Analysis |

Israel Is a Success Story With Vaccines. On Other COVID Fronts, It’s a Fiasco

Amos Harel
Amos Harel
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Transportation Minister Miri Regev at a birthday celebration in a small crowded room. Plenty of food, no masks
Transportation Minister Miri Regev at a birthday celebration in a small crowded room. Plenty of food, no masksCredit: @Democrat_TV twitter feed
Amos Harel
Amos Harel

We’ll always have next week. And next week, we’ll know the impact of the big vaccination push to curb the spread of the coronavirus in Israel. As of Thursday, more than 75 percent of Israelis 60 and older had received the first dose, and a minority had received the second.

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These high numbers are meant to help lower the grim infection rate, as most of the people seriously ill with COVID-19 are elderly. According to the initial findings by the Clalit and Maccabi health maintenance organizations, the high inoculation numbers will indeed help curb the infection rate. (Based on its clinical trials, Pfizer has promised that the vaccination dramatically reduces serious illness, but the company hasn’t reported clear conclusions on preventing infection.)

Since the middle of the week we've apparently seen a limited effect of the lockdown that was imposed three weeks ago and was tightened around a week ago. The rise in daily new infections has been curbed for now, along with the number of new patients in serious condition. The hospitals are under a heavy load; even if the number of seriously ill – about 1,000 – isn’t making them collapse, it’s very likely affecting the quality of care both in the coronavirus wards and elsewhere.

As more vaccines arrive from Pfizer and Moderna, the intention is to increase the number of daily inoculations to as high as 250,000 from 150,000 this week. That would enable the two-dose vaccination of most over-16 Israelis by the end of February. Success also depends on the cooperation of those very Israelis. As is becoming clear with the elderly, it’s harder to persuade people who haven’t found time or haven’t wanted to be vaccinated.

One means of pressure will be to extend the privileges of “green passport” holders (actually to broaden the restrictions on people refusing vaccination). This will include free participation in culture and entertainment events.

Prime Minister Benjamin Netanyahu and Health Minister Yuli Edelstein oversee the arrival of a Pfizer vaccine shipment, Ben Gurion Airport, January 11, 2021.Credit: Moti Milrod

The inoculation drive is being accelerated along with the spread in Israel of the British variant, which considerably heightens the infection rate. Benjamin Netanyahu’s promise – on which the success of his election campaign depends – is to reopen the economy by March and allow a full-fledged Passover seder, which this year falls at the end of that month. But the Health Ministry chiefs are a lot more pessimistic and expect heavy restrictions for quite some time.

One critical question relates to children. Pfizer’s instructions only allow the vaccination of people 16 and older, but it’s possible the minimum age will eventually be lowered by a few years. Until that happens, two separate groups are likely to emerge in March: adults, most of whom have been vaccinated, and children, who haven't been.

First, without the vaccination of some children, it’s impossible to talk about herd immunity, which requires vaccination or recovery from COVID-19 of at least 70 percent and probably 80 percent of the population. Second, the question will be whether to continue with the  cycles of testing and quarantine for schoolchildren when the majority of the older and more vulnerable population is vaccinated and exempt from quarantine.

Will it still make sense to test and isolate children in preschool and primary school when the disease’s effect on children is very minor and in most cases asymptomatic? Those are rich people’s problems, as it were, but Israel may have to decide on them soon.

In the meantime, in total contrast to the success of the vaccination effort, the government’s disgraceful management continues on all other coronavirus-related fronts. The following two paragraphs are a random roundup of this week’s news.

The prime minister, the continuation of whose corruption trial was postponed Wednesday because of the lockdown, used his spare time for an election event in “red city” Nazareth, embracing the Arab voters against whom he incited for years. Transportation Minister Miri Regev had her picture taken at a birthday celebration along with 12 aides and associates in a small crowded room. There was plenty of food but no masks.

Health Minister Yuli Edelstein blamed the infection rate on secular people who went to New Year’s parties, though the rate in the ultra-Orthodox community is at least three times as high. And Public Security Minister Amir Ohana did a media number on elderly prisoners, announcing that he doesn’t intend to vaccinate them.

In the meantime, Health Ministry data shows that a third of COVID-19 patients who returned to Israel arrived from Dubai, with the government not requiring Israelis arriving from the Emirates to isolate for fear of sparking a diplomatic crisis with our new pals. The bottom line is that the government under Likud is continuing with its disdain for the country’s citizens – not that this will stop many of them from voting for the party on March 23.

A coronavirus vaccination center belonging to the Leumit HMO, Tel Aviv, January 13, 2021.Credit: Hadas Parush

The other Netanyahu

Predictably, the vaccination project's success has brought with it a rancorous squabble over who deserves the credit. Netanyahu has claimed and received his due as the person who spotted the opportunity to acquire vaccines quickly. The terrible sluggishness of the vaccination efforts in the United States and Europe only highlights the scale of the Israeli achievement.

On the other hand, many have noted the importance of Israel’s HMOs, which probably have never enjoyed such a flattering image. It’s the HMOs that have ensured the efficient operation. Above all, because of them, the manufacturers agreed to put Israel at the top of the list of countries receiving vaccines.

Many of the successes (and failures) of the Israeli health system can be attributed to the National Health Insurance Law of 1994, sponsored by Haim Ramon, the health minister under Yitzhak Rabin. The law created the HMOs’ structure, which fused competition and service with the promise of basic, almost free health care to all. The legislation also required every citizen to be a member of an HMO.

One brilliant aspect of the new structure is that, unlike most of Europe, the HMOs are budgeted based on the number of members and age. Thus the HMOs have a clear interest in maintaining their members’ health, so Israel leads the world in preventive medicine. This is one reason the annual flu vaccinations are organized by the HMOs: They have a financial interest in keeping their members healthy. This is also the basis for the current vaccination project.

All told, much of the credit goes to Netanyahu, but not to Benjamin Netanyahu. It goes to his aunt, retired Judge Shoshana Netanyahu, who led a committee at the end of the 1980s whose conclusions led to the National Health Insurance Law and the HMOs’ budgetary structure that we know today.

Public Security Minister Amir Ohana on a visit to police headquarters of the northern police district in Nazareth, January 4, 2021.Credit: Gil Eliahu

Second opinion

The documentary by Orly Vilnai and Guy Meroz, “And What If the Whole World Is Wrong,” has generated much discussion in the past two weeks. The film is critical of the policy adopted by governments (by Israel in particular) for the coronavirus crisis, and no establishment broadcaster has agreed to screen it. This has only heightened the noise. Many Israelis have watched the film online, and some have been deeply impressed.

I watched the documentary and wasn’t enthused. I didn’t like the melodramatic editing, the one-sided approach and the mistaken impression that the load in the hospitals is inflated. (The film was shot in November, and since then the load has become far more onerous.)

Also disturbing is the way some interviewees flirt with the idea of achieving herd immunity through unchecked infection. On the other hand, many sensible comments are also offered. Some of the experts – Dr. Yoav Yehezkeli, Dr. Dan Yamin, Prof. Hagai Levine – have also been interviewed in Haaretz, and in both platforms have made good arguments against the Health Ministry’s approach.

All this is a natural part of the legitimate differences over the handling of the pandemic. What I find illegitimate is the violent response by the health system.

The head of Israel’s public health services, Dr. Sharon Alroy-Preis, has described the documentary, with the doctors and scientists taking part in it, as a “film of coronavirus deniers and vaccination opponents.” Also on the bandwagon are certain journalists who appointed themselves the web’s chief scientific censors right after they acquired an epidemiology education in record time.

A man walks past anti-vaccine graffiti amid the outbreak of the coronavirus disease (COVID-19) in Belfast, Northern Ireland, January 1, 2021. Credit: PHIL NOBLE/ REUTERS

Vaccination opponents, who do big damage in normal times as well, shouldn’t be part of the scientific and media debate. The people interviewed in the film aren’t like that, even if their views represent a minority in the scientific and medical community, so it’s odd to see journalists gleefully taking part in the suppression campaign.

This phenomenon can’t be separated from many other worrisome trends; for example, senior health officials who always agree with the government getting unlimited screen time and sometimes political opportunities. Then there are the experts whose remarks in the media studios serve Netanyahu’s information campaign verbatim, and the commentators who advise cabinet members (without proper disclosure) and also give them grades. And there are scientists who receive access to data that is concealed from their colleagues and quickly acquire the status of super-forecasters.

Covering defense issues, I thought I had seen everything in the complex triangle of interests between army, retired generals and arms makers. But you learn something new every day – and the coronavirus pandemic is bringing with it plenty of innovations.

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