Does Israel Really Need 30 Million More COVID Vaccine Doses?

A Gantz-Netanyahu Twitter feud may provide the answer

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Benjamin Netanyahu adjusts his mask during a news conference at a vaccination center in Tel Aviv, in March.
Benjamin Netanyahu adjusts his mask during a news conference at a vaccination center in Tel Aviv, in March.Credit: Miriam Alster/Reuters

"An unbelievable scandal: for the sake of appointments and cushy jobs, Benny Gantz is preventing the signing of contracts for millions of vaccine doses that the citizens of Israel need in advance of the next vaccine," Prime Minister Benjamin Netanyahu’s Likud party tweeted on Sunday evening.

This was the opening salvo in attacks on Kahol Lavan leader Gantz, who also serves as defense minister and alternate prime minister in the outgoing government, which on Tuesday still showed no signs of stopping. A succession of Likud members, including the health minister, have accused Gantz of putting the contracts for the vaccine at risk by refusing to consent to the convening of the cabinet.

"After the huge success of the vaccine and treatment for the coronavirus, after the economy has been put back on track, Gantz is going to set us back by months. The reason doesn’t even matter," Health Minister Yuli Edelstein warned.

But the reason does matter. Gantz said he would not permit the cabinet to convene on Monday, when cabinet ministers were due to vote on purchasing additional coronavirus vaccine doses, as well as billions of shekels in additional funding for the Health Ministry, after Netanyahu's own rebuff.

Without providing a reason, the prime minister refused to hold a cabinet vote on the appointment of a permanent justice minister to fill Avi Nissenkorn's position, vacant since his resignation on January 1. The Justice Ministry is controlled by Gantz’s party.

A Benny Gantz campaign poster for the March 2021 election, depicting him as a backstop to Netanyahu's ruleCredit: Hadash Parush

Instead of pinning the blame on Gantz, Netanyahu could have – and still can – appoint a permanent justice minister, as Attorney General Avichai Mendelblit has demanded. “A situation in which the State of Israel would remain without a serving justice minister for an undetermined period and that could be extensive is highly unusual and serious from the standpoint of governance,” Mendelblit warned.

Netanyahu pushed Gantz into a corner and he is no less at fault for the delay in convening the cabinet. For their part, Israelis got another painful reminder of the heavy price of the country's dysfunctional political system. The contracts for the purchase of the vaccine had been ready to sign for at least a week and a half but were deferred due to last week’s Knesset election – although that undermines the claim that every additional delay is a matter of life and death.

Senior figures at the Health Ministry helped Likud figures convey the consternation over the delay. In an interview with Army Radio, the ministry’s director of public health, Dr. Sharon Alroy-Preis, also expressed concern about the delay in convening the cabinet and signing the contracts.

The ministry's director general, Chezy Levy, who declared he doesn't get involved in political matters, also weighed in: “From the medical-professional standpoint, this delay is difficult. At this time in Europe, they are trying to prevent the sale of vaccine beyond the continent. If we have a contract, we’re protected. The delay endangers our ability to equip ourselves with additional vaccine, to pay the shipping companies that transport them and to continue to successfully fight the coronavirus. This is liable to harm the health of us all.”

But the fight over the cabinet meeting obscures a more important battle between the Health Ministry and the Finance Ministry over the vaccine procurement contracts themselves. The Health Ministry has pushed for expanded procurement of vaccines to give the country a wider cushion of supply, but the Finance Ministry claims that their demands are excessive, profligate and that locking Israel into inflexible contracts would prevent selling excess supply to third countries, while failing to ensure that pharmaceutical firms are obliged to supply future versions of the vaccine that are adapted to deal with variants of the coronavirus.

A pharmacist holds a vial of the AstraZeneca COVID vaccine in a pharmacy in Nantes, western FranceCredit: LOIC VENANCE - AFP

Too many vaccines, and too much secrecy

The cabinet is due to approve the purchase of more than 30 million doses of coronavirus vaccines from Pfizer, Moderna and from the U.S. firm Novavax at a cost of 3.5 billion shekels ($1 billion), at the request of the Health Ministry. Israel has already purchased more than 25 million doses that have either been supplied or are due to be delivered this year from Pfizer, Moderna and AstraZeneca at a cost of more than 2 billion shekels ($600 million). If the new contracts are signed, Israel will have more than 60 million doses for this year and next, and some may expire before they are used.

This includes several millions of AstraZeneca vaccine doses which, according to several reports, have already been purchased and are expected to arrive in September. The company has faced a real crisis in Europe after questions were raised about the safety of the company’s vaccine and regarding its inferior effectiveness compared to the Pfizer and Moderna vaccines. Although European countries have resumed the use of the AstraZeneca vaccine following assurances from the World Health Organization and the European Medicines Agency, the public in those countries is showing less eagerness to receive the AstraZeneca vaccine, which could also happen in Israel.

The main advantage, according to health officials, is that AstraZeneca's jab is based on a virus that causes the common cold in chimpanzees, rather than the messenger RNA of Pfizer and Moderna vaccines, which has unknown effects in its third and fourth doses.

At this stage of Israel’s vaccination drive, it requires just over 2 million doses to finish vaccinating all Israelis aged 16 and over. Ten million doses have already been administered, meaning that the 60 million jabs represent five times the number of doses already injected.

As reported by TheMarker, there is considerable secrecy surrounding the terms of Israel’s vaccine procurement. Dozens of senior finance and health ministry officials have been required to sign strict confidentiality agreements that bar them from speaking about the subject. Over the weekend, Kan public broadcasting reported that cabinet ministers are also being asked to sign a confidentiality form, preventing them from making public comments on the subject.

It is unclear whether the strict confidentiality relates to the agreements themselves, or whether the secrecy is designed to stifle public debate over huge vaccine purchases are unlikely to all be used. Behind the scenes in recent weeks, there has been considerable tension between the finance and health ministries on the subject, TheMarker has learned. The Health Ministry’s demand, particularly regarding the number of doses and their limited shelf life, has sparked considerable opposition at the Finance Ministry, but due to confidentiality requirements, the matter cannot be aired publicly.

Finance Ministry officials argue the quantities, and therefore also the cost of the vaccine, are excessive and go well beyond what the country needs as a reasonable cushion to ensure necessary supplies. So far, 10 million doses of the Pfizer vaccine and several hundred thousand Moderna vaccine doses (which have been given mostly to Palestinian laborers) have been administered by Israel, and it would only require just over 2 million more doses to inoculate every Israeli aged 16 and above.

There are also the unanswered questions over whether Israel would be able to sell leftover inoculations to a third country and whether they are guaranteed to receive vaccines for future variants of the virus from companies with which they have struck a deal. Apparently the answer to both questions is no. Up to this point in time, Israel has provided excess supply to other countries, a move that was halted when the attorney general and the Finance Ministry’s accountant general intervened, and it seems as though Israel could get stuck with surplus vaccines.

Health Ministry officials, however, claim they are preparing for hazy horizons. They are aware that the proposed contracts exceed Israel’s needs, but they claim they are required in light of the prevailing uncertainty regarding the pandemic and future needs, especially in light of the danger posed by shortages of vaccine.

Levy, the ministry's director general, points to Europe's potential ban on exporting the vaccine beyond the continent, particularly to countries such as Israel, where vaccination levels are high. If Israel signs the new contracts, it might be protected against such export bans. The ministry is also hastening Israel to sign contracts prior to the completion of clinical trials of the vaccine on children, before stiff international competition sets in.

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