What the world can learn from Israel’s vaccination ‘miracle’

Neri Zilber is a journalist based in Tel Aviv and an adjunct fellow of the Washington Institute for Near East Policy.

One night this past week, Tel Aviv’s central Rabin Square, a locale known more for demonstrations and concerts, teemed with hundreds of Israelis clamouring for one thing: a COVID-19 vaccine.

Four long lines of anxious people snaked out of a massive tent complex that had been set up just days earlier. Inside, maze-like metal barriers ushered the lucky ones through to a battalion of nurses administering the coveted liquid. The Rabin Square location is just one of hundreds across the country – from local clinics to hospitals to sports arenas – that make up Israel’s globe-leading vaccination drive. In less than three weeks, nearly two million people – more than 15 per cent of the population – have received their first (of two) inoculation shots.

“Israel is the world champion in vaccines,” Prime Minister Benjamin Netanyahu crowed, with some reason, last week. “Maybe we will be the first country in the world to emerge from the coronavirus.”

The “Israeli miracle,” as some international media have taken to calling it, stands in sharp contrast to every other country, even in the developed world. On a per-capita-basis, Israel as of mid-week had administered double the number of vaccines of the second-placed country (United Arab Emirates), 11 times that of the United States and 40 times that of Canada, according to figures provided by Our World in Data. A place often in the news for war and politics is now held up as a medical success story – and a world weary of the interminable pandemic wants to know how.

Local health officials point to a few key explanations. Israel is a relatively small state, both geographically and demographically: 400 kilometres from north to south, with just over nine million citizens (not including the five million Palestinians in the West Bank and Gaza whose local authorities are so far striking an independent path to vaccine procurement).

Vaccine shipments arrive at the country’s sole international airport, from which they are moved to a main national storage facility and on to the various vaccination centres. All of this is done under the supervision of the Health Ministry, which apportions vaccines to the four countrywide health maintenance organizations (HMOs) as well as to hospitals. Already short logistical chains are thus streamlined – an important factor when handling the Pfizer-BioNTech vaccine currently in use, which requires special sub-zero refrigeration.

The four HMOs are the backbone of a universal public health care system that insures nearly all Israelis, and which is now providing the vaccine free of charge. Since doctors and nurses are employed directly by the HMOs, they were able to be mobilized quickly to vaccination centres. Indeed, the Rabin Square complex was a joint effort between the local hospital, which provided the medical staff, and the Tel Aviv municipality, which paid a private events company to build and operate the site.

Finally, digitized medical records and platforms – websites, apps, text messages – run by the HMOs have allowed for the easy identification of those most at-risk from the virus, providing them with early vaccination slots and appointments for the second jab.

Health experts and government officials contend that these reasons – small size, nationalized health care, technology – not only enabled Israel to rapidly launch a successful vaccination program, but in fact enticed Pfizer to provide Israel with a major initial shipment last month. To be sure, Israel had to pay a premium for the supply, which as a wealthy country it readily did: according to reports, anywhere from two to three times the reported market price per dose.

But Israeli officials now openly say Pfizer sees their country as an ideal testing ground for the efficacy of its vaccine on a national scale – a small, enclosed ecosystem that can track who has been vaccinated, their prior medical conditions and any side effects. As Israeli’s Health Minister Yuli Edelstein told Reuters this week: “What we basically said to Pfizer and [the other major vaccination company] Moderna and to the others was that if we will be 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.”

Israel has so far managed to vaccinate some 70 per cent of those over 60 years old, in addition to a sizable segment of those with pre-existing medical conditions. Health care workers and select government employees have also been inoculated, along with younger Israelis lucky enough to find excess Pfizer vaccines that, once thawed, have to be used quickly before they spoil.

This last demographic has spent the past two weeks furiously hunting all across the country for “surplus” vaccines. Facebook groups with tens of thousands of members have sprouted up for this purpose, with rumours spreading like a contagion on social media of far-away clinics allowing general access. Last weekend, outside one Tel Aviv vaccination centre, nurses corralled a passing pizza delivery man and persuaded him to get the jab, lest the vaccines go to waste.

Predating COVID-19, a constant Israeli syndrome is the fear of being considered a friar, that is, a “sucker.” With thousands of people getting vaccinated outside the official Health Ministry criteria, the rush is on to circumvent the guidelines and not be left out. But there was also a more practical concern: By early next week, it was feared, Israel would run out of vaccines.

The initial Pfizer shipment allowed some two million Israelis to get vaccinated, when taking into account the required two-shot regimen (spaced three weeks apart). Israeli officials have guaranteed that anyone who received the first jab will have the second one waiting. Unless Pfizer or Moderna moved up their planned shipments, Israel would be left with a gap of several weeks during which any new vaccination push would have to be delayed.

This wasn’t simply a public-health concern. Promises of achieving herd immunity in Israel by springtime, and a reopening of the economy, are one thing. But Israel is again in the midst of a general election campaign, its fourth in two years. An “emergency corona government” seated last May was dissolved after a mere seven months amid Mr. Netanyahu’s reluctance to honour the agreement he signed with his centrist coalition partners. With election day set for March 23, Mr. Netanyahu is now in a race against (and with) the vaccine; the chiefs of Pfizer and Moderna will arguably have more influence on the election outcome than any politician. The long-serving Premier has seemingly staked it all on their ability to deliver bigger shipments, and quicker, promising that – not coincidentally – by the end of March the country’s entire adult population would be vaccinated.

Adding to the political and health crisis, Israel again imposed a stringent countrywide lockdown this weekend – local infection rates are among the highest in the world on a per-capita basis, vying with the U.S. and nearing British levels. The “Israeli miracle” may apply for vaccinations, but managing the pandemic has proven beyond the government’s capabilities. “Let us make a final effort,” Mr. Netanyahu implored the public, raising the hope that this lockdown would be the last.

The prospect of ending the pandemic in just a few months has buoyed spirits, and explains the mass demand for vaccines. Much of the crowd of people waiting in Rabin Square the other night were sent home disappointed after supplies ran out. Yet a small line of people, perhaps a dozen, could not be convinced, remaining at the slit at the side of the tent for any last possible drop. “We’re like drug addicts,” one young woman in the queue observed. “But we’re hoping for the best.”

The addiction in Israel, like everywhere else, is for what the vaccine represents: a return to our old lives, to normalcy, in a world not ruled by a virus.

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