TA Explained: Behind Israel’s successful vaccination campaign

By Rishabh Shrivastava

Every time we talk about India’s vaccination campaign, we are often reminded of how Israel managed the same and became one of the first countries to carry out maximum vaccination for its people. At present, Canada leads the global vaccination tally at 65.4% followed by Israel at 63.4% and United Kingdom at number three with 61.6% vaccination.

Global vaccination tally. Pic: Fortune

In this explainer, we take a deep dive into what made Israel’s vaccination so successful and efficient.

When did Israel started the vaccination process and which vaccine did it use?

Israel’s national vaccination project started in December 2020 with Pfizer’s BioNTech vaccine. At this time, the country was reeling under the third and the most devastating wave of COVID-19. It had peak seven day moving average of 8328 new infections per day. From March 2021 onwards Israel reported a steep decline in daily cases across all the age groups in the country. Israel delivered more than 10 million doses within four months. The country’s health ministry recommended a 21 day gap between the two doses of the vaccine and started administering it at war footing. By April 2021, the seven day moving average of new cases dropped to 149 per day.

How did Israel overcome the procurement issues?

One of the major reasons for Israel’s successful vaccination campaign was the aggressive procurement process set up by the country’s government then led by the Former Prime Minister Benjamin Netanyahu.

Prime Minister Benjamin Netanyahu was the first Israeli to receive a vaccine.
PM Metanyahu was the first Israeli to receive the COVID-19 vaccine shot. Pic: Amir Cohen/Reuters

Israeli government reached the international vaccine manufacturers as an “early bird” and engaged into several rounds of successful negotiation. The procurement process was kept entirely central and was carried out in sublime manner. The government had contractual frameworks ready to facilitate quick paperwork and approvals to roll out the vaccination process.

How did Israel’s system of HMOs ensured smooth vaccination process?

Apart from Israel’s secret agency Mossad, its system of community health infrastructure is also famous and robust. The reason why international vaccine manufacturers were ready to engage with Israeli government for procurement of vaccines was also because of the well established network and high performance of the Health Maintenance Organizations (HMOs).

As per the Israel’s National Health Insurance Law, every citizen has to register with any four of the provided HMOs known as “Kupat Holim”. These HMOs are governed as not for profit organizations and cannot deny registration to any Israeli. In 2020, Israel’s health system was ranked third most efficient according to Bloomberg Health Efficiency Index.

Since every citizen is registered with HMOs, it became easy for the government to send out alerts and make appointments for its citizens when vaccine became available. For example: when it opened the process for 60 plus, alert went to all the 60 plus beneficiaries of HMOs informing them about the rollout and booking process.

The system at head offices of these HMOs has been orderly and smooth. Small booths were created to facilitate quick vaccination process. It is reported that the jab was administered with a minute or two, same or less time than it had taken for the citizen to get through on the phone to make the appointment.

These HMOs undergo an annual Israel’s National Program for Quality Indicators in Community Healthcare. The program evaluates the  the performance of HMOs on approximately 70 quality indicators; and each HMO undertakes large-scale, coordinated, organization-wide efforts to improve its performance on those indicators.

What role did IT and data played?

Digital technologies can only be enablers. If the system and processes are missing, IT alone cannot do anything. This was proved right in the case of Israel’s vaccination campaign. Since the system of HMOs was already available, digital technology made the process more accessible and seamless for both the government and citizens.

Every HMO had electronic records of the patients and they were able to access it within 30 seconds. These digital capacities were then used to vaccinate the citizens, monitor their health and send alerts/notifications. The availability of super fine and clean data helped Israel immensely in making its vaccination campaign targeted and efficient.

How did Israel managed to deploy trained manpower for vaccinating its citizens?

Israel has a low nurse to population ratio and large number of nurses were infected by COVID-19. Government decided to increase the overtime working hours of these nurses and limit their services only to administer COVID-19 vaccine. These nurses are highly trained in conducting vaccination, making it easy for the government to deploy them in COVID-19 vaccination campaign. The additional tasks of these nurses was shifted to paramedics or social workers.

Israeli government also passed laws to empower paramedics, personnel from Israeli Defense Forces and others to vaccinate the citizens. This shortened the turn around time and provided trained manpower to the state for vaccinating its people.

How did Israel addressed the challenge of vaccine hesitancy?

Country’s vaccine policy makers do agree that the campaign did face resistance in some pockets of the country. However, the public leaders realized this challenge and crafted a response for the same. In some areas, mayors sent voice messages to communities at large, encouraging them to get vaccinated. Photos of public leaders administering jabs were displayed prominently. Government made special outreach efforts for the Israel’s ultra-orthodox Jewish community that was hit hard by the pandemic. Government also roped in local neighborhoods to fight hesitancy against COVID-19. These neighborhoods launched something very interesting – Poster Wars. Pro vaccine posters were put up on walls helping scared citizens come forward to get vaccinated. Government also organized special camps in memory of famous community/local leaders which motivated citizens to get vaccinated.

How did Israel created such robust public health system? Sustained focus and political will

All of this was not created overnight by Israel. It is said that due to its challenging geo-political situation Israel has been proactive in investing and developing a robust public health system. This system was developed by its leaders keeping in mind the large scale emergency situations to which the country remains vulnerable. The country has adopted an “all hazards” approach for dealing with any kind of emergency be it security, natural disaster or health related.

The country’s health ministry has been conducting regular drills to assess the system’s response. This has provided the system and its administrators (doctors, nurses, paramedics etc.) with a real world experience in handling large scale emergencies. The government also communicated that these large scale emergencies are not rare events, instilling a sense of seriousness in citizen groups, civil society, public health professionals and other stakeholders. This has ensured a unified response to the crisis such as COVID-19.

(Author is a lawyer and an independent researcher. He is Co-founder at TA)

The Analysis (TA) is a research and communication group | Analyzing India’s legal, policy and political affairs. Write to us at contact@theanalysis.org.in

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