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Vaccine race

How Israel became the world’s vaccine leader—and where it still struggles

Despite early gains, Israel’s vaccine rollout is still leaving far too many people out, says one expert.
January 22, 2021
Israel medical workers get vaccine
Amir Levy/Getty Images
Hadas Ziv
Hadas Ziv, head of policy
and ethics at Physicians for
Human Rights-Israel

Israel was originally praised for its approach to covid-19 vaccine distribution, and was hailed as a model for how to get things done. But the picture that has emerged since is a lot more complicated. Covid-19 infections have reached record highs, and a new lockdown has been extended until the end of January. Meanwhile, there is inequality and political turmoil behind the headlines, with the UN among those criticizing Israel for refusing to share its vaccines with some 4.5 million Palestinians living in the West Bank and Gaza Strip. 

We spoke with Hadas Ziv, the head of policy and ethics at Physicians for Human Rights-Israel, about that country’s successes and setbacks. She was part of the expert team that compiled covid-19 vaccine policy recommendations for the Israeli government, and the group was among those petitioning for prisoners to be vaccinated. 

This interview has been condensed and edited for clarity.

Q: If you’re an Israeli citizen who wants a vaccine, what steps do you need to take?

A: It's very easy. You're notified that you're eligible, either by an SMS, or you can just go into the site of your [healthcare provider], and immediately you see whether you're eligible or not.

You make an appointment on the internet, or they can send you a link to your phone. It's very, very organized. And you just get the vaccine. That’s it.

Q: Is the vaccine free? Have there been any hurdles or confusing rollout processes?

A: The positive side of Israel is that we have a public health system, and everyone, all residents, are insured. So unless you're in a specific group, like migrant workers or refugees or Palestinians in the occupied territories, you're insured, and you're part of the system. 

Q: Are you seeing problems around vaccine hesitancy or refusal?

A: I think that, in general, Israelis trust vaccines. There were a few conspiracy theories in the media, which made people think whether they should wait to see how it goes for those who are being vaccinated. But I think the fear of the disease is bigger than the fear of the vaccine, and the publicity that the vaccine is safe persuaded many. 

We have specific communities [like some ultraorthodox and Arab communities] where there is less trust and information. There should be an effort made by both the health system and the government to persuade and make the information accessible for them so they come and get the vaccinations.

Q:  Israel was seen as a model for the rest of the world in speedy vaccine distribution. But cases have been rising, and the country is in another lockdown. What does that tell us about the role vaccines play in overcoming the pandemic?

A: There’s a positive and a negative in the vaccination [process]. It was speedy—Israel acted like many other Western countries, in what is known as a trend of vaccination nationalism. Each country for its own. 

We have not solved the compliance of the public. There are big differences between different communities in Israel, and we do not enjoy social solidarity. For example, the ultraorthodox are a little bit above 10% of the population but 30% of new cases of covid-19. There is a danger that once you say this community does not obey the social distancing or cannot because of [social conditions] that there is a lot of public anger toward them. That may even deepen the social conflict within our society. 

If you do want to achieve herd protection, you need to reach at least two-thirds of your population. If we do not reach those communities that are now not likely to want the vaccination, we will not reach this number. 

Q. The government and Pfizer agreed to trade medical data for doses of vaccines. What’s the impact of that? Was the public given enough information on the details of this agreement?

We got a special agreement from Pfizer, and when they publicized the agreement, at least one-third of it was blackened out. And I think it’s done more damage than good, because now we don't know how much information they get on us.

If indeed Israel is leading in vaccinating its population, and you do want to learn about the efficacy and adverse effects, why not give this information for free for all the health ministries and systems and laboratories? It's a global challenge. Why make Pfizer the only one with this knowledge? I don't know. This is something that we are trying to look into.

Q: What’s happening right now with vaccine access for Palestinians?

A: We do not give the vaccinations to the Palestinians in the occupied territories. The [Israelis and Palestinians] are in constant movement and they meet each other. And so not only morally—I speak mostly about the moral obligation to give them vaccinations—but also from a utilitarian public health aspect, we must. 

Citizens and permanent residents of Israel are eligible for vaccination according to the age groups. However, Israel also controls the West Bank and Gaza Strip. There’s lots of arguments whether it’s occupation or not, whether it’s apartheid or not. But I look at it from, what power we have, and what responsibility we have.

If we control how much water they [Palestinians] have, what they are allowed to bring in or out from Gaza, what equipment, what people, or what expertise, we have a tremendous effect on the economy, on their health system, and of course, on their capacity to deal with public health crises. I think Israel is obligated to take the Palestinians as part of their responsibility. 

Q: You’ve been part of the fight to vaccinate people in prisons. What is the danger of not vaccinating this population?

A: Just a few days ago, the [public security minister], responsible for all the prisons in Israel, said that prisoners will not be vaccinated until all Israeli citizens outside will be vaccinated, and then not until all prison guards are vaccinated. The Ministry of Health said prisoners themselves are a priority, and in the prisons, those with chronic diseases and the elderly should be vaccinated at the same time as our citizens.

So we had to go to the High Court of Justice. [Public Security Minister Amir Ohana] did change his mind, but the damage was already done. In the government, you have officials who can take irresponsible, populist views that they think the public wants to hear that are contrary, not only to morality and ethics, but also to public health interests. 

Everyone is impressed by Israeli vaccination, fine. But look at the death toll, look at how we operate. Look how we lose public trust. Look at how we are in the third quarantine, but it’s not effective. I don't think we're a success story. Maybe in vaccinations we are. But if you look at covid-19, as a challenge that is both health and social and political crisis, I think we're a failure.

Q: What are the lessons from Israel for the rest of the world?

A: You have to have a public health system that insures all people. I hope that our government will learn the lesson and will invest and better fund our public health system because this saved us. 

I think that they should not learn from Israel and be more generous about vaccination, certainly to your neighbors. It is a global pandemic and it can only be solved globally. Equal distribution among all countries all over the world, more cooperation, is crucial.

Q: The nature of the pandemic is constantly shifting and the challenges are evolving. What are you watching for?

A: The stability of governments. Israel is now going into a fourth election [in two years]. The combination of a public health crisis with a political crisis is extremely dangerous. The trust of the public in its government is crucial if we want to deal with pandemics. It's not only the trust of my people in my government, it's the trust of people in governments in the world system, because once you lose this trust, you cannot handle any crisis. 

This story is part of the Pandemic Technology Project, supported by the Rockefeller Foundation.

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