'People Feel Protected': Why Are 1 Million Israelis Not Getting the Booster Shot?

Israeli officials worry COVID-19 vaccine holdouts may decide how serious the next wave becomes

Ido Efrati
Ido Efrati
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COVID-19 vaccine in Israel
COVID-19 vaccine in IsraelCredit: Ohad Zwigenberg
Ido Efrati
Ido Efrati

They are not anti-vaxxers or COVID deniers, actually quite the opposite: They have already received the first two doses of the coronavirus vaccine, or were infected and recovered. Nonetheless, over one million Israelis who are supposed to receive a booster shot have not gotten one, even though it is supposed to increase antibodies and reduce the chances of infection.

These “booster refusers,” who are not the same as the approximately 670,000 Israelis who have decided not to be vaccinated at all, represent about 15 percent of Israelis age 12 and older who have been vaccinated. Most of them are young people age 16 and up who have already been vaccinated or recovered (the 12-to-15 age group only began getting vaccinated at the end of June, and they have to wait at least five months between the second and third shots).

At the end of the fourth wave of COVID last autumn, when the population of Israelis not fully protected numbered over 1.2 million people, many experts urged policymakers to focus on this group. But in the end, most of the vaccination effort was devoted to children and adolescents. Only recently, with the spread of the omicron variant of the virus, have Prime Minister Naftali Bennett and health care officials have begun to focus on the booster holdouts and pressure them to get a third shot.

As most of the population is getting further away from the time they received the second dose of the vaccine, which means that efficacy of the vaccine fades, the danger of an outbreak in Israel from the omicron variant has made these Israelis the ones who could determine how serious the next COVID wave becomes.

The fact that only about 5,000 Israelis are being vaccinated every day with the booster shot shows that this group is not about to disappear on its own accord. Along with those who have never been vaccinated against COVID, children too young for the vaccine and those aged 5 through 11 (only 10 percent of whom have been vaccinated), Israel now has about three million people who aren’t fully protected from infection.

A coronavirus testing center at the entrance to a children's musical show, last month.Credit: Moti Milrod

Data from the Health Ministry and the health maintenance organizations shows that as a rule the younger that Israelis are, the more likely they have not gotten a booster. The Clalit Health Services HMO, which insures over five million Israelis, reported that among those 80 and older, only 9 percent of those eligible to receive a booster have not yet done so, and for those aged 70 to 79, the figure is 8 percent. For the 60-to-69 group, it is 12 percent; for ages 50 to 59, 20 percent; for ages 40 to 49, 24 percent; and for ages 30 to 39, it is 30 percent. For the 19-to-29 age group, the figure rises to 37 percent; and only half of those eligible from age 16 to 18 have received their third dose of the vaccine.

“We get all kinds of responses and reasons, but our feeling is that people have lost the willingness,” said Ruth Baruch, who heads the Clalit’s coronavirus vaccination campaign. “They thought this would end with two doses of the vaccine, but now they’re saying to themselves, ‘What, now we’ll get vaccinated every six months, like with flu? We don’t get vaccinated for that, either.’”

In calls to patients, Baruch added, “We hear responses like ‘it’s all over, it’s no longer a burning issue.’ Some think we’ve already beaten the coronavirus, while others think the variants change in any case, and what will happen if a new variant appears in another two weeks? We also sometimes encounter fears about fertility and long-term effects.”

These views may be at variance with the science about the need for boosters, but they are understandable. Vaccines were depicted as a decisive solution to the pandemic, and initially they were highly effective. Vaccination rates were accordingly high. When vaccines first became available and were officially only administered to older people, people ages 30 to 50 thronged to vaccination clinics, hoping for surplus doses so they could get one right away.

But now the situation looks different. The vaccine’s waning effectiveness, the need for boosters and the appearance of new variants has hurt the vaccine’s image. Moreover, incidence of the virus is low, there are few legal restrictions and people don’t feel at risk.

The Social Policy Institute at Washington University in St. Louis has been studying the public’s attitudes toward vaccination over time by repeatedly polling 2,400 people starting in June 2020. Its latest poll, from November, asked Israelis who received the first two doses why they weren’t getting the booster. Respondents could pick more than one answer.

Children receive their coronavirus vaccines in Netanya, this month.Credit: Avishag Shaar-Yashuv

Fully 37 percent cited fears of long-term side effects, 35 percent deemed the booster unnecessary and 33 percent feared short-term side effects. Nineteen percent said they were pregnant, trying to get pregnant or nursing, while 12 percent said they didn’t need to get vaccinated as long as other people did. Nine percent said they didn’t have time or couldn’t get to a vaccination clinic.

Dr. Oren Heller, a research associate at the institute, said the reasons were similar to those given by people who didn’t get vaccinated at all. But these respondents did get the first two doses, indicating that they have changed their minds or no longer have faith in the vaccines’ effectiveness.

Another noteworthy fact, according to vaccination data and sources in the health system, is that vaccine refusal is particularly high in the Arab community. The Meuhedet HMO, for instance, said vaccination rates among its Arab members is 20 percent below its nationwide average. The lowest rates of all are in East Jerusalem.

Dr. Abed Altif Mahameed, a Meuhedet physician whose patients come from the Wadi Ara region, said the biggest factor in booster resistance is that the fear is gone.

People feel protected,” he said. “The hospitals aren’t bursting with seriously ill patients. But perhaps omicron will increase the fear.”

Socioeconomic factors also play a role, he added. “Laborers who return home after a hard day’s work don’t feel they need this.” And a third factor is the time of year. “Summer in the Arab community is full of events,” he explained, and the strict regulations “pushed people to vaccinate. Now, that’s all over.”

Nevertheless, Mahameed said, improving access to the vaccines would help. “Mobile vaccination clinics need to go to the schools and vaccinate as many people as possible there,” he argued, noting that many Arabs getting to a clinic is difficult.

The Health Ministry is running daily vaccination campaigns in towns with low vaccination rates, but it’s focusing on children, and success rates have been low. Earlier this week, for instance, it ran campaigns in seven towns – Bu’eine Nujeidat, Majdal Shams, Jisr al-Zarqa, Zemer, Yavneh, Karnei Shomron and Rahat – dispatching 36 mobile vaccination clinics to schools and 20 in other locations. But only 1,181 people got vaccinated, including just four adults.

With the omicron variant spreading, HMOs are being pressured to ramp up vaccination rates. But so far, the system has found no way to persuade the million Israelis still refusing to get the booster. And time is running out.

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