The caretaker cabinet failed to meet again this week, and therefore did not discuss whether the government needs to spend 3.5 billion shekels ($1.05 billion) on another 36 million doses of coronavirus vaccine – an acquisition that would push the total number of doses Israel has purchased to date beyond 60 million. Sixty million – that’s nearly seven times the country’s population, enough to vaccinate 30 million people. So far Israel has used just 10 million vaccines.
But while everyone is arguing over whether Israel actually needs another 36 million doses, it turns out that there are quite a few issues involving the 27 million doses that Israel already acquired. Finance Ministry Accountant General Yali Rothenberg sent an angry letter to Health Ministry Director General Chezi Levy this week, after it emerged that the Health Ministry had acted surreptitiously, without informing the Finance Ministry, contrary to vaccine acquisition contracts and contrary to the rules of government conduct. The Health Ministry admits that most of the accountant general’s allegations are correct.
In his letter, Rothenberg lists three specific problems in the Health Ministry’s conduct. The first relates to Prime Minister Benjamin Netanyahu’s decision to send Moderna coronavirus vaccines overseas, to friendly countries (the Czech Republic, Rwanda, Honduras and Guatemala), which violated Israel’s contract with Moderna. The Health Ministry complied obediently with Netanyahu’s command. The ministry also admits that after Moderna found out that its coronavirus vaccines had been sent abroad without the company’s permission, the company immediately halted new vaccine shipments to Israel.
Later the Health Ministry requested – and received – permission from Moderna to use vaccines the company sold to Israel to Palestinians who work in Israel. Moderna stated as a condition that Israel needed to ensure that the vaccines were administered in keeping with all safety precautions.
Rothenberg’s second complaint was that Israel received more vaccine doses from Pfizer than it had paid for, and without undertaking to pay for them. Ostensibly it received vaccines for free – except nothing is free when it comes to multinational pharmaceutical companies, particularly not when you’re talking about a vaccine in high global demand and short supply. Pfizer supplied more than the 10 million doses it had committed to providing – enough to vaccinate 5 million people – at the Health Ministry’s request, after it decided to expand eligibility to include people who had recovered from the coronavirus, pregnant women and others, and thus vaccinate some 6 million people in total.
Pfizer provided the vaccines as part of its goal to enable Israel to vaccinate its entire target population, and after the Health Ministry stated that it any case it intended to buy tens of millions more vaccines from Pfizer, and that they’d settle accounts when paying the bill for the massive new order.
The problem, as the Health Ministry itself admits, is that all agreements with Pfizer were made verbally, without informing the accountant general, who is the person who signs the check. In practice the Health Ministry forced Israel to buy more Pfizer vaccines. The Health Ministry’s close relations with Pfizer – top Health Ministry officials along with Pfizer’s scientists authored a scientific study on the effectiveness of the Pfizer-BioNTech vaccine in Israel – raise a good deal of discomfort.
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The third issue that raised Rothenberg’s hackles was the Health Ministry’s commitment to Pfizer that it would be the country’s only coronavirus vaccine supplier – that Israel would use only the Pfizer-BioNTech vaccine until the country reached herd immunity. This is the only allegation that the Health Ministry only partially acknowledges. The Health Ministry counters that it committed only to sharing data regarding the effectiveness of Pfizer’s vaccine and its ability to enable Israel to reach herd immunity. In practice, this data is being collected only in regard to the Pfizer-BioNTech vaccine, and not the vaccines of any other company. In other words, Israel has committed to examine the impact of only Pfizer’s vaccines, and to publish joint research on it.
These issues amplify concerns regarding Israel’s intent to sign contracts to buy another 36 million vaccines. First off, Israel has purchased another 17 million doses of vaccine that it hasn’t used, from Moderna and AstraZeneca. Why can’t we just use these ones? The Health Ministry won’t answer this question directly, raising the impression that regarding the Astra Zeneca vaccines at least, we’re not inclined to use them at all due to questions regarding their safety that arose in Europe. These vaccines will either be thrown out, or sold to other countries, should Astra Zeneca allow it.
Israel’s vaccine waste is likely to only worsen should the country go ahead and order another 36 million doses. The contracts that would be signed now are supposed to be final, and would allow some flexibility through September for the government to decide whether to delay supply until 2023 – but wouldn’t permit Israel to cancel outright. Israel wouldn’t be permitted to export vaccines should it have surplus supply, unless it receives permission from the manufacturers to do so.
In addition, the contracts require only that the companies act with goodwill when it comes to supplying vaccines updated to combat coronavirus mutations – the presumption being that should they update their vaccines, they’ll supply the new version. They also mandate nothing more than goodwill in terms of supplying vaccines that reflect technological advances – such as a vaccine that requires only one dose. Here, too, the presumption is that the companies will offer this if it’s possible.
The contract terms are draconian, and leave Israel dependent on the companies’ goodwill on a long list of issues. At the very least, Israel could limit its exposure by ordering fewer vaccines, but the Health Ministry is insisting on another 36 minion doses – two booster shots for every adult and child, twice a year, every year. In other words, four vaccines a year for all 9 million residents.
The problem is that no one knows whether anyone will need a booster, and if so, how many. Most experts are presuming that the vaccine will likely function like the flu shot, meaning that most people will need a single booster shot once a year. That would mean the country would need some 9 million to 18 million vaccine doses for the next two years, and not necessarily all from the same company. That’s one-quarter to one-half the quantity the Health Ministry is calling to buy.
The difference between 9 million and 36 million doses is enormous. The Health Ministry hasn’t offered a statistics-based scenario explaining the need for a full 36 million vaccine doses, and it’s also not holding public discussions on the matter. This question is falling under the secrecy with which the country is conducting its acquisition negotiations with the companies, even though it’s a professional consideration unrelated to the commercial contract considerations, and even though the Health Ministry has already failed on this point before.
Last year, for example, the Health Ministry forced the country’s health care networks to buy a massive stock of seasonal influenza vaccine, fearing the impact of a flu season on top of the coronavirus pandemic, and ultimately most of these vaccines were thrown out. This year, the health maintenance organizations objected and announced that they wouldn’t buy nearly as many flu vaccines.
Before we repeat that mistake, but five times bigger, we need to be checking our base assumptions with transparency and professionalism.