Another COVID Outbreak and What to Do With the Children: Israel's Post-vaccine Dilemmas

As the country's vaccination craze is waning, it is left with two million unvaccinated children, which raises many medical and ethical questions

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A woman walking with a stroller in Jerusalem, January 2021.
A woman walking with a stroller in Jerusalem, January 2021. Credit: Emil Salman

“I’ve had enough,” one of my friends wrote, and she didn’t even need to elaborate. The woman, who has a senior role in her field and is the mother of young children, was feeling what we’re all feeling. This third lockdown, which was just extended by another 10 days, is the worst and most discouraging of them yet, and has pushed the public’s mental and financial resilience to the brink.

Despite the lockdown and the fast pace of vaccinations, dozens of coronavirus patients are dying every day. Hospitals are struggling to provide their best level of medical care, and millions of Israelis are feeling the stranglehold of the lockdown.

According to a study conducted by Hebrew University researchers, which echoes the findings of teams at the Weizmann Center, the Technion and the Tel Aviv University, coronavirus patients in serious condition are increasingly likely to die, and to die more quickly. Meanwhile, the impact of the vaccination campaign is not yet being seen on the infection rate.

Here are five points that Israel will be thinking about over the next few weeks.

A military nurse prepares to administers the coronavirus vaccine in Tel Aviv, January 18, 2021.Credit: Hadas Parush

1) The vaccine craze is passing

The vaccine campaign, our only great hope for getting out of this pandemic, is nearing the point where the initial rush of early adaptors is waning. The Health Ministry announced that it’s preparing to vaccinate 250,000 people a day – a welcome goal and not trivial at all. The people eager to be vaccinated are already mostly vaccinated, and now the real challenge of getting the hesitant to come in begins, as well as those opposed to vaccination.

To put things into proportion, relative to other countries with high rates of vaccine opposition, Israelis are cooperating impressively with the campaign, but from here onward it will become more challenging.

So far, the great incentive to get vaccinated was the fear of infection itself – the stick. It’s likely that we’ll soon start seeing use of the carrot – benefits and exemptions for people who are vaccinated, such as exemption from quarantine after exposure to a sick person, or permission to enter cultural institutions. These carrots raise plenty of ethical, legal and health concerns, but it’s clear that they’ll play a central role in the efforts to maintain Israel’s pace of vaccination.

2) Fast, unequal infection rate

A week and a half into the stricter lockdown, and nearly a month into the partial lockdown, the virus is still spreading quickly. Maybe it’s the British mutation, maybe it’s the winter, maybe it’s the human component and the disregard for social distancing. In the meantime, the virus has the upper hand.

And yet the virus isn’t spreading evenly throughout the entire population. Currently, there are nearly six times more ultra-Orthodox coronavirus patients per capita than among the general population, and the positive test rate is four times higher among the ultra-Orthodox community (21.5%) than among the public at large (5.1%). The infection rate is also higher than average among the Arab population, with a 12.1% positive test rate over the past week.

This means Israel needs to focus on getting vaccines to these critical at-risk groups, primarily those that are refusing to get vaccinated or at least are in no hurry to do so. The main party here is the Arab community, which has a relatively low vaccination rate, but also parts of the ultra-Orthodox community. Until these communities are broadly vaccinated, we’ll keep seeing high rates of sickness and death.

Israelis receive a Pfizer-BioNTech COVID-19 vaccine from medical professionals at a vaccination center set up on a mall parking lot in Givataim, Israel, January 20, 2021.Credit: Oded Balilty,AP

3) Patience with ultra-Orthodox is over

The disparity in infection rates among the ultra-Orthodox and the population at large is like social dynamite, and the anger currently being felt on social media is close to pouring out into the real world.

The Israeli public, which is sitting home in the midst of a third lockdown, is watching as parts of the ultra-Orthodox public evolved into an enclave with its own rules – rules set by Rabbi Kanievsky, or his grandson.

Parents whose children haven’t been to school in person in months, and whose neighborhoods have low infection rates are watching how in ultra-Orthodox-majority locales schools are still open even as the virus rages, and the government is not send in any enforcement. Even mass weddings are still being held.

The main victims are the ultra-Orthodox themselves, abandoned to sickness and death by their leaders and the government. They are dragging the entire country after them, since every individual is dependent on the conduct of the masses, and the patience for this is wearing thin.

If anyone still thought that the infuriating photos of ultra-Orthodox schoolchildren heading to school en masse or mass weddings would provoke a response from the government or some form of leadership, Prime Minister Benjamin Netanyahu stated at a cabinet meeting on Tuesday, “The police here are enforcing more than anywhere else,” and that international leaders have told him “nothing helps.”

4) The last lockdown? Not clear

Before the third lockdown began, we were told that thanks to the efficient vaccination campaign, this would be the last big coronavirus wave, and also the last lockdown.

Nowadays you won’t find any serious expert willing to say such a thing. Given the rapid rate of infection and the fact that significant portions of the population aren’t running to be vaccinated – or simply can’t – it’s entirely unclear that this will be the final vaccination campaign.

Prof. Doron Gazit from Hebrew University forecasts that even if the lockdown lasts another two to three weeks, and the economy begins to reopen when Israel starts seeing fewer than 1,000 confirmed new cases a day, the combination of the infection pace and the extent of vaccination could lead to another outbreak in March.

5) What about the children?

Soon, as the lockdown comes to its end, we’ll need to discuss an issue that has been pushed aside somewhat: the fact that some two million children under age 16 still are not eligible to get vaccinated anytime soon. This means that they themselves are exposed to infection, and they could infect others, including people with suppressed immune systems, unvaccinated pregnant women and others at risk, even if most other people are vaccinated.

This has massive implications as to when and how the education system can reopen, if it is conceivable medically or ethically to let children become infected en masse and whether we can live with the disease so long as one-third of the population isn’t vaccinated.

These questions are emerging not just in Israel, which is ahead of the vaccination curve, but throughout the Western world, which is currently in the midst of a deadly wave with no end in sight.

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