The secrets to Israel’s coronavirus vaccination success

Just three weeks since the first Israeli citizen received the BioNTech/Pfizer jab — Prime Minister Benjamin Netanyahu himself — the country has raced ahead of the rest of world with vaccinations, covering about 20 percent of its population to date.

Reasons behind this roaring start are fast emerging: Netanyahu revealed on January 7 that Israel struck an agreement with Pfizer to exchange citizens’ data for 10 million doses of the coronavirus vaccine, including a promise of shipments of 400,000-700,000 doses every week.

Under this agreement, Israel will provide details to Pfizer (as well as and the World Health Organization) about the age, gender and medical history of those receiving the jab as well as its side effects and efficacy. No identifying information will be given in order to maintain some privacy.

Ten million doses are a drop in the ocean for Pfizer, which has pledged to produce 1.3 billion vaccine doses in 2021 — and is likely to produce more. Once regulatory approval came in mid-December — ahead of the EU — Israel was waiting with its syringes out, making it worthwhile for Pfizer to remove the first vaccines from its production line to one of the first countries that would use them.

The news couldn’t come soon enough for Israel. It has reported more than 495,000 COVID-19 cases and 3,689 deaths since the beginning of the pandemic — alarmingly high figures for the small country of 9 million.

Pfizer clearly has much to gain by rolling out its vaccine in Israel, turning it into the global pilot for a rapid vaccination campaign — and the depth of results now available to Pfizer, especially if successful, can boost marketing worldwide.

“We convinced them that if they give their vaccine to us first, we will know exactly how to administer it in the shortest time possible — and this is precisely what happened,” Israeli Health Minister Yuli Edelstein told POLITICO via his spokesperson. “We were prepared early, signed the agreements early, and told pharmaceuticals they would see results early. It’s a win-win situation.” 

With some days seeing more than 150,000 people getting vaccinated, Edelstein said, he’s confident about Israel’s success: “We continue to lead worldwide.” 

Still, health authorities aren’t answering direct questions about the exact number of doses Israel has secured or how much it paid for them, saying only that the country signed secret agreements with manufacturers as the vaccination campaign began.

Also unclear was the price it had paid for the Pfizer jab — until January 5, when officials disclosed off-the-record that Israel paid $30 per dose. That’s more than twice the amount listed by Belgium, for example, which accidentally revealed its vaccine price list when Belgium’s secretary of state tweeted it.

Netanyahu — who is hoping to get reelected in March — has also repeatedly brought up his close relationships with the chief executives of Pfizer and Moderna, suggesting his connections helped secure millions of doses. 

“I speak to them all the time,” Netanyahu said. He added that Pfizer CEO Albert Bourla, a descendant of a Jewish family from Thessaloniki, is “a great friend” of Israel.

Small country, strong health care

Israel has a mandatory public health system connected to a nationwide digital network. Health maintenance organizations keep digital records of all patients, allowing any authorized computer to extract people’s medical data since birth — including past hospitalizations, prescribed medications and vaccinations.

“An operation at such scale could not have happened in a private health care system,” said a senior nurse at Israel’s renowned Ichilov hospital in Tel Aviv, who preferred to remain anonymous. She has vaccinated hundreds of people against the coronavirus so far.

“I have never seen so many health care workers volunteering their free time for the greater cause like this,” she explained. The sense of social solidarity and the feeling of being in this together has contributed massively to the speed of Israel’s vaccination campaign — “perhaps more so than in other countries,” she said. 

For now, Israel is prioritizing people older than 60, health workers and people with medical conditions, followed by over-55s with underlying conditions. At this point, more than 72 percent of people aged 60 and older have been vaccinated.

Not without hurdles

Israelis have so far only been receiving the Pfizer jab, but the country has also secured deals with Britain’s AstraZeneca and U.S. manufacturer Moderna. The latter announced last Tuesday that its vaccine had been approved by the Israeli health ministry. 

Moderna promised to supply 6 million doses, enough to vaccinate 3 million people. Israel has already received the first of an expected four shipments coming over the next few weeks, with a second shipment of about 480,000 doses expected Wednesday or Thursday. 

Bottlenecks or distribution hurdles aren’t solved once imported doses cross the border, however. Unlike the Oxford/AstraZeneca jab, the Pfizer vaccine needs to be kept at minus 70 degrees Celsius, which requires special storage techniques.

These jabs are handled by SLE, the logistics unit of Teva Pharmaceutical Industries. Thirty underground freezers located in a facility near Israel’s main international airport hold about 5 million doses, which are then repackaged into 100-dose bundles and delivered across the country.

Distributing the jabs quickly is crucial, and this is one area where the eagerness among Israelis to get vaccinated is accelerating the effort. Interest is so high that every day, queues of younger people hoping for leftover doses form in front of inoculation stations. WhatsApp groups filled with people contacting each other to secure these doses have also appeared. 

Ahead of the pack

Despite leading vaccination campaigns worldwide, Israel has come under fire from human rights groups and news organizations for failing to provide vaccines to Palestinians in the West Bank and Gaza. The Palestinian health ministry has more than 100,000 confirmed cases in the West Bank, with more than 1,100 deaths, in a population of roughly 3 million. Gaza has reported over 45,000 cases in 2 million residents, with more than 400 fatalities.

There is also the issue of cross-border traffic: About 60,000 Palestinian workers enter Israel every day, most of whom work in the construction industry. But Israel only started testing them in December, when the Coordinator of Government Activities in the Territories (COGAT) announced it would start conducting sample testing.

Despite the urgent situation, the Palestinian Authority (PA) in the West Bank has not publicly asked for Israeli assistance in vaccine procurement, and Hamas, which controls the Gaza strip, is highly unlikely to coordinate with Israel in any vaccination effort.

But according to the Russian Direct Investment Fund (RDIF), which is responsible for marketing the main Russian vaccine against COVID-19, known as Sputnik V, the Palestinian health ministry has approved its jab for use on Monday, with the first shipment of the shot expected to arrive next month.

Over the weekend, Palestinian general director of public health Yasser Bozyeh said that the PA had also sought supplies from Moderna, AstraZeneca and Johnson & Johnson, in addition to supplies expected through COVAX, the WHO’s vaccine program for poor and middle-income countries.

Still, Israeli media reported last Wednesday that thousands of doses have already been passed to the West Bank, a claim which was later denied by the PA Health Ministry.

There also remain pockets of communities that might hold out. Israel’s Arab minority — about 21 percent of the population — has shown wariness towards vaccination. And numerous ultra-orthodox Jewish communities are ignoring the coronavirus-control measures altogether, resulting in infection rates sometimes five times higher than in many secular cities.

In the meantime, Netanyahu has vowed to increase Israel’s vaccination pace to at least 170,000 people per day. But as many of his critics point out, it takes more than a country’s leader to secure such operation.

“Personally, I am truly excited to take part in the vaccination efforts,” said the Ichilov senior nurse, who’s also a fierce critic of the prime minister. “The amount of people wholeheartedly committed to this operation is what made it all possible.”

This article is part of POLITICO’s premium policy service: Pro Health Care. From drug pricing, EMA, vaccines, pharma and more, our specialized journalists keep you on top of the topics driving the health care policy agenda. Email [email protected] for a complimentary trial.