Israel outpaced the world in Covid-19 vaccinations. Now it’s seeing results.
February 6, 2021
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Israel has outpaced the world in vaccinating its population against Covid-19. Now the results are starting to come in. And, so far, the news is good for both Israel and the world.

Data suggests that the pandemic is starting to slow in Israel. Infections and the number of seriously ill people are declining, particularly among those over 60, one of the groups targeted in the early rollout of the vaccination campaign.

The vaccine, out in the wild, is also mirroring the results of clinical trials, which found the Pfizer/BioNTech vaccine (the dose most Israelis have received so far) was about 95 percent effective in reducing infections.

Maccabi Health Services, one of Israel’s four health maintenance organizations (HMOs), tracked 163,000 Israelis who had received both of the two required doses of the Pfizer vaccine; only 31 of those people tested positive for Covid-19, compared to an unvaccinated sample in which about 6,500 did.

According to data from the Israeli Ministry of Health, 531 of 750,000 fully vaccinated people over 60 years old tested positive for Covid-19 — which is just 0.07 percent. Out of the people who tested positive, only 38 were hospitalized, with symptoms ranging from moderate to critical. Another Israeli HMO, Clalit, found that Covid-19 positivity decreased by 33 percent among 200,000 people 14 days after they’d received just the first Pfizer dose compared to the same number of unvaccinated people.

This is all very promising, especially as the world banks on a vaccine as the best path out of this pandemic and as new variants of the virus emerge. “We say with caution, the magic has started,” Eran Segal, a scientist at the Weizmann Institute, posted on Twitter, accompanied by data showing a decline in hospitalizations and critical illness among the 60-or-over group in recent weeks.

But scientists caution that there’s still a long way to go. Experts noted that serious cases are declining, but overall infections are not diminishing as swiftly. And many of these studies rely on preliminary data, and these findings may change over time, especially with these new coronavirus variants emerging.

Israel also entered a strict lockdown in early January, just as the vaccination campaign was ramping up, which may have also helped nudge cases downward.

Who’s getting vaccinated, and how people might behave once they get those shots, may also influence the findings. Those who got vaccinated early and have gotten their full two doses might have been highly motivated; now comes the more challenging part of inoculating vaccine-hesitant or more marginalized communities. Israel has also faced criticism for its failure to extend its vaccination program to Palestinians, which could also make herd immunity harder to achieve.

Israel offers lessons in how to vaccinate a population quickly, but it’s also starting to show the challenges — and how difficult global immunization efforts are going to be. “Israel is the canary in the coal mine,” said Bruce Rosen, director of the Smokler Center for Health Policy Research at the Myers-JDC-Brookdale Institute (MJB) in Jerusalem.

How Israel’s vaccination program offered a real-world vaccination test case

Israel started its vaccination program in December. Since then, about a third of the country’s population (about 3 million people) has received at least one dose of the Pfizer/BioNTech vaccine. Nearly 1.8 million people have also gotten their second dose of the vaccine. That’s in a country of a little more than 9 million, according to recent figures from the Israel Ministry of Health.

The rates are even higher for those in the over-60 group; for example, more than 90 percent of people between the ages of 70 and 79 have gotten the first vaccine dose, and nearly 80 percent the second. The vaccination program has since expanded so that anyone over the age of 16 is now eligible for a shot.

Israel leads by far in worldwide vaccinations

Our World in Data

Israel achieved this largely because of its existing health infrastructure, a universal, digitized system that gave the country a ready-made way to track and communicate with people.

All Israeli citizens are enrolled in one of four health maintenance organizations (HMOs) for their care. Everyone has an ID number, which allows for easy access to electronic records.

This system also allows health care workers to update a person’s vaccination status, monitor any side effects, and schedule an appointment for the next dose. Many Israelis said they got their appointment for the second dose shortly after getting injected with the first, usually scheduled for exactly 21 days later.

This public health infrastructure meant massive vaccination sites popped up quickly, places that were accessible and big enough to be able to space people out and keep them as socially distanced as possible. Experts told me in January that Israel’s knack for responding in emergencies meant it was particularly suited for the logistical and speed challenges of a vaccination campaign.

Israel also benefits from being a small country, and word of mouth did help in the vaccination rollout. Though Israel prioritized people over 60 and health care workers in the first phase of the campaign, it embraced a “no waste” policy, meaning vaccine providers prioritized using the doses above all else. If there were extra jabs at the end of the day or week, they might call in the pizza guy or the lady standing at the bus stop.

“For a vaccination campaign, we are well-prepared, but we’re also flexible,” Hagai Levine, an epidemiologist at Hebrew University-Hadassah School of Public Health, told me in January. “When you plan, you don’t know, for example, how the cold chain will look, how many vaccines you will get — so you need to make rapid adjustments. And we are good at that.”

Prime Minister Benjamin Netanyahu (who, with elections approaching, has a lot to gain from a successful vaccination campaign) has said that Israel’s population could be fully vaccinated by the end of March.

Experts said that’s still feasible, though it’s far from as simple as it sounds.

Important questions remain around Israel’s vaccination program — and the world’s

Israel’s data indicates that the vaccines are working at the individual level; the outcomes of those who have been inoculated compare favorably to those who haven’t. Israel’s streamlined health infrastructure makes it very easy to know who’s been vaccinated and how they’re responding, and compare it against those who haven’t.

But that system is also helping it win the vaccine race in another way: In a world where vaccines are in short supply, Israel is getting a regular stream in part because the country promised to provide the vast collection of vaccine data to Pfizer, so it can monitor the effects of the vaccine. (Israel, however, also reportedly paid a premium for the vaccine doses.)

But experts said it only gets more complicated from here, especially when it comes to achieving the goal of herd immunity — basically, when enough of the population is immune to the virus that it provides indirect protection to everyone else.

New variants of the virus pose a challenge, especially if those mutations make the virus better at getting around the protections offered by the vaccine. Right now, the vaccines available have shown to be broadly effective against these variants, but that could change.

There are other questions scientists and public health experts want to answer. Brian Wahl, an epidemiologist with the Johns Hopkins Bloomberg School of Public Health, said that the vaccines are effective against the disease, they’re still learning about its impact on transmission. That is, how likely it is that a vaccinated person who doesn’t get ill from Covid-19 could still spread it.

Another question is how long the protection from the vaccine will last. “We need to be continuing to look at how well the vaccine protects several months beyond administration, Wahl said.

This is also a new vaccine, and not everyone is enthusiastic about getting it. Often the people first in line for their doses want to be there; it doesn’t take much to get them to their appointments. This is not always the case for vaccine-skeptical or -hesitant people, and getting those people vaccinated is a challenge Israel, and other countries, face.

Israel’s Arab and Orthodox Jewish communities show greater degrees of reluctance to getting the vaccine, and the latter of which have been hit particularly hard by the pandemic.

But Ann Blake, a postdoctoral fellow at Baylor College of Medicine who’s been studying Israel’s efforts, said she feels optimistic about Israel’s ability to overcome some of this hesitancy.

“Israel’s vaccination campaign showcases a coordinated and organized communications campaign that uses local community leaders and credible messengers in tandem with a synchronized message from the highest levels of government with the specific aim of encouraging vaccination among the vaccine hesitant,” she wrote in an email, adding that it could serve as a model for other countries, including here in the United States.

Beyond hesitancy, experts pointed out that, right now, only people 16 or older are eligible for the Covid-19 vaccine, and scientists are unsure when kids will be approved for Covid-19 vaccinations. All of that leaves a chunk of the population that won’t get vaccinated and could still transmit the virus. “If you had 100 percent [of people] vaccinated, it would be one thing,” Rosen said. “But you don’t. So this is much more complicated in reality.”

Israel has also faced criticism for excluding Palestinians living in the West Bank and Gaza Strip from its vaccination campaign, despite making the shots available to Israeli settlers living in the West Bank.

Israel says that based on the terms of the Oslo Accords, the 1990s agreements signed between Israel and the Palestine Liberation Organization (PLO), the Palestinian Authority is responsible for health care in the Palestinian territories. But human rights and health groups have pressured Israel to “ensure that quality vaccines be provided to Palestinians living under Israeli occupation,” arguing that restrictions imposed by the occupation limit the Palestinian Authority’s purchasing and distribution capabilities.

The Palestinian Authority doesn’t have anywhere near the resources Israel does. The territories just received 10,000 doses of Russia’s Sputnik V vaccine (which appears to be safe and effective); they are also supposed to get doses through the Covax facility, the WHO-linked international consortium, but distribution won’t begin until later this month.

Israel did send about 2,000 Moderna doses to Palestinian authorities this week, with a promise of 3,000 more. But that is nowhere close to enough to serve the entire population of more than 4.5 million.

If Palestinians lack safe and effective vaccines, that could also undermine Israel’s efforts at achieving herd immunity, especially since many Palestinian workers move back and forth into Israel every day.

“We have to insist that Israel is responsible for Palestinian health as an occupier, especially during pandemics, and that infectious diseases do not know borders,” Rita Giacaman, a professor of public health at the Institute of Community and Public Health at Birzeit University in the West Bank, told me.

Indeed, the uneven distribution of vaccines will ultimately prolong the coronavirus crisis everywhere. Israel’s example shows how a rapid campaign can work, but also the limitations of just one country succeeding against the pandemic.

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