11 January 2021

How Israel turned its Covid disaster into a vaccine triumph

By

Israel’s successful vaccination drive may have attracted much international attention, but the country has failed in almost every other aspect of the crisis. While the population is being vaccinated at breakneck speed, new infections are spiking and the country has entered its third nationwide lockdown. How has Israel succeeded in getting so many people vaccinated after months of shambolic handling of the coronavirus? And are the success and failure due to the same factors?

As I write, nearly 2 million Israelis have received their first jab of the Covid-19 vaccine (a few have already got their second dose). With over a fifth of its population vaccinated, Israel is outstripping every other country. Britain and the United States have only managed 2% of their populations so far.

The pandemic has served as a global stress-test for every country in the world, exposing the weaknesses in their societies, economies and governance systems. Even the most powerful and wealthiest democracies have failed to counter the spread of the infection and tamp down the death rates. In fact, the open borders, freedom of movement and widespread reliance on either private healthcare or creaking public systems, has in many cases made it much more difficult to deal with Covid-19.

The tiny handful of countries which have, so far, remained relatively unscathed by the pandemic tend to be self-sufficient island states with well-disciplined populations, like New Zealand and Taiwan, where it was relatively easy to close the borders early on and isolate the small number who had already been infected. Israel is not an island, but going into the pandemic, seemed to have attributes that would afford similar protection.

Israel borders four different countries, but to most relevant purposes it is an island economy. It is in an official state of war with two of its neighbours (Syria and Lebanon) and has few economic ties or tourist exchange with the other two (Egypt and Jordan). Nearly all of its trade is with distant countries and over 90% of departures and entries are through just one international airport. Add to that the fact that all Israelis enjoy near-free healthcare and have digitised medical records, and that the country has recent experience in facing national emergencies, and you’d expect Israel to handle the pandemic quite well.

That was the feeling at least in the initial weeks. Israel was quick to close its borders and skies, enforce social distancing and then a nationwide lockdown. Carriers of Covid-19 arriving from abroad were quickly tracked and their contacts informed, hospitals rushed to open coronavirus wards. The infection curve was swiftly flattened, numbers of deaths remained relatively low and by mid-May, the lockdown ended, with daily infections down to single figures.

But we weren’t out of the woods. Out of consideration for the sensitivities of his ally Donald Trump, Prime Minister Benjamin Netanyahu delayed the decision to ban flights from the United States. As a result, two-thirds of the cases of Covid-19 in Israel in the early months of the pandemic were traced to the US. Netanyahu also decided not to enforce the social-distancing and lockdown on the ultra-Orthodox community, which constitutes around 13% of the  population. The ultra-Orthodox parties are members of his embattled coalition – without them Netanyahu cannot remain in office. Coronavirus spread like wildfire through the heavily crowded ultra-Orthodox neighbourhoods, resulting in around a third of all Covid-19 cases.

Eager to portray himself as Israel’s saviour, Netanyahu had concentrated all the coronavirus decision-making within a small circle of advisors, refusing to include government agencies beyond the understaffed national security council and health ministry, both headed by his loyalists. As a result, not only were the decisions heavily politicised, but due to the lack of experience and planning capacity, once the first lockdown was over, Israel had no coherent exit-strategy. As the infection rate was low, restrictions were removed haphazardly, and without sufficient testing  or contact-tracing capability, infections began spiking once again in a matter of weeks. By the end of August, Israel was the world-leader in the daily rate of infections per capita. In September, it became the first country in the world to enter a second nationwide lockdown.

The past few months have been more of the same. The lockdown brought down the rate of infection somewhat, but as the wider population began losing patience with the government, restrictions lost their effectiveness. For diplomatic reasons, Netanyahu was loath to ban flights to Dubai, a new destination – and infection-source – for Israelis following the signing of a historic ‘normalisation’ agreement between Israel and the United Arab Emirates, in which he had taken much pride.

Infections began shooting up again. Recommendations by public health officials for localised lockdowns (similar to Britain’s tier-system) were shot down by Netanyahu under pressure from his political partners. In a major concession for Netanyahu, responsibility for contact-tracing was transferred to the military, but that failed as the number of cases overwhelmed the soldiers and Israelis were reluctant to disclose details. A previous attempt to track infections using the security service’s counter-terror surveillance had proven a miserable failure as well, since the data needed to track the movements of suicide-bombers isn’t accurate enough for pin-pointing virus infections. Israel’s much vaunted military technology was failing. The expertise that had been accumulated throughout decades of warfare and terrorism wasn’t what was needed to face a pandemic.

As a third wave of infections crashed over Israel and a third nationwide lockdown beckoned, death rates in Israel remained relatively low only thanks to a much younger population than in Western countries and excellent public hospitals.

Netanyahu began focusing on the silver bullet of vaccinations. At first, that seemed to be a losing strategy as well. He had ordered the national biochemical research centre, back in February, to begin working on an Israeli vaccine. But that was still in the early stages of development as much larger pharmaceutical giants were already in advanced trails. Israel then signed deals with Moderna and AstraZeneca in June, only to discover in November that Pfizer would be the first out of the gate with an approved vaccine.

Netanyahu ordered his officials to enter emergency negotiations with Pfizer and got on the phone with the company’s CEO. He authorised government lawyers to sign a contract whereby Israel would pay double what EU members are paying per dose, and waived any liability for Pfizer, as long as Israel would get its first shipment of four million doses at the earliest possible date in December.

By the time the first shipment from Pfizer arrived on 9 December, there was already a storage and logistic operation in place and 10 days later, Netanyahu was the first Israeli to be jabbed, live on Saturday night television. The next morning the rollout began across Israel and has been an unqualified success so far.

So how did the shambles turn into such a success overnight?

Israel is a small, crowded and mobile country, with nine million citizens on just 20,000 square kilometres (not including the militarily occupied Palestinian territories). This allowed the virus to spread quickly. And the vaccines to be delivered within a few hours from the main storage facilities to vaccination centres across the country.

The decentralised health system, which couldn’t handle mass-testing or contact tracing, was perfect for jabbing up to 200,000 Israelis a day, thanks to the internal competition between public healthcare providers.

For historic and political reasons, Israel has four of these, which fight for members and government funding (imagine the NHS broken up into four separate organisations and allowed to compete with each other). To attract members, and to keep their costs down, the four health funds have invested heavily in digitisation, outreach and preventative as well as predicative medicine. This has lead to a high level of engagement with members who are easily called in for their vaccination appointments.

Being free to choose and move between their healthcare providers, nearly all Israelis live near their clinics and know and usually trust their GPs, with whom they can consult over the phone or via video consultations. Being put to the test, the health funds had a clear incentive to prove to their members they were as quick as their competitors in setting up efficient and streamlined vaccination centres.

And then, of course, there’s the political angle. The concentration of powers in the prime minister’s office and Netanyahu’s politicisation of the decision-making hampered so much of Israel’s initial handling of the pandemic, but certainly helped with vaccinations. Especially since Netanyahu, facing a tough election on March 23, is making the successful vaccination campaign the centrepiece of his case for re-election.

Netanyahu’s involvement may, or may not be the main reason Pfizer and Moderna have been prepared to ship Israel early consignments of the vaccines. His single-mindedness and political survival instincts have certainly been factors. As has Israel’s relatively small size and its willingness to pay a premium and to share all data on the efficacy and side-effects which will be gathered by the health funds, with the vaccine manufacturers. In return, Pfizer has already promised more expedited deliveries.

As the global community seeks to learn the lessons of the year of the plague, Israel serves as the perfect test-case – for how not to deal with a pandemic and how best to vaccinate an entire population.

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Anshel Pfeffer is a senior correspondent for Haaretz and the author of Bibi: The Turbulent Life and Times of Benjamin Netanyahu

Columns are the author's own opinion and do not necessarily reflect the views of CapX.