Doctors Charge Israel's Health Ministry With Being Unprepared for Measles Outbreak

Senior physicians tell Haaretz that the ministry waited months before taking action, then doing so in a hestitant fashion and deploying insufficient human resources

File photo: An ultra-Orthodox child getting a measles shot, Jerusalem, November 2007.
Daniel Bar-On

Senior physicians are harshly critical of the Health Ministry’s handling of the recent measles outbreak, saying it waited months before taking action, then did so in a hesitant, disorganized fashion and deployed insufficient human resources.

This has created confusion and even panic among the public, they added.

“The penny didn’t drop that this was a significant event,” said a specialist in infectious diseases. “The ministry should have realized back in the summer that we were facing an emergency and had to mobilize all systems.”

After multiple measles cases over the summer raised fears of an outbreak, he added, the ministry made do with recommending that people traveling abroad be vaccinated.

>>Everything you need to know about the measles outbreak roiling Israel

Sources at the ministry’s Kol Habriyut hotline said they had told ministry director general Moshe Bar Siman Tov back in 2017 that they had gotten many calls about measles, but he did nothing with this information.

The ministry first recognized that it had a real problem only six months after the media began reporting the outbreak. The number of measles cases started rising noticeably in March, and in August, 250 cases were diagnosed, about eight times as many as in all of 2017.

Additionally, many measles patients were discovered on flights to and from Israel. But as noted, the ministry merely recommended that people get vaccinated before flying to certain parts of Europe, where the outbreak began.

In October, there were almost 700 known cases. The most significant outbreaks were in ultra-Orthodox neighborhoods of Jerusalem, Beit Shemesh and Betar Ilit, due to crowded conditions and vaccination rates of only about 50 percent. Smaller outbreaks occurred in the north and in West Bank settlements; there were also dozens of cases in Tel Aviv.

Last week, an 18-month-old infant in Jerusalem’s ultra-Orthodox Mea She’arim neighborhood died of the disease — the first death from measles in 15 years. To date, there have been more than 1,400 measles cases, and doctors at Jerusalem hospitals said they’re afraid they’re losing control.

“This is a scandal,” a senior official at one of Israel’s main health maintenance organizations said of the ministry’s conduct. “We’re lucky it’s only measles and not some other disease.”

The ministry “has made every possible mistake in managing the crisis and explaining it,” he added. “What’s happened in recent days is an attempt to cover this up by working with the media to look as if it’s doing something. But the result has been panic.”

The ministry’s handling of the outbreak differed greatly from its handling of a polio outbreak in 2013-14 under then-Director General Prof. Ronni Gamzu. To combat distrust of the system among certain communities and the influence of vaccination opponents on social media, he met personally with opinion leaders in various communities, including rabbis and imams. As a result, 980,000 children were vaccinated against polio between August 2013 and January 2014, and the disease caused no injuries or deaths.

The difference in the handling of these two crises “is enormous,” one senior doctor said. “The polio crisis was defined as an emergency at an early stage and the crisis was handled through mobilization of and cooperating among many players — doctors and experts, HMOs, local governments and others.”

“There’s a key problem of leadership here,” added a person involved in handling several previous health crises. “I don’t think the person heading the ministry today can run the response to such an event.”

“This is both a professional and a communications crisis,” he continued. “It needs a lot of knowledge and experience in both fields and requires active management ... and a level of information far more detailed than what exists today.”

The crisis has also revealed the poor state of Israel’s public health service and its unpreparedness for an emergency. In 2012, this service employed 1,227 nurses, who administered vaccines and tracked epidemics by locating anyone exposed to a given disease.

Today, however, the number has shrunk to 920, leading to waits for vaccinations and follow-up visits. In addition, examinations have become less thorough and less frequent.

Since the measles outbreak began, these nurses have been working 12-hour days. This week, therefore, the ministry asked nursing students to help out.

“All 920 nurses are now dealing with the measles; all routine activity has been halted,” said Moriah Ashkenazi, an official in the nurses union. “The load is so heavy that the nurses aren’t managing to collect information and send reports to the Health Ministry in real time.”

“We’re seeing families whose children have never been vaccinated,” she added. “We have to complete not just their measles shots, but also other vaccinations, with all their explanations, records and instructions.”

Ilana Cohen, who heads the nurses union, said the outbreak has shown how neglected the public health service is. “There has been no correspondence between population growth and the number of nurses,” she said. “We’re short at least 140 nursing positions in the public health service.”

Compounding the problem is the fact that no ministry official has communicated with the public directly or given media interviews to explain the situation. And waiting times at the Kol Habriyut hotline are 10 minutes or more.

Parents said they are feeling pressured, confused and angry. They feel they lack information to deal with the crisis and complained of lack of access to medical personnel. Hotline operators don’t seem to know much, they added, and it’s hard to make appointments. Moreover, the ministry’s published recommendations are confusing.

One mother from Herzliya, for instance, said she tried for three days to call her local vaccination provider to arrange a booster shot for her son, but there was no answer.

And when Haaretz tried to make an appointment for a booster shot for an adult, it was told that the next available appointment at Tel Aviv’s district health office was on February 11.

Another problem is that responsibility for vaccinations is divided among several agencies — district health offices, well-baby clinics, companies hired to provide health services to students, HMOs and clinics — depending on the patient’s age and condition.

“The first thing that stands out is the confusion and ignorance of people who call to ask questions,” said a senior HMO official. “Even our hotline operators don’t have all the answers.”