How Israel Became the World Vaccine Leader The country made a deal with Pfizer: enough shots for everyone in exchange for data on the results. By Tunku Varadarajan
More than 55% of Israelis over 16 have been fully vaccinated against Covid-19 in the 12 weeks since the first jab was administered to a wincing Prime Minister Benjamin Netanyahu on national TV. That’s the world’s best immunization rate and roughly four times the U.S. rate.
To find out how the Jewish state has become such an overachiever, I interview its national Covid-19 coordinator, Nachman Ash. Dr. Ash, 60, began his medical career in 1987 as a combat physician in the Israel Defense Forces. Before retiring from the service, he rose to the rank of brigadier general and the position of IDF surgeon general. Seated in his spartan office in Lod, south of Ben Gurion International Airport, he tells me he’s fighting a “24/7 war.” His current job is “the most intensive” he’s ever had, “much harder” than being chief medical officer of the Israeli army, even in wartime.
Dr. Ash is Israel’s second Covid czar. He took up the post on Nov. 12, after his less diplomatic predecessor quit amid clashes with Mr. Netanyahu and tussles with (frequently recalcitrant) ultra-Orthodox Jews, who chafed against lockdowns and other social restrictions.
Like all good officers, he’s proud of his victories but quick to credit others. He ascribes Israel’s vaccination successes to its political leaders, who showed foresight in concluding early deals to stockpile the Covid vaccine. Officials had “direct discussions” with Pfizer, in which they offered the company a scientific quid pro quo. Israel got the shots early, and in the quantities it needed, and in exchange Pfizer received access to the results of the vaccinations, tabulated by a country with a first-rate medical system and a reputation for statistical and scientific integrity. Dr. Ash calls it “a win-win deal” and believes Pfizer would say the same.
The results match those of earlier, much smaller clinical trials. “We’re seeing around a 95% effectiveness for preventing disease,” Dr. Ash says. “So in real-life data analysis, the results are as good as the research that Pfizer had done.”
Widespread vaccination has curbed infection rates and improved morale in a gregarious country that has endured three rigorous lockdowns in the past year. The last one, much-hated by Israelis, ran from Jan. 8 to Feb. 7, 2021. Citizens were confined to within 1,000 yards of their homes. Schools were shut.
Dr. Ash doesn’t apologize for the hardship. “I believe that each of the three times we had to use the lockdowns, it was absolutely necessary.” He disagrees vehemently with the Great Barrington Declaration, in which a group of epidemiologists advocate “focused protection” of the vulnerable and an end to lockdowns.
“No, no, no. I think that’s a very dangerous way of dealing with the pandemic,” Dr. Ash says. “They believe in stopping the pandemic by what I’d call ‘natural herd immunity,’ which you achieve by allowing people to be infected. But this is wrong, because we will lose a lot of life.” An adamant commitment to protect its citizens’ lives has been a hallmark of Israel’s civic compact since its creation. The same aversion to loss of life that marks Israel’s civil defense against Hezbollah’s rockets can be seen in its cautiously incremental approach to resuming normal life amid the pandemic. The country is betting big on vaccinations. “Once around 80% of the population of Israel is vaccinated,” he says, “we’ll be close to herd immunity.”
Dr. Ash talks me through Israel’s vaccination methods—and numbers—with a quiet satisfaction. “We vaccinated those at risk first, but not in slots that were too narrow.” Israel started in December by offering vaccines to everyone over 60—the age limit in most U.S. states is 65—as well as to anyone with comorbidities. When the number of over-60s being vaccinated plateaued, “we opened it up to those 50 and above.”
Next, Israel extended the vaccine to those between 16 and 18. “We wanted them to be vaccinated before a return to school, once the lockdown ended,” Dr. Ash says. Children younger than 16 are excluded because the U.S. Food and Drug Administration—whose regulations Israel is adhering to—hasn’t approved the Pfizer-BioNtech vaccine for that age group.
After the teenagers, vaccination was thrown open to nearly all comers. “We’re not yet vaccinating anyone who has had Covid and has recovered from it,” Dr. Ash notes—though they will soon get one shot to bolster their natural immunity. As of Friday, Dr. Ash’s spokeswoman reports, 3.1 million Israelis have received both shots and 5.1 million have received the first shot. For Israelis 50 and over, the full-vaccination rate is 86%. When you exclude the ineligible—children and the 738,000 people with immunity from previous infections—from the denominator, you end up with a full-vaccination rate better than 80% for all ages 16 and older.
Vaccines have been administered through Kupat Holim—Hebrew for “sick funds”—the four insurance organizations that are the mainstay of Israeli healthcare. Every citizen is required by law to sign up with one of the four, and Dr. Ash was director of the Health Division at Maccabi Healthcare Services, the second-largest, before he became Covid czar. There are clinics even in the smallest towns. “Every Kupat Holim,” Dr. Ash says, “is vaccinating its people.” This is an aspect of vaccination delivery that would be impossible to replicate in the U.S., with its hodgepodge of unconnected medical providers and insurers.
What the two countries have in common is an observable pattern of Covid-vaccine skeptics. In Israel, three groups stand out for their susceptibility to what Dr. Ash calls “fake news” about the vaccine: Arabs, immigrants from Russia and young women. At the request of the Israel government, Facebook has taken down “deliberately mendacious” Hebrew-language content asserting that the vaccine was a poison designed to cull the population and implant tracking chips in bodies. “Some young women,” he adds, “are afraid they risk losing their fertility. This is baseless.”
But the government might have turned a corner with another group—the ultra-Orthodox—who’ve also been resistant to the state’s direction. “These groups are influenced by their rabbis,” Dr. Ash says, “and we have had good discussions with the rabbis about the vaccinations. They are encouraging people to get vaccinated, so we’re now doing pretty well with them.” The key is to persuade leaders of tight-knit communities that vaccination makes sense. “There is no other way, whether with the ultra-Orthodox groups or the Arabs,” though with the latter group, the divide isn’t religious: “We work with mayors and local leaders. They can get the message across to their people much better than I can do.”
One way of overcoming resistance to the vaccine, he says, is with the inducement of a Green Pass. Israelis can download an app that verifies they’ve been vaccinated or have recovered from Covid. This enables pass-holders to enter gyms, hotels, concert venues and other spaces that are off-limits to those who aren’t immune.
What about the Palestinians? Israel’s critics argue it hasn’t done enough for them. Dr. Ash responds that the Palestinian Authority has its own vaccine contracts and is a part of the World Health Organization’s Covax initiative for low- and middle-income countries, but he also points to a pattern of contacts between his team and administrators in the Palestinian territories.
Israelis and Palestinians, he adds, “share a very small territory, with many interconnections.” Many Arab Israelis go back and forth to the West Bank, and Palestinians come to Israel to work. “So the disease links us, definitely, and they will be vaccinated. Not just for their sake, but also for ours.”
Mr. Varadarajan, a Journal contributor, is a fellow at the American Enterprise Institute and at New York University’s Classical Liberal Institute.
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