Why Israel leads the world in vaccination
Mar 4, 2021 | Charles Lipson
No country has been more successful in getting the coronavirus vaccine to its citizens than Israel. Why? Three reasons stand out, and the third one is likely to help people around the world.
Israel can vaccinate the population quickly because it has a very competent, comprehensive national health system, based on several Health Maintenance Organisations, all supervised by the Ministry of Health. The system includes digitised medical records for everyone in the country.
Israel bought enough vaccine. Earlier in the pandemic, it contracted for millions of doses from Moderna. More recently, it agreed to buy millions more from Pfizer so that everyone over the age of 16 can be vaccinated by the end of March. To clinch the Pfizer purchase, Jerusalem gave the company two incentives: It paid well above the market price, and it offered to share medical data with the company – data that few other countries could gather.
Israeli biostatisticians can pair the medical reactions of millions of vaccine recipients with each one’s medical history and demographic data. This will allow public health professionals worldwide to gain a nuanced understanding of how the vaccine works, both in the entire population and in various subgroups, such as women over 80 or people with type II diabetes.
The country could afford the mass purchases thanks to decades of economic growth, grounded in high-tech, medical research, water conservation, sophisticated weapons development, cybersecurity and more.
To distribute the doses, Israel is depending on its effective public health system, which can reach the entire population in emergencies. Israel has had a lot of preparation for those crises, unfortunately, after decades of threats from terrorists and hostile neighbours. Faced with these ever-present dangers, the Government learned how to contact everyone quickly with vital information and respond to emergency conditions anywhere in the country. These communication and public health systems mean that the Government can reach the entire population, tell people where to get vaccinated, explain why it’s so important and then execute this complex operation.
In terms of the logistics of Israel’s vaccination program, the vaccines arrive at Israel’s Ben Gurion International Airport. From there they go to an underground facility, run by the country’s pharmaceutical giant, Teva, with enough freezer capacity to hold five million doses. The doses are then sent to 300 to 400 vaccination locations, established by the Health Ministry. Those locations not only include major hospitals but also drive-through stations, numerous small sites and more than two dozen mobile stations, all equipped to keep the vaccines at the required temperature: -70 degrees Celsius.
All shots are free, with priority for the elderly, healthcare workers and patients with pre-existing conditions.
“What we basically said to Pfizer and 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 win-win situation,” said Health Minister Yuli Edelstein.
This win-win was amplified when Israeli scientists figured out ways to improve delivery, beyond the manufacturer’s own ideas. One, approved by Pfizer, was to repackage the large frozen packets of vaccine that were flown into the country into many smaller ones, the size of pizza-delivery boxes. The small ones could be delivered efficiently to remote sites.
Reuters reported that Israeli doctors have also discovered ways to get more than the advertised number of doses from each vial.
Israel offered Pfizer something valuable besides a premium price – it could provide the company with reliable, comprehensive data on how well the medicine works in a very large population. This data goes far beyond the 50,000 people Pfizer worked with in phase three trials. Equally important, each recipient’s response to the vaccine can be paired (anonymously) with that person’s health record and demographic details. That’s possible because Israeli health authorities have maintained and digitised more than 30 years of medical history for the entire population.
Pairing this data with Pfizer vaccinations means that the company and public health officials around the world can gauge how well the shots work with different groups, such as people over 65 with asthma or pregnant women. Is the vaccine more effective with some groups than others? Are there any rare side effects that tests on smaller populations might have missed?
This data should be pouring in soon since, by late March, a majority of Israelis should be fully inoculated.
What have we learned so far? The earliest data covers the whole population, not subgroups, but it is very encouraging. It shows that the vaccine is actually more effective than Pfizer reported from its phase three trials. By Jan. 30, six weeks after Israel began inoculations, more than 1.7 million Israelis had received two doses of the Pfizer vaccine. Another 1.3 million had received their first dose. Of those who received the full inoculation, only around 300 later showed any significant COVID symptoms (less than 0.5%). Only 16 needed hospital care, less than 0.002%.
Encouraging as this data is, the country has suffered badly from the pandemic. Israel’s lockdown has been the longest in the world [for any country as a whole, Ed.], and not everyone has complied willingly.
And despite a successful vaccination program, “herd immunity” is months away.
Still, Israel’s rollout of the new vaccines has set the pace for the world. The hope now is it generates data and distribution strategies that will help other nations achieve better outcomes.