How is it that these two developed countries have such contrasting vaccine distributions?
Israel is currently leading the world in their COVID-19 vaccination efforts. As of March 2021, over 50% of the Israeli population has been fully immunized against COVID-19. In the same time, the US has vaccinated only a tenth of its population.
The factors that contribute to Israel’s success include differences in demographics – Israel has a much smaller and a younger population. Additionally, the Israeli government purportedly paid a premium for vaccine doses (reportedly twice the cost per vaccine paid by the US) and made a heavily publicized and controversial deal with Pfizer and BioNTech to trade a rolling supply of coveted inoculations for medical data on the vaccine’s distribution. Israel also has a public health care design that provides an easy and centralized system for organized vaccination delivery. However, it is the national emergency infrastructure that allowed Israel to quickly and effectively immunize its population while the US continues to lag.
Israel has a mandated universal healthcare system consisting of four Kupat Holim organizations analogous to Health Maintenance Organizations (HMOs) that exist in the US. They also have one of the most advanced electronic medical record systems in the world and an estimated 46.25 physicians per 10,000 population (vs. 26.12 per 10,000 in the US). With over 900 different insurance companies, all with vastly different resources and approaches to communication, the US cannot mobilize their health care organizations for such a massive task as quickly and efficiently as Israel.
An older population and lower literacy rate in the US limit the ability for effective online outreach and marketing campaigns. The US also has an uphill battle to regain confidence with communities of color after a longstanding history of racial inequity in medicine. Additionally, the US struggles with combating an indelible sentiment of conspiracy around the vaccine incited by the previous administration’s contentious relationship with scientific leaders. While Israel has had to battle vaccine misinformation campaigns, particularly among the ultra-Orthodox and Arab communities, the country generally fosters a positive and trustful relationship between their health care systems and their population.
ISRAEL’S HEALTH care system has been consistently ranked in the top 10 of the Bloomberg Health-Efficiency Index, which considers life expectancy and health care spending to determine the countries with the best healthcare outcomes. In 2020, the US ranked 55th on the Bloomberg index. In other words, while Israel has invested money into technology and a simple healthcare infrastructure to create an accessible, economical and capable program, the US spends more money for an often disorganized and more ineffective system unable to meet the needs of their population.
Ultimately, however, the aspect that makes Israel’s handling of their COVID-19 vaccine rollout most unique, and consequently most efficient, is their utilization of a centralized national emergency response system. In the US, as a result of the federalism ideals of the previous administration, the federal government has delegated responsibility for vaccine distribution to state health departments. These departments, whose resources and finances are already stretched thin by the pandemic, struggled to stay organized and keep up with the massive demand for inoculations. Also, each state has different eligibility criteria and varying communication and distribution strategies. Even within a state, one must navigate dozens of websites and phone numbers to find a center with available immunizations. This has led to confusion, canceled appointments, and, worst of all, wasted vaccine doses.
In contrast, Israel, a country whose short history has been defined by its precarious geopolitical position and pervasive warfare, has developed a strong and centralized national emergency response system that allowed it to meet this moment of crisis.
Designed to protect and inform civilians during national threats, the Home Front Command of the Israeli Defense Forces (IDF) was employed during the COVID-19 pandemic to help provide medical care, perform testing and conduct epidemiological research. The IDF has similarly taken a role in distributing the COVID-19 vaccine, working closely with the Health Ministry in setting up vaccination centers, transporting vials, sending out clear and concise communication, and deploying 700 reserve duty paramedics to assist in the vaccination rollout. By keeping their effort centralized and transparent, the Israeli government, the Kupat Holim organizations and the IDF have worked together to streamline a clear, effective and accessible national vaccination campaign.
And yet, 6,000 miles away, where the US continues to struggle in its vaccination effort, the question remains: How will we learn from Israel in our response to the next national health crisis?
Indeed, in his first week in office President Joe Biden signed several executive orders targeted at organizing the federal governments involvement in vaccine distribution. He has encouraged governors to utilize the National Guard and invoked the Defense Production Act to bolster the federal government’s public health supply chain. While certainly a step in the right direction, how these initiatives will be implemented, coordinated and received across the 50 states, Washington DC, and the five US territories remains to be seen
Until then, my mom continues to refresh.
The writer is a resident physician in dermatology and an MPH student in the School of Public Health at SUNY Downstate Health Sciences University.