'It's a World War, Competition Is Mad': Israel Fails in Its Hunt for Ventilators Abroad

Suppliers of ventilators from the U.S., Germany and China backed out from providing equipment, leaving medical authorities with narrow options to avoid shortages in battle against the coronavirus

Ido Efrati
Ido Efrati
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The Hadassah Ein Kerem hospital, March 2020.
The Hadassah Ein Kerem hospital, March 2020.Credit: Emil Salman
Ido Efrati
Ido Efrati

Israel’s efforts to quickly procure ventilators from abroad to address the coronavirus pandemic ended in clear failure this week, official documents obtained by Haaretz show.

As a consequence, Israeli authorities decided to halt further efforts to buy the equipment overseas, and to concentrate on meeting the needs through domestic resources.

For a number of weeks, Israeli health care authorities have been anticipating substantially boosting supplies of ventilators through orders that had been placed. The new items were promised to intensive care units and hospitals, in preparation for a spike in the number of patients needing them because of the coronavirus. About a week ago, however, a German supplier withdrew a commitment to supply 1,000 of the devices in the time frame that had been agreed upon.

And at the beginning of the week, according to official documentation, U.S.-based General Electric gave a similar notice that it could not meet its commitment to supply another 1,000 devices within the original time frame. For his part, Oren Karasik, the technology vice president of Levant Technologies, which supplies General Electric ventilators in Israel, told Haaretz that Israel’s order from GE has not been canceled and may still be supplied in the future. He insisted that, contrary to the official documentation, at no time had GE committed to a specific time frame for delivery.

A doctor undergoes a training in a new department for critical coronavirus patients at the Sheba Medical Center at Tel Hashomer, March 2020.
A doctor undergoes a training in a new department for critical coronavirus patients at the Sheba Medical Center at Tel Hashomer, March 2020.Credit: Eyal Toueg

In yet another discouraging development, it became apparent that China was no longer an option as a supplier after an Israeli agent who was to obtain another supply of 1,000 ventilators there gave notice that the machines had been taken by another customer.

The fact that Israel’s major effort to secure ventilators abroad was unsuccessful increases the risk that demand might outstrip supply, as was the case in Italy and other countries. The number of coronavirus cases keeps rising and patients who require ventilators need them for an extended period of two to three weeks. Data issued last month by the Health Ministry shows that Israel has 2,864 ventilators, only about half of which would be available to new coronavirus patients. Last week, the ministry announced that it had a contingency plan to prepare for the prospect that within three or four months, Israel’s hospitals would have to provide care for 15,000 moderately to seriously ill coronavirus patients, including about 5,000 who would require respirators.

In a letter to the hospital directors last week, Dr. Vered Ezra, who heads the ministry’s medical management division, wrote: “Despite the difficult steps that we have taken, the rate of infection is high and the number of those infected has grown at a rate that is concerning. The characteristics of the disease and the pace of infection require wide-ranging continued preparation.”

In recent weeks, the hospitals have been preparing to step up their intensive care units’ treatment of patients on ventilators in the expectation that they would also be receiving additional machines and equipment. As a result, the hospitals have been providing training and carrying out drills with medical staff, including doctors who normally don’t treat patients on respirators.

Doctors in the department for coronavirus patients at the Sheba Medical Center at Tel Hashomer, April 2020.
Doctors in the department for coronavirus patients at the Sheba Medical Center at Tel Hashomer, April 2020.Credit: Ofer Vaknin

On the positive side, figures from the past several days regarding the number of seriously ill patients on respirators shows that their numbers are growing at a more modest pace, providing grounds for cautious optimism.

One set of data obtained by Haaretz indicates that the coronavirus crisis is expected to end by this summer, with a sharp drop in August in the number of patients on respirators, even to the point of a return to normal in the health care system. But the data are not accompanied by an explicit statement regarding the projected end of the crisis. One way or another, the consistent message coming out of the health care system and from others involved in handling the crisis is that the situation is still precarious and could quickly deteriorate to a drastic extent, with a spike in patients on ventilators.

With the anticipated major shipments of ventilators from abroad now not an option, Israel will have to rethink its plans. The country does not have the capacity to manufacture its own devices on a large scale and instead will immediately have to be creative and look to Israel’s R&D and improvisation capabilities, which already exist.

The data also show that protective gear for medical personnel are in short supply. For example, the country has 20 million surgical masks, which would be expected to suffice only until the end of this month. Supplies required for May are in the process of being purchased and produced. There is also a shortage of high-performance N95 masks and of gowns, goggles and overalls.

Ventilators provided by Israel's defense industries.
Ventilators provided by Israel's defense industries. Credit: ministry of defense

In the current reality, it’s difficult to consider the retraction of commitments for ventilators from the United States, Germany and China surprising, or to say that the possibility was not considered from the beginning.

“It’s a world war. There’s mad competition to buy ventilators, medicine, medical equipment and protective gear. It has been with us since the beginning of the crisis and it’s just intensifying,” a health care system procurement official.

“All of the stories are true. Representatives of Israel have been going around with cash and closing [a deal] with suppliers, but a short time later it’s canceled because representatives from another country have made a better offer,” he said. The stiff competition and the pace at which things are moving don’t always make it possible to check the equipment in an orderly manner before it is purchased, he explained. “There’s a constant race against time, because a country that you’ve managed to get equipment from today won’t necessarily be available tomorrow. This whole expedited process is constantly presenting dilemmas over the balance between speed and the quality of the equipment.”

U.S. ambassador David Friedman and Mossad chief Yossi Cohen in Jerusalem, in 2019.
U.S. ambassador David Friedman and Mossad chief Yossi Cohen in Jerusalem, in 2019.Credit: Yoav Dudkiewicz

The Health Ministry’s main medical procurement affiliate is the Sarel firm, which generally does purchasing for Israel’s government hospitals and has been providing vaccines and public health system equipment. There are also other entities that do procurement for the public health system, including the country’s four health maintenance organizations.

Clalit and the Mossad

Clalit, the largest HMO, does procurement for the 13 hospitals that it owns as well as for its community clinics and other facilities, which on their own provide medical care for half the country’s population. Clalit has a network of ties and a wide range of suppliers around the world and is considered one of the world’s largest purchasers of medical equipment.

Nevertheless, due to the global shortage of equipment and the stiff competition that has developed due to the coronavirus, the Mossad espionage agency has become Israel’s dominant player in leading procurement efforts and chasing down medical equipment.

“It involves a wide variety of medical equipment – a lot more than ventilators – parts and tubing for the machines, various monitors, protective equipment and drugs,” the medical procurement official said.

Another individual who is involved in purchasing for the public sector and who has worked with the health care system claimed that not everyone in the system and at the Health Ministry has understood the implications of involving the Mossad in buying masks or medical equipment. “In this situation, there was absolutely justification in resorting to ‘special means’ to obtain the necessary equipment. The only mistake is that it became public. The Mossad’s work should have been kept confidential.”

“One of the advantages in deploying an agency like the Mossad for rapid procurement abroad is that it can work by bypassing bureaucracy such as a law requiring a bidding process or getting an exemption from bidding,” a former senior Health Ministry official remarked. “The way that things are being done from that standpoint includes steps from the world of espionage and recruitment of agents, including quick payments in cash or bribery, if necessary.”

And he added: “These are means that are not naturally part of the procurement and bidding systems of the Health Ministry. It’s an exceptional approach that is resorted to in a special emergency situation.”

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