Why Israel is leading the world with COVID-19 vaccinations

Every day, the online research publication Our World In Data releases information about vaccine doses being administered across the globe. And every day, one country emerges as a world leader: Israel.

For example, when the University of Oxford-based organization released its Jan. 1 data, the total number of vaccination doses administered per 100 people for Canada was 0.26. For the U.S., it was 0.84. The United Kingdom: 1.47. And for Israel it was 11.55, 44 times more than Canada.

But Israel, with a population of nine million, was also tied for third in the world in total number of doses (1 million), behind China (4.5 million) and the U.S. (2.79 million). Canada's dose count totalled just under 100,000.

As Max Roser, founder and director of Our World In Data tweeted on Friday: "the country is rapidly getting to a point where mass deaths and mass lockdowns are over."

The reasons for Israel's success are multifaceted, and there may be lessons that Canada can learn.

'Should be commended for it'

"I think it's remarkable watching how organized Israel is in terms of getting access to a tremendous amount of vaccines and mobilizing vaccine rollout in a very expedited manner," said Dr. Isaac Bogoch, an infectious diseases physician and member of the Ontario government's vaccine distribution task force.

"And they should be commended for it."

But the rollout is not without some controversy. Palestinians in the occupied West Bank and in the Gaza Strip will not be vaccinated by Israel, a responsibility that some aid groups believe Israel shares with Palestinian officials.

Still, the country continues to garner praise. Since the start of its vaccination campaign on Dec. 20, Israel has inoculated just over 11 per cent of its population — one million of its citizens — and aims to vaccinate a quarter of all Israelis by the end of the month.

Certainly, Israel's small size, and dense population, especially compared to a sprawling country like Canada, gives it an inherent advantage in terms of reaching its population with a vaccine, suggested Allon Moses, director of the Hadassah Medical Organization's Department of Clinical Microbiology and Infectious Diseases.

Moses said the fact that Israel's medical services are centralized, provided by four main health maintenance organizations (HMOs) has made it easier to reach the population through emails and advise people to make appointments. (Everyone over the age of 18 must register with one of the four government-subsidized HMOs.)

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Israel's experience in war and battle has also meant the country "is built on dealing with emergency, the country is built on recruiting soldiers to help," Moses said.

About 700 paramedics on reserve duty have joined the civilian vaccination campaign in order to make the operation more efficient, the Israel Defence Forces said in a statement.

"So we are a small country with a relatively good infrastructure of medicine and a lot of good-willed people who are willing to help to get the country to be vaccinated in record time," Moses said.

Digitized medical record system

Nadav Davidovitch, director of the School of Public Health at Ben Gurion University, also lauded the country's digitized medical record system as "one of the best in the world," which is helping with the organization of vaccination efforts and helping keep track of those on the priority list who should get a shot.

Perhaps most significantly, Israel was able to secure a large supply of vaccines — although how many has not been disclosed — but enough to vaccinate a million of its population. (Israel will have a two-week break in the vaccination of the general public due to an expected shortage of vaccines, the Jerusalem Post reported.)

Davidovitch said Israel and its tech-based economy, and connections to the pharmaceutical industries, made it an attractive candidate for Pfizer to supply its vaccines.

"It's important to have vaccines being distributed in a place that will be very successful," Davidovitch said. 

As well, Davidovitch said Israel had been preparing for a couple months in advance for the vaccine rollout. 

There have been more than 150 vaccine clinics running across the country, while vaccination vans travel to periphery towns.

In comparison, Ontario, with a population of 14.5 million, has only 19 vaccination clinics across the province. These 19 sites all contain the special freezers needed to store the Pfizer-BioNTech vaccine.

Pfizer has advised Canadian health officials to administer early doses of the vaccine at the sites where they are first delivered in large batches. Health officials have been told by Pfizer that too much movement of the vaccine can lead to deterioration.

Repackage vaccine

But according to Israel's health ministry, it is the first country in the world to repackage the vaccine to distribute it across the country.

"Fortunately, the solution for safe transport of the vaccines allows us to vaccinate in small and remote locations, in retirement homes and nursing homes," Hezi Levy, director general of the Ministry of Health, said in a statement.

Vivian Bercovici, a former ambassador of Canada to Israel, suggested that politics may also be at play. With an election slated for March, a successful vaccine rollout campaign certainly would be a boon for the political fortunes of Israeli Prime Minister Benjamin Netanyahu.

"So he knows that if he is able to turn Israel into this beacon of accomplishment in terms of national vaccination program, it will not only reflect well on him personally, but it'll be a matter of national pride."

Bogoch said that while Israel deserves all the praise it receives for its speed in administering the vaccine, it is easier for smaller countries to more efficiently administer vaccines in general.

"Canada has pretty significant logistical hurdles just based on the size of the country. We have rural populations, we have remote Indigenous populations, and everybody needs access to this," he said. "Even the northern part of the country is also going to pose some significant challenges as well."

Bogoch said that it's pretty clear that per capita, Israel certainly has access to significantly more vaccines to begin with. And because Israel has so many, it likely started planning administering the vaccines much earlier. 

Dr. Zain Chagla, an infectious diseases physician at St. Joseph's Healthcare Hamilton, Ont., said Canada could take some lessons from Israel.

He said Canadian officials could also learn how Israel is setting up its registration system and how it appears to be managing through bureaucratic hurdles.

But most importantly, Canada could learn how Israeli officials have been able to transport the vaccine around to other locations.

"Israel has been able to move the vaccine around to multiple different places, multiple different sites, pop ups and that type of thing," said Chagla, who is also an associate professor at McMaster University.

"The ability to not centralize in a single place, does help with the distribution. They can mobilize more volunteers."