad at all. After a National Security Council held in November 2020, it was decided that it should be the Prime Minister, Benjamin Netanyahu, who would present the option to the directors of the laboratories. He would, of course, have advisers who would give him a hand and a checkbook that would allow him to pay a very good price for the doses.
Pfizer listened to Netanyahu, eager to raise his reputation before next March’s election. The company then consulted the World Health Organization and other health authorities. In the end, the multinational decided to take a closer look at Israel’s health system and was impressed with the quality of information it had in its databases. With all the medical records digitized and a system covering the entire population, it seemed almost a given that Israel would quickly provide reliable data on side effects, efficacy or the time it takes someone to develop antibodies. Also about how much a single dose can protect (the Pfizer vaccine is made up of two). They could discriminate the information according to population groups, ages or comorbidities.
The 20-page agreement was signed a few days later. In it it was clear that the objective would be “to determine if herd immunity is achieved after reaching a certain percentage of vaccination coverage.” As has happened in many countries, the price and the number of doses to be sold were kept hidden, although some media have risked giving a figure. The Guardian assured that Israel would pay US $ 62 per dose. Others have simply said that it is twice the value charged to the US (US $ 19.50).
“What we basically told Pfizer, Moderna and the others was that if we are one of the first countries to start vaccinating, very soon these companies will be able to see the results. It’s a kind of win-win situation, ”Yuli Edelstein, Israeli Health Minister, summed up to Reuters news agency. “We hope to be a model for the world. Others can learn from our experiences; They don’t have to start all over again, ”added Arnon Afek, Deputy Director of Sheba Medical Center.
As reported by local media, after those talks Pfizer has sent between 100,000 and 500,000 doses per week to Israel. On average they inject 150 thousand people per day, although a few days ago they achieved a record of 210 thousand.
“We will be the first country in the world to come out of the coronavirus,” Netanyahu said. His promise is that by the end of March (when the elections are) all those over 16 years of age will already be vaccinated.
The secret of success
But why was Israel so attractive to Pfizer? One of the key points has to do with a not very large population: 9.3 million people (not including the Palestinians of the West Bank and Gaza) concentrated in only 22,145 km² (Colombia has about 1,143 million km²). This allows authorities to move quickly between a developed infrastructure, something vital to administer a vaccine that requires a temperature of -70ºC.
However, the real draw of Israel is its healthcare system. In 2017, a team led by Professor Mark Clarfield, from the Medical School for International Health at Ben-Gurion University (Israel), explained in an article published in The Lancet the strengths and weaknesses of a model that already had solid foundations when it was established the Israeli State (1948) and that in 1995 it had already managed to secure 95% of its population.
The great leap had been made a year earlier, when parliament approved the National Law on Health Insurance. Avoiding many details, it allowed all residents of Israel (legal, of course) to have free access to health services and to a “basket” of medicines and technologies that is updated periodically (although they must, as in Colombia, pay copayments) . Without having a high expenditure on health, which they criticized because it seemed to be “stagnant”, they enjoyed favorable health indices and a high life expectancy (80 years for men; 84 for women), Clarfield reported.
One of the success points, it seems, lies in its scheme. There are four “Health Maintenance Organizations” (HMOs) competing to recruit patients, which has forced them to offer good services. The proof of this is that less than 2% of users switch HMOs each year.
Also, as Professor Clarfield points out, it has been key to have well-equipped hospitals “although crowded” and a “solid primary care infrastructure”. The other essential point has been the digitization of the clinical information of the patients, something that has made it easier to identify those who are at higher risk of contracting the virus and assign them vaccination appointments.
To all this we must add another couple of Israeli strategies. The first has to do with a campaign to increase confidence in vaccines and combat groups that do not believe in them (in fact, it successfully petitioned Facebook to remove four anti-vaccine groups). The other lies in avoiding that no dose of any batch is lost, so in addition to the elderly, they have invited young people to go to the vaccination points.
The situation was summed up by Neri Zilber, from Tel Aviv, in the Canadian newspaper The Globe and Mail: “Last weekend, in front of a vaccination center in Tel Aviv, the nurses cornered a pizza delivery man who was passing and they persuaded him to take the first dose so that the vaccines are not wasted. ” He says that there are even groups on social networks that have dedicated themselves to locating the places where there may be surpluses.
“An Israeli syndrome is the fear of being considered a friar, that is to say, a ‘fool’ ”, pointed out Zilber. “With thousands of people who are vaccinated outside the official criteria of the Ministry of Health, the rush is to evade the guidelines and not be left out.”
And although all these figures have made the Israeli health system look like a role model, it is far from perfect. Clarfield and his group pointed out The lancet that there are serious challenges that must be addressed. One of the main ones has to do with a growing privatization of services. “Supplemental insurance” tripled between 1997 and 2015, leading to serious disparities. For example, they wrote, 40% of citizens had delayed or given up necessary dental treatment due to cost. The few beds available was another of the great challenges: in 2019 it had 3 per thousand inhabitants, while Japan or Korea have 12. Germany, 8.
“Given the ever-present possibility of a national mass casualty event the health care system clearly does not have adequate reserves,” they noted.
Paradoxically, in their article they highlighted the good relationship that, despite the conflict, Palestinian and Israeli doctors had forged. Together they had solved serious epidemiological problems and were cooperating to develop different programs. “We believe,” they said, “that health in its broadest sense could help provide a bridge to peace.”
