Israel’s COVID-19 vaccinations limit pandemic

More than six weeks after Israel began implementing the COVID-19 vaccine left behind by the rest of the world, public health experts are breathing a sigh of relief as the effects seem to finally kick in.

Earlier this week, as the country reported a clear and sustained decline in the number of people aged 60 and over who were seriously ill, experts became confident that they were seeing the effects of the vaccine. People over 60 have been put in the forefront in the early stages of Israel’s vaccination, and this is where the signal is expected to appear in national COVID-19 statistics.

“We say with caution, the magic has begun,” tweeted data scientist Eran Segal of the Weizmann Institute of Science in Rehovot, Israel, on February 1, noting that COVID-19 cases, hospitalizations, and serious illnesses all fall under the age of 60.

In addition, follow-up studies conducted by one of Israel’s largest HMOs, Maccabi Healthcare Services, indicate that Pfizer’s COVID-19 vaccine, used for most shots given so far, works in the real world almost as well. well as it has done in clinical trials, with more than 90% efficacy after two doses. This was no guarantee: Drugs and vaccines may perform slightly differently outside the controlled limits of clinical trials.

This is good news for the US and other countries hoping to emulate Israel’s success in delivering COVID-19 vaccines to their population. But the data coming from Israel also shows the challenges ahead.

Israeli experts interviewed by BuzzFeed News hoped that these positive results would appear faster. They attributed the delay largely to the fact that the Middle Eastern nation fought the highly transmissible B.1.1.7 coronavirus variant first seen in the UK – now more than 70% of Israeli cases make out. And although both Pfizer and Moderna have reported that their vaccines effectively block the B.1.1.7 variant, other variants first identified in South Africa and Brazil appear less susceptible to current vaccines, which could undermine further progress if they or new variants with similar mutations become dominant.

Meanwhile, Israel has been criticized by human rights organizations for not extending their vaccination program to the Occupied Palestinian Territories. And the rollout is slower among Palestinian Arab citizens of Israel and ultra-Orthodox Jewish communities – which is worrying because these are the groups hardest hit by COVID-19.

This concerns health experts watching the Israeli rollout in the US, as it happens despite the fact that the Israeli government has launched a major communication effort involving religious and other community leaders, to try to get the hesitant vaccine among Arab and ultra- to address Orthodox communities.

In the US, black Americans have been excessively killed and made ill by COVID-19, and they are already falling behind in the US vaccination campaign. And while black Americans have good reasons to distrust the medical institution, given a legacy of racism within the health care system, there was nothing in the US like communicating with Israel to convince skeptical groups of the benefits of being vaccinated, Peter Hotez, a leading vaccine researcher. at Baylor College of Medicine in Houston, BuzzFeed News said.

Hotez fears a terrible toll among black communities if vaccine vaccination remains low and poses more dangerous coronavirus variants. “We are losing a generation of mothers and fathers and brothers and sisters,” he said.

Israel owes its rapid vaccination to a health care system that requires every citizen to be a member of one of the four HMOs, which collectively operate clinics almost everywhere in the small, densely populated country. After having the vaccine supply of both Pfizer and Moderna, the country was able to use this solid healthcare infrastructure to continue faster than any other vaccination: as of Wednesday, Israel had given about 59 shots per 100 people in the country, while the US had nearly 10 gave.

The rules for who is eligible for vaccinations in Israel were also much simpler than in the US, where decisions were left to the states based on factors such as age, occupational exposure to the virus and existing medical conditions. Instead, Israel put older people first, encouraged everyone to take shots, and opened call centers to streamline appointments. And even with its existing infrastructure, it has opened large vaccination centers for outdoors.

“They made it very easy to sign up,” said Ann Blake, a colleague of Hotez’s in Baylor who trained as a doctor and in public health in Israel. “If there is a vaccine left at the end of the day, you have clinical secretaries who explode text messages.”

The US, with a much more fragmented health care system and many people without health insurance, is facing major challenges facing Israel’s vaccination campaign. Blake argued that the country should learn from what worked in Israel, open more large vaccination centers, and simplify vaccination rules.

“We need to open stadiums across the country,” she said. “We’re starting to do that. We have to do it on a large scale. “

But Israel was less effective in controlling the spread of the virus. The start of the vaccination campaign, on 19 December, caused a large increase in cases in the early stages due to the currently dominant B.1.1.7 variant. A nationwide exclusion followed on December 27, making it difficult for scientists to distinguish the protective effects of the vaccine from the reduced transmission due to the closure.

“With all these strong winds pushing things in different directions, it’s hard to discern the effect of the vaccine,” Uri Shalit, a computer scientist at the Technion in Haifa who specializes in studying healthcare, told BuzzFeed News said.

Recently last week, Shalit and other experts continued to anxiously search for the differences between trends in this exclusion compared to the previous one that ended in October. But this week, it was clear that Israel was seeing a decline in the number of older people with severe COVID-19, even as serious cases began to increase among younger people.

As the maps above and below show, the decline in severe cases began in January, shortly after a sharp increase in the number of older Israelis receiving their second vaccine shots. At present, more than 75% of those over the age of 60 have had two shots, although the increase has slowed in recent days – to the concern of some scientists. “You have exhausted the early adopters,” Yaniv Erlich, a computer scientist at the Herzliya Interdisciplinary Center who tracked down COVID-19 data, told BuzzFeed News.

Follow-up studies by Israel’s HMOs nevertheless contribute to the hopeful picture. In an early research article published online on January 29 and not yet peer-reviewed, researchers from Maccabi Healthcare Services followed more than 350,000 Israeli adults 13-24 days after receiving their first dose of Pfizer vaccine. . it was 51% effective in preventing infection.

And in hitherto unpublished data, the Times of Israel reported last week that researchers from Maccabi found that the vaccine was 92% effective after two doses, based on a comparison of 163,000 Maccabi patients who were fully vaccinated with a group that not vaccinated. If these results stand up, it means that the Pfizer vaccine performs almost as well in the real world as in clinical trials.

Erlich en other warns that these results may overestimate the effect of the vaccine. One problem is that Israeli couples are usually vaccinated together, which provides additional protection in families that do not occur with volunteers in a clinical trial.

But Cyrille Cohen, an immunologist and vice-dean for life sciences at Bar-Ilan University in Ramat Gan, was delighted with the reports. “This is in line with what was predicted,” he told BuzzFeed News. “I’m always careful, but so far this is very good news.”

Less encouraging are the lower vaccination rates in ultra-Orthodox Jewish communities and in cities with large Arab Israeli populations. Many ultra-Orthodox Jews are skeptical about vaccines and are against restrictions to limit the spread of the coronavirus – highlighted by the attendance of thousands of mourners at the funeral of a prominent rabbi in Jerusalem on January 31, in defiance of the current locking up the country.

And by the end of January, less than 70% of those over 60 in Nazareth, sometimes called the “Arab capital” of Israel, received their initial dose, which lags far behind the national average. In Nazareth and other Israeli cities with a large Arab population, the low uptake of vaccines is thought to be linked to wider mistrust in Israel’s government.

Another point of contention is the vaccination for Palestinians in the occupied territories. Israel has maintained that under the Oslo Accords, health is the responsibility of the Palestinian National Authority, which apparently plans to buy 100,000 doses of Sputnik V vaccine, developed by the Russian Gamaleya Research Institute.

Under pressure from groups, including Human Rights Watch, which claims that the fourth Geneva Convention requires Israel to provide medical supplies, Israel has begun sending a small number of vaccines to the Palestinians. The move was also spurred on by concerns that a steady stream of unvaccinated people across checkpoints – tens of thousands of Palestinians working in Israel – would undermine the country’s own vaccination process.

The gaps in Israel’s introduction of vaccines mean that even the world leader in the vaccination of COVID-19 will have elements of its population where the coronavirus is still circulating freely. This includes children: Pfizer’s vaccine is currently only allowed for children 16 years and older. “We will not vaccinate children under the age of 16 until we get the results of the clinical trials conducted by Pfizer,” said Cohen, who is on the committee advising the Israeli Ministry of Health on clinical trials for COVID. 19-vaccine.

As long as the virus is in circulation, there is a possibility that new variants, some of which may evade current vaccines, may emerge. Pfizer and Moderna are both the test options to respond to the variants, including additional booster shots or completely new vaccine formulations. But this means that social distancing measures are likely to still be needed, especially if emerging variants cause future coronavirus outbreaks.

This is of concern to Hagai Rossman, a researcher in the group of Segal at the Weizmann Institute, who fears that further strict restrictions will be strictly adhered to. “The public will not accept a harsh exclusion again after the vaccination campaign,” Rossman said.