Insights into Israel’s Remarkably “Successful” COVID-19 Vaccination Campaign:
How to improve vaccine rollout policy for future pandemics
All eyes were on Israel as they were one of the first countries to receive the Pfizer/BioNTech vaccine in December 2020 promising to take it and run the world’s fastest, most efficient rollout. As the weeks and months passed, they kept their promise. Israel proved that they had the “secret sauce” behind what it takes to get people vaccinated quickly. With 10% of their population receiving their first dose less than two weeks into the campaign, they started strong (1). As of mid-May 2021, 60% of Israel’s population has been vaccinated with one dose, and 56.2% have been fully vaccinated (2). This pales in comparison to most countries, such as the US where, after floundering their first rollout and a successful second attempt, they still remain at 35.5% fully vaccinated (2). So what was Israel’s secret? And what can the rest of the world implement into their current strategy and utilize during their planning for the next imminent pandemic?
For one, Israel’s early initiative to develop contracts with pharmaceutical companies to procure vaccines helped get people vaccinated before anyone else (3). Israel submitted themselves as a sort of nationwide laboratory for a real-world phase 4 trial, and that situated them at the front of the queue for vaccine doses (3, 4). Israel offered up data from their unique national database to be used in future studies and to provide a real-world study of the infection prevention, efficacy, and post-surveillance of the vaccine. They were also willing to pay a premium, although official numbers are not available, officials have noted that they paid almost double the cost (3, 5). This effort took collaboration from every facet of the health system from information and financing to service delivery agreements to governance and political leaders and shows that Israel’s framework of facilitating that cooperation is strong (3).
Secondly, prioritization, outreach, and incentives were at the heart of Israel’s initial strategy. Israel was quick to begin a mass educational campaign around the vaccine as well as a clearly defined priority list which was organized by their National Immunization Technical Advisory Group (NITAG) (3, 6). The prioritization strategy emphasized speed over the strictness of determined brackets (10). It was also prompt to reach out to Israeli resident communities lacking access outside of urban centers utilizing its expansive community nurse workforce as well as the Israel Defence Forces (IDF) to set up impromptu vaccination sites (3, 7).
Israel also opted out of more traditional forms of incentives such as “no jab, no pay” schemes for more positive, rewarding ones. They developed a phone app called the “Green Pass” which tracks vaccinated, immune, and tested individuals that allow exemptions from quarantine and access to social, cultural, and sporting events for a determined amount of time according to your status — maximum six months access if fully vaccinated (8, 9). This incentive allows for economic flow and social freedom and only penalizes those who have not been vaccinated, inducing a certain social pressure on those hesitant (8, 10). Due to their success, Israel is operating at near-normal capacity as of March 2021 (10). Again, behind these incentives, outreach, and prioritization strategies lies Israel’s true secret as to why they were able to be so successful. Clever strategies towards things such as incentives are certainly useful to other nations and can be applied to some, but do tend to vary on the population and particular circumstances of any city or nation.
The most significant reason Israel was so successful is the long-term and sustained investment into its healthcare system and the commitment to cooperation between divisions. It is the reason every policy, strategy, and initiative that Israel put forward, flourished. This early investment provides them with the availability, affordability, accessibility, and quality of care (AAAQ) necessary to carry out a mass vaccination campaign quickly and efficiently. Israel’s healthcare system is unique from its advanced technical, logistics, and data systems to its strong workforce and insurance providers (11). Israel has had Universal Health Coverage (UHC) since 1995 and has been making progressive health reforms ever since (11). The WHO’s health system review has shown Israel pegged at 28 out of 191 and often ranks amongst the top ten healthcare systems in the world according to consumer satisfaction (upwards of 75%) and efficiency. It offers residents a choice of four not-for-profits, but still competing, plans to choose from which are always trying to improve their AAAQ (11, 12). They all have the competency to do something that most health insurance providers in other nations do not: communication and cooperation with one another (3, 11). The plans share and aggregate data into a national database that is used for epidemiological and health policy research, which allows for better studies of the population, leading to better healthcare policy (3, 11). In terms of COVID, the unique Israeli childhood immunization registry was helpful in terms of follow-up and post-vaccination effects as well as providing data for the phase 4 trial (3, 5, 11).
Israel is also unique in that healthcare has politics on its side. Politicians often work together with policymakers and scientists to craft policies and campaigns that benefit the population (3). This can be seen with the COVID vaccination rollout, where they had the key political stakeholders deeply involved, including Prime Minister Netanyahu (3). Israel’s key to this campaign was that it was not up to just one strategy, rather it was all of them working in tandem together. The interwoven nature within the divisions of their health system is enhanced by the support of the government, politicians, and the trust of the consumers using it.
This is not to say that the Israeli vaccination plan is without flaws, as there are challenges the whole world is struggling with and Israel is no exception: vaccine hesitancy and vaccine inequity (13). Uptake of the vaccine within Israeli progressively slowed and has now all but halted, leaving Israel with more supply than demand (1). The most vaccine-hesitant are religious minority groups that officials are still struggling to reach via failed campaigns due to distrust of the government. Likewise, in other parts of the world, many countries are still grappling with similar failed outreach attempts to minorities that are being pummelled with misinformation (3, 13). Understanding how to ease vaccine hesitancy will be significant to reaching a global herd immunity of COVID-19, but also to understand how to navigate this in future pandemics.
While there is no question that the Israeli health system did remarkable work in vaccinating their Israeli residents, there are much larger questions about its policies around how far their health system should reach regarding Palestine. Vaccine inequality has been rampant throughout the world, and this is where Israel went wrong. The UN has denoted that the Israeli government is responsible to vaccinate those residing in its territories, yet that vaccination effort began months after the Israeli one did, December of 2020 as compared to March of 2021 (14). Nor did they have the same gusto in their response; as of May 11th, 2021 the number of Palestinians fully vaccinated is 0.9% compared to 56.2% in Israel, with total doses of 214,000 in Palestine and 10.5 million in Israel (2). The UN/WHO/GAVI initiative to help vaccinate those in developing nations, known as COVAX, has agreed to help vaccinate 20% of Palestine’s population. What about the other 50% needed to reach herd immunity (15)? According to Médecins Sans Frontiers, Palestinians are 60 times more likely to contract COVID than Israelis, yet the effort to protect Palestinians is meek at best (16). Without aiding in the Palestinian vaccination effort, Israel is unlikely to reach herd immunity (14). Similarly, without the developed nations of the world coming alongside those still developing nations, the world is unlikely to move past this pandemic quickly.
In future pandemics, the aim should be to offer everyone an equal chance at life. An inclusive strategy is the best strategy when it comes to preventing death and suffering, especially when the resources, infrastructure, and political will are in place to do so. Only time will tell how successful Israel will be at tackling the challenges that stand in its way of herd immunity and future vaccine equity.
Ultimately, the COVID pandemic has shown a light on how important early investments into healthcare are key to the successful pandemic response. A mass vaccination campaign is nothing without the healthcare system foundation that lays beneath it and the countries that have done the best have shown to make these investments long before the crisis strikes. If anything can be taken from this pandemic and applied to what is sure to be the next inevitable one, it is that a strong universal healthcare system that allows for fluid communication and cooperation amongst its sectors is the key to prevent numerous deaths and economic turmoil during a global emergency.
**Please note that this was written for a Health Systems module at the London School of Hygiene & Tropical Medicine as of mid-May 2021 and does not reflect changes in policy, actions of the actors at play since then.
References
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