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COVID Vaccinations in Israel

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Chart tracking the progression of COVID vaccination in Israel (first dose only). Data from the Ministry of Health coronavirus dashboard. Chart produced by twitter user LittleMoiz.

According to the Israeli ministry of health’s coronavirus dashboard, as of this morning, 1.8 million Israelis have received the first dose of the Pfizer coronavirus vaccine. This constitutes just over 20% of the population, and around 75% of the initial target population (mostly over-60s, plus medical staff). Yesterday the Israeli health funds began administering second doses of the vaccine, and this morning the ministry of health announced that over-55s are now able to apply to their funds for a vaccination appointment. Teachers and educational staff are also expected to be targeted starting this week. It’s assumed that vaccination of over-50s will begin next week. Also yesterday, the government signed an agreement with Pfizer guaranteeing steady supplies of their vaccine in the coming months. At the current rate, the entire population of Israel may be vaccinated against COVID-19 by March.

There are several factors playing into the speed and efficiency of Israel’s vaccination project. To begin with, Israel is a small, relatively densely populated country, and distances between towns (and thus between vaccination centers) are manageable to most people. For the same reason, it’s easier for medical teams to transport vaccine supplies even to far-flung parts of the country, while maintaining the cold chain required to keep Pfizer vaccines viable.

A second factor is money. Israel is paying around $30 per vaccine dose, which is around twice the cost in the US and more than twice in the EU. This, as it turns out, is less of an inducement to Pfizer than you might think—the COVID vaccine is the epitome of a product where you make your profits in volume, and we’ll discuss their real interest in selling to Israel shortly. But it indicates the importance of a third factor, politics. Israel is heading into yet another round of elections at the end of March, and Netanyahu has openly stated that arriving at that date with the country fully or mostly vaccinated will be to his electoral advantage. To that end, he has dedicated his managerial and diplomatic energies to the task of securing vaccines with the same intensity with which he has ignored, over the last nine months, every other aspect of the coronavirus crisis. Which leads to a bizarre situation in which Israel leads the world in vaccinations, even as our infection graph climbs at a rate not at all dissimilar to the UK’s.

In other words, Netanyahu has grasped what, as we have all commented on more than once on this blog, Donald Trump so disastrously failed to understand—that handling the pandemic well works to his political advantage. This is why he leapt into action in March 2020, sending Israel into lockdown much earlier than many other Western countries, and crushing the curve so effectively that he began boasting that the leaders of other countries were calling him for advice on how to handle the pandemic. This decisiveness helped to secure him a unity government with Benny Gantz, until that point the greatest threat to his decade-plus premiership (and to his chances of evading jail for bribery and other charges).

As soon as the ink was dry on that deal, however, Netanyahu lost interest in corona. The result, as I’ve already written about here, has been a cycle of lockdown and reopening that has resulted in more than 3,600 dead Israelis, nearly a million unemployed, countless shuttered businesses and shattered livelihoods, and a months-long, country-wide protest movement. Even now, as Israel supposedly experiences its vaccine miracle, the country is in the midst of a third lockdown. Or perhaps a fourth. Or third-and-a-half. The lockdown allegedly began in mid-December, but was immediately scaled back (including permitting schools to remain open). The result has been that, for the first time, Israel’s daily confirmed cases have climbed above five figures, and there are more than a thousand serious cases in hospitals, straining the already cash-strapped medical system’s resources to the breaking point. A stricter lockdown was imposed on January 8th, but it remains to be seen how fully the resentful, exhausted Israeli public will comply with it. So Netanyhau needs the vaccines to arrive and he needs them to work. And as we saw in March, when it’s his own interests on the line, he knows how to hustle.

But the most important factor in achieving the swift and effective vaccination of Israeli citizens—important in more ways than one, as we’ll soon discover—is the Israeli health system. I’ve written about this system here in the past, and as I described it then, it is something of a happy accident, an agglomeration of institutions created before the country’s founding and folded into a structure that incorporates public funding, private healthcare, and free market competition. One result of this—which is something that I’ve noted the absence of even in what I’ve seen of other countries with robust socialized medicine systems—is an easily accessible and technologically advanced system. Most of my interaction with my health fund—renewing prescriptions, making appointments, finding specialists or facilities—happens online or on the phone, and this was true even before the pandemic. And most Israelis live within a short distance of a medical center where they can access not only their GP, but medical secretarial services to help them navigate the system.

So the advantages of the Israeli system are not only that all Israelis are guaranteed medical services, but that all Israelis are already members of a body tasked with, and experienced at, delivering those services nation-wide. And that the method of interfacing with that body and getting a vaccine appointment was already in place for every other aspect of medical care. To get your vaccine appointment, you call the same number you’d call for a doctor’s appointment or a CT (or, more recently, a coronavirus test), and are directed to a facility within convenient reach (or even inconvenient reach, if you’re willing to make the schlep).

The funds have also been deliberately profligate with their vaccination strategies. It’s not just that any member of a fund can access medical services at any one of the fund’s facilities (so if you want to and are able, you can drive from Tel Aviv to a village in the middle of nowhere for your vaccine if they have an appointment available). But that the policy has been to make excess vaccines available to all comers, regardless of age. A now-famous story has a nurse, at the end of the day and with doses to spare, calling out to a passing pizza delivery man to come in and get vaccinated. And a bustling WhatsApp group titled “Vaccines With Friends” keeps users abreast of facilities where doses are available. Everyone has a story about a friend or a relative who lucked into a vaccine by being at the right place in the right time, or by hustling a little, and since all of these vaccinations happen under the funds’ auspices (and since the ministry of health’s policy has from day one been to hold back a single dose for every dose delivered), they are already guaranteed a second dose and a complete vaccination procedure.

This, as it turns out, is what attracted Pfizer to us, far more than the inflated price per dose. By demonstrating that Israel had the medical and technological capacity to quickly deliver vaccines to its entire population, Israeli officials convinced Pfizer that it could use us as a test case for demonstrating their vaccine’s effectiveness. If Israel goes back to the pre-pandemic normal in March or April—not just schools and workplaces but restaurants, places of worship, event halls, cultural venues—it will be the first instance of defeating coronavirus through vaccination in the world, and Pfizer wants it. (What remains unclear, as Israeli privacy advocates have been pointing out, is what kind of medical information Pfizer has been promised as part of its newly-signed agreement with the Israeli government.)

And now, the caveats. As you may have already deduced, the system by which vaccination appointments are allocated privileges the technically literate, not to mention those with free time. When my family’s health fund announced that it had begun vaccinations, my mother spent two hours calling their overloaded hotline before she got through, then another forty minutes on hold (this was right at the start, though, and Israelis love to be early adopters; I understand the wait time isn’t as intense now). And, of course, the ability to go anywhere in the country to get the next available appointment requires a certain amount of mobility. This means that a sixty-year-old in good health who owns a car and is easily able to limit their exposure to others might get their vaccine long before an eighty-year-old on a fixed income who takes the bus everywhere and doesn’t know how to do online grocery shopping. Unsurprisingly, the cities with the highest rate of vaccination within the eligible population are also the wealthiest in the country (where coronavirus is less prevalent), and the lower socioeconomic tranches have had the least vaccine penetration. Like most things, Israel’s vaccine miracle is not evenly distributed, and it will take active effort by the health funds to address that inequality.

But really, the elephant in the room is the Palestinians. It’s been striking to observe the difference in how foreign and local news sources and political commentators have approached the matter of vaccinating the Palestinians. The former have taken it as a given that it is Israel’s responsibility to supply vaccines to the occupied Palestinian population. The latter—when they’ve acknowledged the issue at all—have treated it as a matter of foreign policy, in which Israel might choose to give the Palestinian Authority vaccinations as an act of charity, not obligation. (This, for example, was the attitude taken by minster of health Yuli Edelstein when he was interviewed on CNN recently.) It speaks to the extent to which the Israeli pubic, even those who don’t consider themselves right wing, have been trained to ignore the reality and implications of the occupation. Of course, the truth is that even if you set aside moral considerations, there is no defeating coronavirus in Israel without doing the same in the PA. It’s only in the last week (in other words, as it’s become clearer that there isn’t going to be a vaccine shortage) that I’ve started to see Israeli politicians and NGOs start to say the same, and even then, only very faintly.

Part of the issue is that this might be the sort of problem that’s easiest to solve if you don’t talk about it. Netanyahu’s government has a nasty tendency to be scared off of doing the thing that is most sensible and effective because it arouses the rage of authoritarians and far-right fanatics. See, for example, internal security minister Amir Ohana (who is auditioning for the role of Israel’s answer to Josh Hawley) going against the common sense, thoroughly uncontroversial policy of the ministry of health, and instructing the prison service not to vaccinate prisoners who are over 60 (several court cases are currently pending against this decision, and one can only hope that, having successfully done a populism, Ohana will back down). The same ministry of health is already saying that vaccinating the Palestinians is in our own interest, but it’s very easy to imagine some racist grandstander in Netanyahu’s government deciding that it’s a winning play to come out against this policy, and turning it into a political hot potato. For that matter, it’s an open question how willing the Palestinian government and populace (not to mention Hamas in Gaza) will be to receive vaccines from Israel, especially if it becomes a big deal. This is the sort of thing that a functional American administration might be useful in smoothing over, and maybe things will shift in that direction after January 20th. But for the moment, it’s all up in the air, and casts a pall over Israel’s self-congratulatory celebrations.

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