National Review

Why Is Israel Doing Better Than Everyone Else in COVID Vaccinations?

Eleven years ago, Dan Senor and Saul Singer dubbed Israel the “Start Up Nation” for its disproportionately large number of technology start-ups and NASDAQ stock listings. Make way for the Vaccination Nation. Israel leads the world in COVID-19 vaccinations. It has already vaccinated nearly a quarter of its population, including 75 percent of the population most at risk, people over age 60. It has administered 24.5 doses per 100 persons, nearly double the next-best country (the United Arab Emirates) and about 8 times as many people per capita as in the U.S. and the U.K. Israel’s per capita vaccination rate is 24 times that of the normally efficient Germans and 50 times better than the world average. Only three other countries in the world — the U.S., China, and the U.K. — have administered more vaccines. Why is Israel doing so much better than anyone else? Israel’s small size simplifies logistics. But there are other factors. First, unlike American states, which have administered only about a third of the doses they have received, Israeli made sure it was ready to use its supply. Officials set up large vaccination centers and mobile units in advance. They reached out to minority groups, such as the ultra-Orthodox and Arab citizens, ahead of the roll-out to encourage vaccine uptake. Israel started vaccinations in mid-December and by the end of the month was vaccinating more than 150,000 people a day. Second, Israel secured a large supply from Pfizer by promising to provide comprehensive safety and effectiveness data. Israel has a nationwide, computerized health database that can provide anonymized outcomes for all citizens, letting Pfizer use the country of nearly nine million as a real-time laboratory. In return, Pfizer has pledged to provide enough doses to vaccinate every Israeli over 16 by the end of March. In addition, Israel was the first country outside of North America to approve the Moderna vaccine and has purchased six million doses. Israel also paid premium prices — a wise investment in ending the economic devastation occasioned by pandemic lockdowns. Needless to say, Israel is good at planning for and executing during emergencies. Senor and Singer identified universal army service as promoting Israelis’ resourcefulness and willingness to take the initiative to improve existing systems. Pfizer packages its vaccine in trays of 1,000 doses, which, because of the need for ultra-cold storage, must be all be used within a short period of time once they have been defrosted. The large number of doses limits vaccinations to centers that can line up large numbers of recipients. Israel figured out how to repackage the trays into smaller lots of doses to improve flexibility for delivering doses to a broader range of providers and less populated locations. Israelis are also willing to buck established authority. The Pfizer multi-dose vaccine vials were authorized to hold five doses. This led many American vaccinators to discard vaccine remaining after administering five doses, even if it was adequate to provide one or two extra doses, for fear of running afoul of FDA instructions (the FDA eventually clarified that it is acceptable to use every obtainable full dose). Israelis, in contrast, were willing from the start to use windfall sixth and seventh doses. American vaccinators have been reluctant to give remaining doses to people outside of government-mandated priority order — New York’s Governor Cuomo promised hefty fines for vaccinating out of order — leading to doses’ being discarded at the end of the day. Israeli providers vaccinated end-of-day walk-ins outside of the guidelines to avoid wasting valuable doses. Finally, Israelis’ willingness to pull together and treat the pandemic as if it were a war and the government’s successful roll-out have changed Israelis’ initial reluctance into eagerness to be vaccinated. Prime Minister Netanyahu set an example by being the first Israeli to be vaccinated. The prophet Isaiah said Israel would function as “a light unto the nations,” providing spiritual and moral guidance to the world. Modern-day Israel, the Start-Up Nation, can provide technological and practical guidance as well.