Analysis |

These Factors Will Determine if Israel's Vaccination Drive Succeeds

It's all about speed and efficiency ■ Despite public doubts and fake news, there may actually be too much demand for the vaccines ■ Why it's in Israel's interest to expand the drive to the West Bank and Gaza

Amos Harel
Amos Harel
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Prime Minister Benjamin Netanyahu and Health Minister Yuli Edelstein arrive at the Maccabi Healthcare Services vaccine complex in Tel Aviv on December 13, 2020.
Prime Minister Benjamin Netanyahu and Health Minister Yuli Edelstein arrive at the Maccabi Healthcare Services vaccine complex in Tel Aviv on December 13, 2020. Credit: MARC ISRAEL SELLEM /AFP
Amos Harel
Amos Harel

A historic and heartening milestone will be marked on Saturday evening, December 19, when Prime Minister Benjamin Netanyahu will become the first Israeli citizen to be vaccinated against the coronavirus. Other senior figures will follow, among them President Reuven Rivlin and IDF Chief of Staff Aviv Kochavi, as well as hundreds of thousands of medical personnel. The inoculation of the masses is set to begin next week. First in line will be the elderly and those with underlying conditions – populations that are at high risk of serious consequences if infected.

The measure of the health system’s success will be first and foremost the speed and efficiency with which the high-risk population is vaccinated. Two doses of the vaccine are required within 21 days, followed, most likely, by another few days to build maximum immunity.

How COVID – and Israel’s Trump-brokered lovefest with Arab states – are affecting PalestiniansCredit: Haaretz

But the value of the process for more than 1.5 million Israelis is expected to be high and almost immediate. If 60,000 to 80,000 people are actually inoculated every day, it’s possible that relief from the pandemic could be felt from mid-February. With the high-risk groups relatively well protected, this reduces the danger of the hospitals being flooded with seriously ill patients, and mortality in Israel from COVID-19 would also gradually decline.

Even before that, the fact that most of the medical teams will have been vaccinated should put a stop to the vicious circle of infection and quarantine among them, thus enabling the hospitals and community clinics to function better.

Still, it will take time to reduce the level of infection among the general population. As the danger of serious illness and death from the coronavirus diminishes, the government will come under increasing, and justified, pressure to reopen the economy and kickstart the activity that was suspended this year.

But not everyone in Israel will be vaccinated. At the directive of the Health Ministry, which emulates the American model, children under the age of 16 and pregnant women will not be vaccinated at present. That represents about a third of the population, according to Central Bureau of Statistics data for 2019. In other words, if, as thought, herd immunity for the coronavirus is achieved when 60 to 70 percent of the population is vaccinated (or has recovered from COVID-19), pretty well the entire remaining population needs to be vaccinated to reach the necessary level.

The past few days have seen mild panic in the media, stemming from the false allegations being spread by anti-vaccinationists on social media. A distinction needs to be drawn between ideological opposition to vaccination as such, and understandable fears harbored by segments of the public about a new vaccine that was authorized for use rapidly owing to the global emergency. A serious public relations campaign is needed, so it’s a good thing that Netanyahu and Rivlin, both of whom violated the lockdown regulations at the start of the crisis, are stepping forward to be inoculated and are setting a personal example.

Unwarranted boasting

However, looking a little farther ahead, Israel could well face the opposite problem. A large demand for the vaccine might develop, which the state will have a hard time meeting initially, especially when people grasp that their chance to return quickly to a comparatively normal life depends on their readiness to be vaccinated. The Health Ministry estimates that about 4 million doses of Pfizer vaccine will arrive in Israel by the end of the month, and another 3 to 4 million doses during January. The vaccine developed by Moderna, which this weekend is likely to become the second vaccine to receive the approval of the U.S. Food and Drug Administration, will probably arrive in Israel during the first half of 2021, but at the moment there’s no guarantee that this will happen already at the beginning of the new year. Pfizer’s 8 million doses will suffice to vaccinate 4 million people. On the assumption that the health maintenance organizations meet the planned rate of 60,000 to 80,000 a day, a bottleneck could develop in April, with demand for the vaccine exceeding the supply of available doses.

Netanyahu, who acutely discerned that the vaccination campaign is Israel’s only way to break free of the epidemic, is presently occupied with trying to increase the number of vaccine doses that will be sent to Israel and with moving up the supply date. Because he’s in a never-ending campaign, he is also inflating his achievements. “I worked very hard to bring in the vaccine,” he reiterated on a number of occasions this week, as though he himself had developed the medication and as though other Western countries hadn’t been ahead of Israel and hadn’t bought a far larger number of doses for their citizens. Some of those countries also refrained from holding a welcoming reception by their leadership for the arrival of the first cargo plane – but never mind, a little sentiment isn’t out of place.

The only problem is that this celebration has another goal: to obscure the government’s blunders in dealing with the coronavirus crisis, snafus that are still going on. The policy on the planes landing in Israel is a scandal that parallels the onset of the epidemic. Allowing thousands of yeshiva students to enter the country in March, under pressure from the Haredi parties, has now given way to obstinate insistence on not classifying the United Arab Emirates as a “red” country. This, in defiance of the emerging understanding that tens of thousands of Israelis have turned Dubai into a venue to escape the stricter regulations in Israel and that no small percentage of them return from there as carriers, though the authorities here aren’t even trying to impose quarantine on them. Fear of offending our new friends from the Gulf has so far overridden the danger to public health.

Ultra-Orthodox Jews wear face masks and are separated by plastic partitions in Bnei Brak, Israel, September 21, 2020.Credit: Oded Balilty / AP

The Health Ministry is now discussing the possibility of classifying all countries as red and thereby obligating all returning Israelis to undergo quarantine. The emerging solution recalls the lengthy refusal to single out the red cities in Israel – Arab and Haredi – for special treatment, with the result that more serious restrictions were inflicted on the general population. Dr. Sharon Alroy-Preis, head of public health services, hinted that the decision about the flights is not wholly professional in character. As such, she echoed the allegations of the former coronavirus chief, Prof. Ronni Gamzu, who saw the politicians undermine and torpedo his “traffic light plan.” (The experts’ frustration at the government’s behavior is also discernible in the belated admission this week by the outgoing acting police commissioner, Maj. Gen. Motti Cohen. In his farewell message to the police force he suddenly remembered to note that he had been forced to cope with attempts to intervene in his work, and that the two-year delay in appointing a new commissioner was “not without ulterior motives.”)

In the meantime, the coronavirus morbidity rate continues to rise. This week far more tests were conducted and more carriers were found, but concurrently an unconnected increase was recorded in the rate of those who tested positive, which went up by about a percentage point, to 3.5 percent. There are now 110 red and orange communities in which restrictions are in force. An average of more than 2,500 new carriers are being confirmed in Israel daily, above the bar that the government set for entering a condition of “tighter restraint.” Like other dubious linguistic innovations, this is a bureaucratic euphemism aimed at blurring the true implications: a partial lockdown that will again shut down the street-front stores, malls and markets and close down most of the education system in the orange and red locales, as well as reduce public transportation.

Israel is not exceptional in the difficulties it is experiencing with the epidemic. The incidence of sickness and death rose again this week in most of Europe, while the United States has yet to record a downturn from the appalling records that were broken there in the past month. It’s unlikely that Israel can feasibly adopt the means and methods that other countries, such as Taiwan and New Zealand, have tried, which kept them relatively safe from the virus. But when Netanyahu takes pride in the relatively low mortality rate here from the coronavirus, it’s necessary to recall the facts. The population in Israel is very young on average and the level of medical treatment is high – those are the real reasons for the results.

What the Netanyahu government actually stands out for is its fitful, panicky, failed response to the crisis. A person who has been involved in the decision-making in the affair from the start told me back in June that the way things looked, only a vaccine would rescue Israel from the health and economic crisis it was plunged into by the pandemic. He was right. But the hoped-for success of the mass vaccinations will not be able to erase the government’s blunders, and before we arrive at good results, additional multitudes here will be stricken by the coronavirus.

The Palestinian connection

The future success of the vaccination campaign in Israel is deeply dependent on another factor, too: the situation in the Palestinian territories. As has been shown throughout the crisis, there is no way to separate the morbidity inside Israel from that in the West Bank. The virus spreads on both sides of the Green Line via Palestinians who work in Israel and in the settlements, and through commercial and family ties between the inhabitants of the West Bank and the Arab population in Israel. The state of the epidemic in the Gaza Strip also has ramifications for Israel. In this case, the rigid physical separation does in fact generally prevent the virus’ passage, but there’s another danger: If Israel is perceived to be overcoming the epidemic while COVID-19 continues to spread in the Gaza Strip, that will be an incentive for Hamas to resort to violence to force Israel to help the authorities there.

A Palestinian merchant wears a protective face masks as he serves a customer in Rafah in the southern Gaza Strip on December 10, 2020Credit: SAID KHATIB / AFP

Accordingly, extending the vaccination campaign to the West Bank and Gaza Strip is an Israeli health and security interest. Efforts have been made in the past few weeks to get rich countries in the Gulf, such as the UAE or its rival, Qatar, to finance the purchase and transport of vaccines for the Palestinians. So far, Israel’s assistance to the Palestinians in coping with the coronavirus has been limited to instructing medical teams and supplying testing kits. The next stage will be more difficult and more expensive, but without it there will probably be no way to succeed in the battle against the coronavirus in Israel.

The virus remains the most influential factor in shaping the security situation. The exceptional quiet stood out in a visit to the Gaza Strip border this week. That has to do with what most concerns Hamas: 210 COVID-19 deaths as of Thursday and 500 to 700 new cases a day – among them, recently, the leader of the organization in the Gaza Strip, Yahya Sinwar.

Possibly, though, a deeper insight is taking shape here. To some extent, Hamas is now arriving at the conclusion reached by Israel, also painfully late, in connection with Operation Protective Edge in 2014. Namely, that another military campaign in the Gaza Strip will not lead to anything new. In the past, Hamas’ leaders claimed that if they occasionally made waves of escalation and rocked the boat, ultimately Israel would be forced to lift some of the restrictions it imposes on the Strip, and there will always be someone in the Gulf to pay the costs of rehabilitation. But only part of the promised funds have reached Gaza since the last operation, more urgent needs have developed in the Arab world amid the regional shake-up, and what is most disturbing to the Palestinians: The normalization between Israel and a growing number of Sunni Muslim countries is reducing their commitment to the Palestinian cause.

Incidents have occurred along the Gaza border lately, too. In September, Israeli troops detained a Palestinian who tried to cross the fence and was found to be wearing an improvised explosive belt whose detonator had apparently failed. In another case, young Palestinians were seized after crossing the fence with grenades (apparently with a desire to be apprehended, knowing that in the absence of proof of intent to commit sabotage, the army would simply return them to the Gaza Strip). And last week, when a Golani infantry brigade unit entered the so-called Israeli “security perimeter” zone which the sides accept – about 100 meters west of the Gazan border fence – it was closely accompanied by Hamas fighters armed with machine guns. Had it not been for the restraining presence there of senior Israeli officers, the tension might have erupted into an exchange of fire.

However, from the viewpoint of the Israel Defense Forces, these events don’t change the essentials. Hamas is now looking for economic relief, projects to improve the infrastructure and aid in dealing with the coronavirus epidemic. Acceding to its requests – which are contingent as well on finding a solution for the complex negotiations on the return of two Israeli civilians and the bodies of two soldiers – could usher in a lengthy period of quiet in Gaza.

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