Israel has vaccinated a larger share of its population against the novel coronavirus than any other country in the world.
While there are many politicians who would like to take the credit for Israel’s rock-star performance – not least Prime Minister Benjamin Netanyahu – there is more at play here than petty politics.
"I am asked all over the world how Israel does it," said Health Minister Yuli Edelstein on Sunday. "The reasons are that we were prepared on time, signed on time with the leading companies, and convinced them that if they gave us the vaccine, the health funds would know how to administer it in a very short time. That is exactly what is happening."
Here are nine more reasons why Israel is currently the world’s No. 1 vaccinator:
1. Universal healthcare
Universal healthcare has existed in Israel since before the founding of the state and has continued to be a valuable factor ever since. According to Dr. Dorit Nitzan, director of emergencies for the World Health Organization, the coronavirus pandemic has proven that this type of care was key to managing the health crisis.
Now, according to Ran Balicer, chief innovation officer for Clalit Health Services and chairman of the National Expert Advisory Panel to the Government on COVID-19, it is proving essential in vaccinating against the virus.
As part of a universal care offering, the most critical types of care are provided to citizens free of charge, including general practitioner, urgent hospitalization, lab work and vaccination.
“The system revolves around the intimate connection from cradle to grave between citizens and their healthcare provider,” Balicer said, adding that general practitioners have a list of people for whom they feel responsible in health and sickness, which has proven critical for reaching the country’s elderly and chronically ill and getting them into their funds to vaccinate.
According to Tamar Fishman-Magen, a registered nurse and a member of Meuhedet Health Maintenance Organization’s Nursing Division, “This is the proof that we have been waiting for so long – the importance of community medical services.”
2. People trust their health funds
In an era when some 62% of the population lacks trust in its prime minister, according to the Israel Democracy Institute, it is striking to know that according to a 2020 survey conducted by Myers-JDC-Brookdale, 90% of Israelis are satisfied with their health funds.
Only around 1% of Israelis annually choose to switch to an alternate health fund, although it is easy to do so, Balicer said.
“This tells you something about the level of trust and infrastructure built over the years,” he said.
3. A focus on preventative care
Health funds are focused on ensuring their clients take care of themselves and not only healing them after they are sick. Some health experts suggested that one of the reasons that the coronavirus mortality rate in Israel was lower than in other countries was because there is less untreated and undiagnosed chronic illness in the country.
In Israel, health funds are paid by an age-adjusted per capita amount of funding for every member, rather than by services provided. As such, there is a lot of emphasis on preventive, proactive care and outreach, and clients are used to hearing from their health funds.
Clalit, for example, has turned to using predictive models, advanced big-data analytics and artificial intelligence to identify patients before they become sick and provide preventive care to them so they will not experience actual diagnoses or symptoms of a disease. This year, even before the coronavirus vaccination, Clalit used these mechanisms to provide influenza vaccines to patients at highest risk for complications, Balicer said.
4. Israel knows emergencies
“We are like sprinters,” said Arnon Afek, deputy director-general of Sheba Medical Center in Tel Hashomer. “Israel knows how to mobilize.”
He recalled how in 2010 when a massive earthquake struck Haiti, Israel was on the ground within 48 hours and was already operating a sophisticated field hospital even before the Americans arrived.
“We have become used to working in a state of emergency,” Balicer said. “Our four health funds have been used to moving quickly, instantaneously gearing up for emergencies and providing complex reassignments of a lot of personnel.”
In short, Israel knows how to get things done.
5. A lot of people work for the health funds
Clalit is the largest employer in Israel with more than 45,000 workers. According to Leumit Health Care Services’ website, the fund employs 2,000 specialists among its tens of thousands of staff members.
Having this immense manpower – a clinic in every neighborhood in the country from north to south – gives the health funds a lot of power, Balicer said.
6. This is not the first time the funds vaccinated a lot of people
“We run vaccination campaigns all the time,” Fishman-Magen said. “We do it every winter when we vaccinate against flu, and we have been called upon to vaccinate against other things, too. Measles or polio. This is something to which we are accustomed.”
As such, according to Ido Hadari, Maccabi Healthcare Services’ director of communications and government, the funds had the infrastructure in place to make the coronavirus vaccination campaign happen in a big way.
“Making appointments for vaccination, to inform you or remind you that you have an appointment tomorrow, to understand why you did not come, to set up the second appointment for the second dose during the first interaction – we make it look very simple,” he said.
For this particular vaccination campaign, it was important for the funds to separate the healthy patients coming for inoculation from those who were sick, which meant erecting separate vaccination compounds.
Maccabi put up 85 compounds across the country, but according to Hadari, they had a rehearsal only a few months previously.
“In regular years, we give the flu vaccination in the clinic,” he said. “But this winter, with coronavirus, we started giving flu vaccinations outside most of them in the same compounds we are now using for COVID.”
The health funds have the process down to a science. Maccabi knows that it takes seven minutes to inoculate someone, so it makes appointments every seven minutes, with an extra slot left free to accommodate for the unexpected so they don’t end up backlogged, Hadari said.
“My husband and I had [the vaccine] via Maccabi at Shlomo Arena in Tel Aviv,” Shelley Goldman wrote last week in a Facebook response to an inquiry about her vaccination by The Jerusalem Post. “Everything was very well organized.”
“Was at Haturim [in Jerusalem],” wrote another respondent, Deborah Lustig. “No wait at all. No crowding. Super impressed.”
There is also the challenge of avoiding vaccine loss; each vaccine dose costs Israel around NIS 100, or NIS 200 per person. According to Balicer, Israel has had to destroy less than 0.1% of its doses.
Although the funds are super-organized with its appointments, as Hadari explained, each Pfizer vial contains five to six doses, and if, at the end of the day, a bottle is going to be opened to inoculate two patients, the funds are flexible enough to reach out to people who don’t have appointments and invite them in.
7. Data and technology
The health funds all work with computerized records that feed data securely and without revealing private details to the Health Ministry to track the vaccine campaign’s progress and any side effects or other information reported by those who get them.
“Israel has a technical edge,” Afek said.
Though there is no contract with Pfizer to share data, he said, he assumes the company “saw the possibility of Israel not just to vaccinate but to monitor whether people have side effects and realized that Israel can become an international experimental arena to see fast and effective vaccination of the public… For any company this is so valuable.”
But this data also works for the patients, too, said Fishman-Magen.
The funds’ personalized medical records date back 50, 60 and 70 years, and doctors and other relevant medical professionals can quickly ensure that patients who will be vaccinated have no contraindications or problems that might be caused by giving the vaccines.
8. Communication
The country did not just launch its campaign, but together with the health funds and hospitals, it ran a widespread TV, radio and newspaper campaign encouraging people to take the vaccine, noted Fishman-Magen.
At some health funds, each person who gets the jab is encouraged to photograph his or herself and share it on social media to encourage others who might be hesitant.
Balicer also noted efforts to gain public trust in the vaccines’ safety and efficacy before inoculation began.
“We took the time to explain the scientific evidence,” he said. “I personally went to key sessions with the haredi [ultra-Orthodox] community and held long discussions with their leadership until we had a rabbinical ruling that vaccines are safe and should be sought.”
The country’s understanding of the need to have a lot of cultural competency and targeted messages has proven effective, he said.
According to Fishman-Magen, “Before the campaign began, we had only around 40% of the population saying they would vaccinate, and other percentages said maybe or they were not interested. Now, we see that everyone is interested, and we have to prioritize.”
9. The spirit of the People of Israel
But in the end, it comes down to the people, said Afek.
The health professionals, first, who volunteered to work extra hours to ensure people were vaccinated, he said.
But also the general public.
“You can have all the staff ready and trained and the supply available, but if the public does not cooperate, it cannot be done,” Hadari said.
“We really, really feel the public was waiting for this vacation like a hope that is coming true,” he added.
Hadari recalled how as a child during the First Lebanon War, when he lived in a village in the North, when a helicopter would land near the village, the people would come running out with cakes and juice to thank the soldiers.
“Now, the people are bringing our staff pizza and hamburgers and trays of fruit,” he said. “We feel like the soldiers now, and the public is really giving us that warm hug. The public is really grateful.”