The news that sent stock markets soaring on Monday has two bottom lines for Israel. On the one hand, the vaccine being developed by Pfizer isn’t ready yet, but it certainly seems very promising; on the other hand, Israel needs to hope that it will reach a deal with Pfizer in order to actually buy some vaccines, hopefully by the second quarter of 2021.
None of this is certain yet. Pfizer is at the end of its stage 3 trials, the critical stage for receiving approval for its coronavirus vaccine. Stage 3 hasn’t finished yet because the results currently don’t meet the standards for statistical significance. Of the 30,000 people participating, half received the vaccine and half received a placebo injection. To date, 94 of them have caught the coronavirus.
The excellent news is that 90% of those infected had received the placebo. This is a particularly high percentage, which could indicate that the vaccine is effective at protecting against the coronavirus. The bad news is that in order to show that the results are statistically significant, a full 164 people need to catch the virus. Another 70 trial participants need to fall ill – and there’s no plan to try to infect them intentionally, so Pfizer just needs to wait until it happens on its own. Before it happens, it can’t declare the vaccine a success.
Furthermore, not much time has passed since the participants were vaccinated, so it’s also too early to draw conclusions about the risks or problems the vaccine might create.
So while Pfizer can’t call the vaccine a success yet, it did come out and state that the vaccine trial is advancing better than expected, in that 90% of all virus cases were among people who received the placebo. Presuming that the next 70 infections are distributed in the same manner, we can congratulate Pfizer on a job well done, and declare that we have an effective vaccine against the coronavirus.
But then there’s the second issue, which is more problematic for Israel. First off, Israel has no acquisition deal with Pfizer, so the vaccine trial results mean nothing for it. This leaves Israel jealously watching from the sidelines: Millions of Americans will likely receive the Pfizer vaccine and return to their pre-virus routines while Israelis continue sitting through lockdowns, unable to get their hands on it.
Israel has indeed conducted vigorous negotiations to acquire vaccines from Pfizer, but it still hasn’t signed a purchase contract, and the whole world is going to be jumping on Pfizer now – even as all indications show that the Americans will try to keep as many of the vaccine doses within the United States as possible. In other words, Israel might as well find itself 237th in line to buy Pfizer’s vaccines.
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And yet, there’s some hope: The negotiations are in an advanced stage, Pfizer is a massive company capable of producing a high volume of vaccines, and Israel is a small company that could manage with even a small number of vaccines, at least to protect those at highest risk: health-care workers and other at-risk populations. In other words, maybe we will manage to buy a small number of vaccines within reasonable timeframe – by the second quarter of 2021. But it’s still hard to say how likely this is.
This brings us back to the point of Israel’s vaccine acquisition strategy. Israel has purchase agreements with only two companies: Arcturus, a small firm that announced Monday that it expects to start distributing vaccines by the first quarter of 2021, but is still in the first stage of testing; and Moderna, a mid-sized company whose vaccine is in the third and final stage of testing, but which still has not announced results.
Israel is also part of a World Health Organization initiative called COVAX, under which countries buy vaccines together and distribute them based on needs, with vaccines going to the poorest nations first. This is an important initiative but it’s primarily philanthropic, and it’s not clear how much Israel itself will actually benefit from it.
Israel’s main assets in the vaccine race are two acquisition deals with private pharmaceutical companies, Arcturus and Moderna. Should one of these companies actually produce a vaccine, Israel’s situation will improve greatly, but this is still far away from actually happening.
Israel’s vaccine acquisition strategy raises several questions. First off, why did we sign acquisition contracts with only two companies, and with small-midsize companies at that? Second, both companies are using an innovative technology (mRNA) to develop a vaccine, which may be quite an advanced technology, but no actual vaccine has been developed using it yet. The vaccines that Pfizer and Moderna are developing are the most advanced attempt to develop a vaccine using this method.
It’s exciting to be at the forefront of technology, but given the level of risk, Israel probably would be better off if it were to sign contracts with companies using a better-known method, and to balance its risk by signing with companies using a range of technologies. This hasn’t happened.
A third question relates to production capacity. Even if Arcturus and Moderna produce a vaccine, Israel may not actually get access to it, or may not get enough of it, since the companies may not be able to meet demand.
Moderna signed with a large Swiss pharmaceutical company to increase its production capacity. But this creates another problem for Israel: Just as the Americans are likely to keep most if not all vaccine doses for their own use at first, the Swiss government may be inclined to do the same thing.
Furthermore, Israel has signed a contract to buy a relatively small numbers of vaccines from each company – 1 million does from each. The COVAX initiative could potentially provide a large number of vaccines, but at this stage it’s entirely theoretical. This means that under the best-case scenario, only one-quarter of all Israeli residents would get a vaccine at an early stage. In Canada, for comparison, the government has signed contracts to buy four times the number of vaccines needed to inoculate the entire population, with the exception being that only some of the vaccines will pan out. Israel has done no such thing.
Regarding the two contracts that Israel did sign, the conditions may have been too draconian. Israel paid $238 million to Moderna that it won’t get back under any circumstances – even if the vaccine fails, if Moderna can’t supply it for other reasons, or if it turns out to be unsafe in retrospect. The contract with Arcturus is even more expensive, but at least it is conditioned on success.
Israel is also unlikely to be able to protect itself should the vaccines turn out to be unsafe due to American legal protections preventing lawsuits or reimbursements in such cases, among other reasons. But most countries are also facing that problem.
The final challenge will be carrying out a mass vaccination campaign, as well as the logistics involved in getting the vaccine here. The United States is preparing for a mass vaccine delivery campaign amid concerns of shortages of glass vials and needles. Meanwhile, Moderna’s vaccine needs to be stored at minus 20 degrees Celsius, and Pfizer’s vaccine needs to be stored at minus 80 degrees Celsius – so a dry ice shortage could be on the way, too.
Beyond that, Israel will need to decide who gets the vaccine first, and stick with it. The whole thing is a massive project, and the United States has drafted the military and the shipping companies to make it happen. It not likely that Israel will be equally as ready.