By Raphael Benaroya
As nations inoculate their citizens against COVID-19, disparate approaches to vaccine administration have produced starkly different outcomes. Comparing the efforts of the United States and Israel raises concerns about the US approach, but also offers a number of valuable lessons for the future.
In the US, the federal government pushed rapid development vaccines and procured stocks under “Operation Warp Speed.” But individual states’ attempts to administer the vaccine have been chaotic, sometime resembling a rush hour traffic jam.
In New York, for example, vaccine doses had to be discarded because not enough patients matched the state’s guidelines. (Once opened, each batch has a short shelf life.) After an outcry against this travesty, the state changed its guidelines to try to ensure all doses will be used before they expire.
Florida was more flexible in its vaccine eligibility requirements than New York, but demand quickly outstripped supply. Many residents encountered disorganization and long lines at vaccination centers. The chair of Florida State University’s social medicine department noted: “It’s not surprising that there would be halting progress and missteps getting something of this magnitude underway.”
And New Jersey, with apparently poor planning and inefficiency, administered only a small portion of its stockpiled doses during the first weeks of its vaccination program.
In the same time span, Israel vaccinated approximately 20% of its citizens.
The contrast between New Jersey and Israel is apt. They both have a populace of roughly nine million, in an area a little under 9,000 square miles.
While New Jersey struggled to deliver its first 100,000 doses, the Israeli government reported 280,000 vaccinations in the first week of its program, and is now surpassing 150,000 per day.
On a per capita basis, Israel’s vaccination pace is almost double that of the next-fastest nation (the UAE), about 10 times faster than the United States, and almost 90 times faster than the world average.
How is Israel doing it? Israeli Health Minister Yuli Edelstein summed it up in three words: “We were prepared.”
Here is how Israel is achieving its extraordinary vaccination results.
To begin with, as a nation, Israel has a culture of preparedness. It has succeeded in meeting threats by engaging the whole of its society: the government, the private sector, and every citizen. In addition to a patriotic commitment to mitigate the nation’s risks, Israel uses the power of legislation, regulation, and drills to prepare effectively.
Israelis do not simply put plans on paper. They practice executing those plans in advance of potential adversity.
Israel’s coordinated vaccination response reflects this discipline. As Professor Ran Balicer, Chief Innovation Officer of Clalit Health Services, noted: “We have become used to working in a state of emergency.”
Also, failure for Israel is not an option. The nation has demonstrated time and again that it will not let itself be weakened by external threats—in this case, the pandemic.
Next, one of the most important aspects of Israel’s vaccination preparedness was early planning and hedging its bets on vaccine supplies. The country was quick to enter contracts with both Pfizer-BioNTech and Moderna, and is said to be in discussions with at least one other potential supplier. It did not put all its eggs in one basket.
Israel has not been content with its initial vaccine contracts, either. It has aggressively pushed shipments forward, moving up deliveries of at least a million Moderna vaccine doses from March to early January.
It is possible that the Israelis paid a premium to get to the front of the vaccine line (contract terms are undisclosed). But they had something else of value to offer the pharmaceutical companies: fast, efficient distribution and detailed metrics on the vaccine’s real-world effectiveness.
Health Minister Edelstein said, “We convinced them that if they gave us the vaccine, [our healthcare system] would administer it in a very short time.”
This highlights another crucial element of Israel’s vaccination success. The country engaged its entire healthcare system to coordinate efforts, along with its homeland security command.
Israel’s healthcare system is a public-private partnership administered by four nonprofit health maintenance organizations (HMOs). These insurance companies worked closely with medical providers and the government to plan ahead for the personnel and facilities needed for the vaccination program.
“Our four [HMOs] are used to moving quickly…gearing up for emergencies and providing complex reassignments of personnel,” said Professor Balicer.
Israel’s homeland security organization also helped with vaccination planning. Security forces set up temporary vaccination centers across the country and maintain order at the sites.
The efficient response of Israel’s healthcare system in executing the vaccination program is attributable to several key elements:
- Centralized, comprehensive data. All nine million Israeli citizens must maintain health insurance through the HMOs. Using electronic medical data, including age and underlying conditions, the authorities were able to create a thorough, prioritized vaccination plan.
- Trust in vaccinations. Israel has a history of nationwide vaccine programs. Its national vaccination registry, created originally for childhood inoculations, is expediting the COVID-19 vaccination process.
- Proper resource allocation. In addition to its existing network of healthcare facilities, Israel acted early and quickly to set up dedicated vaccination centers, ad hoc sites, and mobile units. And it allocated proper personnel to administer the vaccines. At the same time, Israel obtained permission from Pfizer to break the standard 1,000-dose shipments into smaller units, to better serve small towns. All these measures have helped ensure easy vaccine access, minimizing long lines, confusion, and frustration.
- Speed and flexibility. In preparing to administer vaccines, Israel made speed a top priority. No paperwork is needed at vaccination sites; people simply present their HMO identification. And while the country prioritized vaccine recipients, it did not limit itself with rigid rules. To avoid waste, vaccination centers can give surplus doses to anyone, letting market demand play a role in the process.
- Transparent communications. Well in advance of receiving vaccines, Israel created and promoted a vaccination reservation system based on its priority guidelines. Healthcare providers also reached out early and often to patients through a variety of media. And vaccination data, including on side effects, is tracked and published in near real time. This transparency lets people know what to expect and what is happening, which helps dispel anxiety people may feel about getting the vaccine.
Another reason Israel’s vaccination program is succeeding is unified, motivational leadership focused on allaying fears and driving participation.
The country launched a national “Give a Shoulder” publicity campaign, and Prime Minister Benjamin Netanyahu became the first Israeli vaccinated—on live TV—to show the country it was safe. (Mr. Netanyahu was also directly involved in negotiations with Pfizer’s CEO to ensure early access to large quantities of vaccine.)
Importantly, in a sign of unity, the vaccination program did not suffer from typical political squabbles. Every faction of the government—including influential religious leaders—cooperated to promote the benefits of the vaccine over any perceived risks.
Public health officials focused particularly on Israel’s ultra-Orthodox and Arab minorities, as groups that might be less inclined to get the vaccine. And many religious leaders received the vaccine publicly to support the program.
All of these factors have contributed to Israel’s impressive accomplishments in COVID-19 vaccinations.
According to the Israeli Ministry of Health, two million Israelis—close to one-fourth of the population, including those at highest risk—should receive their second vaccine dose by the end of January, 2021.
There are important lessons in Israel’s focus on preparedness. While Israel plans ahead, it also takes its plans to the operational level. The Israelis establish an organization with clear lines of authority, develop detailed processes, stockpile assets, and practice executing the entire integrated system. All to make the plan actionable when needed.
Another global health crisis is sure to come. Israel understands this, and will be prepared, just as they were with their COVID-19 vaccination program.
We in the US should take notice.
Raphael Benaroya is an American businessman, currently the Senior Partner of Biltmore Capital. He serves as Vice Chairman and executive committee member of Business Executives for National Security (BENS), a Washington, D.C.-based, non-partisan NGO. In that role he has received numerous awards for his work on national security.