Was Israel’s decision to give everyone COVID boosters a shot in the dark?

Some parents are now questioning if Israel didn’t rush too fast to jab their children.

An elderly Israeli is seen receiving the third COVID-19 booster shot at a Clalit clinic in Jerusalem, on August 1, 2021. (photo credit: MARC ISRAEL SELLEM/THE JERUSALEM POST)
An elderly Israeli is seen receiving the third COVID-19 booster shot at a Clalit clinic in Jerusalem, on August 1, 2021.

The US Food and Drug Administration’s (FDA) decision to refrain from administering COVID-19 vaccination boosters to the general public has put Israeli health officials into a quandary.

Some parents are now questioning if Israel moved too fast in jabbing their children. And several health professionals and politicians are demanding the abolition of a policy expected to go into effect next month, which states that the Green Pass will be given only to those who receive a third dose of the vaccine six months after getting a second vaccination.

Scenes of empty vaccination centers were shown on the evening news, quoting young adults who said they are not so sure now if they want to get that third shot.

Some 100 Israeli doctors and researchers sent a letter to senior Health Ministry officials calling on them to end the condition of a third vaccine for receiving a Green Pass, threatening that if the ministry does not change its policy, they will file an urgent petition to the High Court.

The letter accuses the new policy of being political, and of depriving its citizens of a number of basic rights, including freedom of movement, when, they claim, FDA experts ruled there the booster is not medically justified.

“I would have felt more comfortable if we had proceeded more gradually,” said Prof. Cyrille Cohen, the head of the immunology lab at Bar-Ilan University.

Although he did not sign the letter, he said he believes the country could wait longer to require the third jab for people under 30 to receive a Green Pass until a little more data is known.

Signage is seen outside of FDA headquarters in White Oak, Maryland. (credit: REUTERS)Signage is seen outside of FDA headquarters in White Oak, Maryland. (credit: REUTERS)

The only study published in Israel on the significant effects of the third shot focuses on people over the age of 60.

Others, like Prof. Nadav Davidovitch, an epidemiologist and public health physician and Head of Ben-Gurion University of the Negev’s School of Public Health, have said the changes needed are not in who qualifies for a Green Pass, but rather what requires such a pass. He said that parks, open swimming pools, outdoor seating at restaurants – places that are not at high risk for infection - should be removed from the Green Pass outline for epidemiological reasons and to make it easier on families.

“The Green Pass is not meant to punish anyone nor to enforce vaccination,” countered Davidovitch. “The idea is to create safer places.”

On the other end, there are those who say that doing anything but rolling out the Green Pass in its strictest form is unwise.

“We know the efficacy of vaccination drops and that infection probability is very similar to that of the unvaccinated population after five or six months, so it makes no sense to keep the validity of the vaccination nor the Green pass after that period,” countered Prof. Eli Waxman of the Weizmann Institute of Science, Rehovot, who formerly oversaw the National Security Council’s expert advisers committee concerning the coronavirus outbreak. “If you want to maintain the vaccine’s validity then you need to get a third shot to increase effectiveness.”

Moreover, he said that given the rate of new severely ill patients, which has been stable but appears to be rising over the past week, the government would be responsible to roll out additional restrictions.

“The government should take steps to reduce the infection rate by reducing activities that are not crucial for the economy, like mass gatherings,” Waxman stressed. “We are not yet over this wave.”

“I do not think we can say that we are in control of the daily infections,” Cohen added.

MUCH OF the infection is actually among children who cannot be vaccinated anyway. Some 28% of infections are in kids below the age of 10, meaning between one-quarter and one-third of all infection. Some 50% of infection is made up of people ages 19 and younger.

Many young people who did vaccinate chose only to do so right before the start of the school year, meaning they are not yet eligible for a third shot, which should buy Israel some time to gather more data and decide whether it wants to reevaluate its decision – on the extra vaccination shot or the Green Pass.

While the data show that only 37% of people between the ages of 16 and 19 have had a third shot, this is likely not because they are refusing, but because they are not yet eligible.

Israel only voted to vaccinate children between the ages of 12 and 15 in May. It was not until June, when the country had several large outbreaks at schools, that it began strongly recommending that this age cohort get the jab.

With the booster, too, Cohen believes it is not a question of whether someone who received a Pfizer vaccine will need it, but when.

The United States is around two or three months behind Israel in its vaccine rollout, meaning that its decision on Friday is more reflective of decisions made in Israel in July than in late August. Additionally, America has used a combination of Pfizer, Moderna and Johnson & Johnson vaccines. It has been shown in several studies that Moderna’s vaccine efficacy wanes more slowly than Pfizer’s. As such, the situation in the two countries cannot be directly compared.

Yet the FDA panel’s ruling is actually supportive of Israel’s policy.

First, the panel was not approving the COVID vaccine in principle. The Pfizer coronavirus vaccine has already achieved full approval by the FDA. The question on Friday was more about what the schedule of booster doses should be.

There are certain scientific facts that have already been proven.

First: The efficacy of the vaccine drops over time. This was proven in multiple studies, including a study published on Friday by the Centers for Disease Control and Prevention.

Second: The booster makes the vaccine’s efficacy much better, even as high as 95% – the protection level afforded immediately after the first two shots.

Third: The booster is safe or it would not have been approved at all.

Fourth: The side-effects of the third shot are no worse than the first or second, including the more severe adverse events such as myocarditis. This was shown in a study published this month by Maccabi Health Services.

“The US authorized the booster shot not only for people over 65, but also for teachers and others who come in contact with large groups of people,” said Waxman. “Its decision implies that we agree on the essential points.”

Nonetheless, the country cannot focus only on boosters, said Davidovitch.

“I agree with the FDA that the first priority should be to invest in vaccinating people who are not vaccinated at all,” he said, noting that the previous government made little effort in getting the country’s last 1.1 million people inoculated. The new government has done more, and since August, around 300,000 more people have been jabbed. But there is more that could be done.

“The booster is working in a beautiful way in preventing severe cases and hospitalizations,” Davidovitch added.

The majority of Israelis who are ventilated are people who are first and foremost those who are not vaccinated, followed by those who were vaccinated more than six months ago with only two shots.

While coronavirus has generally thrown the world into a state of confusion, and decisions often require re-examination, when it comes to the need for booster shots to be fully vaccinated, Waxman said, “Israel is definitely not making a mistake."