Countries around the world are looking to Israel as a model of how vaccination could bring a return to “normal,” but whether it can be replicated remains unknown.
With 57% of its population fully vaccinated, the country may have already reached herd immunity if those who have contracted and recovered from COVID-19 are included in its protected group.
Cases have fallen from a peak of more than 8,000 a day, on average, in mid-January to just a few hundred per day, with only about 250 people currently hospitalized and 160 seriously ill. With the help of a vaccine passport system, Israelis are going back to gyms, restaurants, stadiums, and theaters. The country has also lifted an outdoor mask mandate, and inked new deals with Pfizer and Moderna for booster shots as more variants emerge.
Some of the factors that have helped Israel speed the vaccination process may prove difficult to emulate, but there are measures the U.S. — and other countries with slower vaccine uptake — could turn to, experts said.
The Israeli government has taken certain actions that have made it different from other places, Dorit Reiss, PhD, professor of law at UC Hastings College of Law in San Francisco, told MedPage Today. In January, the government signed an initial deal with Pfizer in which the company would deliver vaccines early in exchange for sharing aggregated data on its inoculations.
Israel is an ideal place for mining vaccination data because its healthcare system consists of a small number of large HMOs, and most people are a part of it, Reiss said. The necessary infrastructure is already in place for conveniently distributing vaccines and maintaining data on inoculations. That’s far different the decentralized U.S. system, she said.
Many people in the U.S. have had to travel a long way to get the COVID-19 vaccine, Reiss said. In Israel, if someone has to travel half an hour to get to a doctor, it’s highly unusual.
Israel’s small geography and population of just about nine million has helped, said Vardit Ravitsky, PhD, professor of bioethics at the University of Montreal. But beyond geographic accessibility, “the organization of the healthcare system was suitable for this type of delivery,” she said.
“Everything was centralized and clearly delivered,” Ravitsky said. “The rollout was fast and furious.”
Israel had priority groups for vaccination, but was also flexible when it came to getting vaccines into as many arms as possible, she said. If there were a few leftover doses on certain days at certain locations, they would be given to anyone.
The benefits of reaching herd immunity are not only about preventing hospitalizations and deaths; they’re also about stopping the emergence of new variants, Ravitsky said. Through its data-sharing agreement with Israel, Pfizer will study those potential benefits at certain vaccination milestones.
To date, the benefits have seemed vast. Though there have been reports of the B.1.617 — or “double mutant” — Indian variant in Israel, the country has reported some vaccine efficacy against it. A study in the New England Journal of Medicine showed that two doses of the Pfizer vaccine — in this nationwide, mass vaccination setting — reduced cases by 94%.
Reiss said Israel’s “green pass” or vaccine passport may have provided marginal help when it comes to vaccination rates, but that there are other things that may prove more useful in the U.S., such as better data collection and greater efforts to bring vaccines directly to people, she said.
Aimee Afable, PhD, MPH, of SUNY Downstate Health Sciences University’s School of Public Health, concurred, citing the public health tenet of bringing care to where people are.
“We could apply that to vaccination,” Afable said. “I still don’t see it happening” because of barriers like people not having time to wait on line at vaccination sites, or not having access to the technology needed to sign up for appointments.
The concerns about a slower rollout are real, she said.
“The more you’re allowing the virus to spread in a population and also within the host, the more likely the virus can mutate,” Afable said. “Low levels of vaccination will contribute to a higher likelihood of mutation and more variants.”
Given the significantly higher levels of full vaccination in Israel — compared to about 25% in the U.S. — there are more possibilities for the virus to mutate in the U.S., she said.
Additionally, Afable said, the slower a country is with vaccination, the less effective vaccines will end up being. Recently, there have been more positive cases in people who have been fully vaccinated. (Even a small study out of Israel noted the potential for breakthrough infections, especially as a result of new variants.)
Though Afable said she doesn’t know if the U.S. will ever move toward universal healthcare, she said she believes more centralized electronic medical records could help to address some of the challenges of low uptake the U.S. is facing.
“With better data, those things can be much more easily identified,” Afable said, “and then remedied.”