As coronavirus bites, comptroller warns Israel ill-prepared for pandemic

The latest findings are likely to exacerbate concerns voiced in recent weeks regarding underinvestment throughout the healthcare system.

People are seen in front of the entrance to the emergency room at the Hadassah Ein Kerem hospital in Jerusalem (photo credit: REUTERS)
People are seen in front of the entrance to the emergency room at the Hadassah Ein Kerem hospital in Jerusalem
(photo credit: REUTERS)
As Israeli health authorities battle day and night to contain the novel coronavirus outbreak, a stinging State Comptroller report published on Monday warned of severe gaps in Israel's readiness to combat an influenza pandemic, which would likely infect some 2.25 million citizens or a quarter of the entire population.
In a lengthy report, State Comptroller Matanyahu Englman warned that the Israeli healthcare system is "not fully prepared" for such a pandemic, highlighting insufficient and expired medication, decreasing rates of vaccination, and a lack of readiness ranging from the Health Ministry to healthcare providers and the general hospitalization system.
While hospitals are already overcrowded year-round, struggling under the demands of the current outbreak, an eight-week influenza pandemic is likely to see approximately 150,000 patients admitted to hospitals, 25,000 patients requiring intensive care treatment and 12,500 needing intubation.
Despite the Health Ministry formulating a program in 2005 to prepare the healthcare system for such a pandemic, including the mass purchase of anti-viral drugs, it was found that there are sufficient drugs for only 16% of the population today, rather than the necessary 25%.
The latest findings are likely to exacerbate concerns voiced in recent weeks regarding underinvestment throughout the healthcare system, which has primarily focused on the lack of protective equipment and the quantity of respirators.
While the expiration date of inhalers in storage has been extended, required for the treatment of at-risk infants and pregnant women, the Health Ministry said it is currently unable to test the plastic in the devices. Material dispersion tests, however, indirectly indicate that the inhalers are in working order.
IN ADDITION, the state comptroller highlighted the lack of a detailed program to close identified gaps in the healthcare system – including intensive care beds, medical staff and equipment – that will enable effective treatment in the case of a pandemic, and bolster capabilities to manage other major outbreaks.
"Given that this is a real threat to the State of Israel, the Health Ministry – in collaboration with the Defense Ministry and the National Emergency Authority – must determine the possible and appropriate way for the State of Israel to come to an influenza pandemic and prepare accordingly," Englman said.
According to the report, giving additional cause for concern, the seasonal influenza vaccination rate of citizens aged 65 and older decreased from 64.3% in 2015 to 60.4% in 2018.
Englman called on the Health Ministry to explore novel ways of encouraging compliance with vaccination targets, in addition to targeting specific population groups and training more staff to administer vaccines.
During the recent global measles outbreak of 2018-2019, the report stated, Israel had the seventh highest morbidity rate worldwide. Some 60% of 4,300 infected individuals were children up to nine years old. Three Israeli citizens died during the outbreak.
Following a growing trend of anti-vaccine sentiment, the Health Ministry estimates that a total of 1.1%-1.7% of the population is not vaccinated against measles today, compared to 0.6% in 2011.
During the recent measles outbreak, among infected patients aged between two and 19 years old, at least 49% were children of vaccine refusers. Half of all those infected were residents of Jerusalem, of which 80% were from the ultra-Orthodox Jewish community.
"The growth of ideological opposition to vaccination, the current measles outbreak and the draft legislation that has been submitted in recent years point to the need for the Health Ministry to develop a long-term, systematic solution for dealing with vaccine opponents, with the aim of maintaining public health, while respecting human privacy and dignity," wrote Englman.
The failure of parents to bring their newborns to well baby clinics (tipot halav), where children receive their first vaccination, was primarily attributed to ideological or religious opposition, forgetfulness, fear of side effects and economic difficulty.
"While the Health Ministry receives information on the number of babies born each month, it does not use this information to track and locate infants who do not arrive at the well baby clinics, and especially to pinpoint strongholds of vaccine refusers," Englman said.
FURTHERMORE, a dramatic increase in cases of leptospirosis, also known as Weil's disease, was identified between July and September 2018. A total of 705 cases were diagnosed in 2018, compared to just six in 2017.
The increase in the animal-transmitted disease is attributed to increased pollutants in rivers in northern Israel. An inter-ministerial team was established in March 2019 to reduce pollutants and waterborne diseases.
Responsibility for tackling deficiencies outlined in the report primarily rests with the Health Ministry, Englman said, though healthcare providers and other government ministries also have an important role in closing the gaps.
A key to preventing outbreaks of diseases is greater vaccination of the population, and effective monitoring of public health. In the case of measles, it is necessary to develop a nationwide plan to overcome opposition to vaccinations among specific population groups, including by engaging opinion leaders in relevant communities.
Responding to the report, the Health Ministry said it was studying its findings and already applying some recommendations in the current coronavirus outbreak, including the purchase of additional hospital equipment and establishing dedicated isolation wards.
"Israel is probably one of the countries that coped best with the global measles outbreak," the ministry said in a statement.
"Dedicated programs for dealing with pockets of low vaccination rates have been established and a dedicated budget has been allocated... We note that vaccine rates in Israel are among the highest in the world, and stand at 97% for the first dose and 96% for the second dose... It is not possible to prevent the formation of pockets of [vaccine opposition] but their scope can be reduced."
The ministry said measures already implemented to increase vaccination rates included information campaigns; geographic information system-based analysis of areas of low vaccination; increasing accessibility to well baby clinics; legal proceedings against vaccine refusers and doctors contradicting Health Ministry recommendations; preventing unvaccinated children from entering schools during the outbreak; and prioritizing the second dose of measles vaccines in areas with high levels of morbidity.
Following publication of the report, the Prime Minister's Office emphasized that the Israeli health system was ranked among the top 10 in the Bloomberg Healthiest Country Index in 2019, and that the health budget had almost doubled over the past decade. The office added that there was still room for improvement, and that the government would study the findings of the report.
"The report is not relevant to the coronavirus, as there has been no such event in the past century and no country in the world could have predicted or prepared for the spread of the virus," the Prime Minister's Office said. "Prime Minister Netanyahu has led a quantum leap in the Israeli healthcare system, ranking it as one of the top 10 health systems in the world. Doubling the health budget during the past decade has significantly improved the health system in Israel."