While Europe Celebrates – Israel & Bahrain Vaccinate Medicines & Vaccines 30/12/2020 • Elaine Ruth Fletcher Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to email this to a friend (Opens in new window)Click to print (Opens in new window) Just-vaccinated – Client walks out of Maccabee Health Fund’s night station in Jerusalem’s Arena conference center Jerusalem – The huge neon sign over the city’s football stadium flashed over the highway and into the night. “Jerusalem is vaccinating” – it proclaimed. Across from the stadium, in a giant Arena that in normal times hosts conferences and trade shows, a steady stream of older people – some in wheelchairs, moving with walkers or assisted by family members or caregivers, were entering the big hall at 8 pm to get their first shot of the Pfizer’s Covid vaccine. The arena has been turned into an impromptu vaccine station for one of Israel’s four public health funds – Maccabee. It features a large, airy waiting room with numbers flashing across a big screen – and 8 vaccination stands down a hallway where people were immunised within minutes behind a flimsy curtain and then ushered back to wait 15 minutes to insure no allergic reaction It’s a scene that is being repeated all over Israel – including at some drive in vaccine facilities- as the country goes into vaccine overdrive. “It was just like an A&W drive-thru,” marveled 65-year-old retired teacher Deborah Sullum, who was vaccinated at a drive-in facility in the coastal city of Haifa just last week together with her husband, a medical doctor. “You roll down your window, place your order with your magnetic Maccabee (health fund) card. At the second station, you get your injection and at the third station you wait in the parking lot for 15 minutes to make sure there are no allergic reactions. Super efficient.” As of Tuesday evening, 29 December, some 643,000 people received their first vaccine, making Israel, with nearly 9 million people, the country with the highest rate of COVID vaccine coverage per capita in the world, and third highest in absolute terms, just beyind the United Kingdom, China and the United States. As of Wednesday morning, 30 December, that reached and then exceeded 700,000 vaccines, as numbers mounted by the hour. With most health care workers and over 20% of people over the age of 60 already having received their first shot, the aim is now to become the first country in the world to vaccinate its entire vulnerable population. Immunizations of teachers and younger people with chronic health conditions are slated to begin next week. While over 100,000 vaccines a day are being administered already, the goal is to reach 150,000 vaccinations daily. If that pace is sustained, then some 2.25 million people may already be immunized with the full two-dose course of the Pfizer vaccine by the end of January, or about one-quarter of the entire population. “Jerusalem is vaccinating – maintain hygiene” proclaims a sign over west Jerusalem’s Teddy football stadium Hype, Efficiency & Creative Chaos Of course the process, which kicked off on December 19th with the televised vaccination of Prime Minister Benjamin Netanyahu and Health Minister Yuli Edelstein, hasn’t been entirely smooth going. The initial days also saw chaotic moments of long and crowded vaccine queueing in some hastily erected health fund stations – along with well publicized moments of queue jumping, which is almost a national sport in tiny, crowded Israel. There has been vigorous media coverage examining which one of Israel’s four public health funds are providing the best and the worst vaccine services – including where people have been getting appointments immediately or after delays of a few weeks. In some cases, wannabe vaccine candidates were able to register online. In others, they had to call a hotline dozens of times just to make an appointment, some people complained. Despite the hiccups, the strenous advance preparations, media hype and hopes that vaccines will help return a semblance of normalcy to life have helped propel the campaign – and vaccine acceptance to unexpected heights. Vaccine response rates have compared well in progressive, higher income areas of Israel’s central region – and more low-income rural areas on its periphery. It has lagged in some smaller, and more conservative, Bedouin and Palestinian communities where vaccine hesitancy is higher, but the general assumption is that those pockets of doubt will be overcome by the otherwise huge turnouts seen. Vaccines are being administered at stretches of 12 hours a day – even in some cases on the Jewish Sabbath. The demand is so great that lines of younger people and those with chronic conditions, who don’t yet qualify to get vaccinated officially, form outside of some of the larger vaccine stations toward the end of the evening, just before closure, with people aiming to get doses that would otherwise be thrown out – because they won’t survive overnight without the ultra-cold storage that they require. Intense media coverage of how many vaccines are arriving, and what health funds and cities are outperforming in terms of vaccine coverage, has added to the hype. The camapign has also been a morale booster, placing the efficiency and muscle of Israel’s four public health funds that provide universal health coverage front and centre on full display. Although beyond the strength of the health system, there are other obvious ingredients to success. Those include the country’s small size, high-level political commitment despite incessant political infighting – and the ability to pay for a big vaccine supply right away. Reportedly Israel, which opted to buy the Pfizer/BioNTech COVID vaccine relatively late in the game, paid a premium price of US$ 28 per dose as compared to the US$ 19.50 paid by the United States and US$18.34 paid by the European Union. But along with the higher price, the deal, reportedly sealed in a series of late night phone calls between Netanyahu and Pfizer’s CEO Albert Bourla, also included a schedule of rapid, high-volume deliveries. As a result, Israel will have already received 3.8 million doses of the Pfizer vaccine by the end of this month – out of a total order of 9 million doses. Add to that six million doses of Moderna’s vaccine, which is based on a simlar mRNA technology, Israel already has enough vaccines to cover most of its population, as well as ensure a steady supply so that immunizations can proceed uninterrupted over the first four months of 2021. And that is without considering a domestic vaccine that it is currently in Phase 2 trials. Covid vaccination doses administered per 100 people as of 30 December, 2020 Interestingly enough, Israel has not been the only country in the region to have advanced so quickly – while Europe has seen delays due to a more cautious process of regulatory approvals followed by Christmas and New Year’s holidays. Bahrain, a tiny Gulf country with just 1.7 million people, currently ranks second in the world behind Israel, in terms of COVID vaccine coverage, per capita. That rollout also has included Bahrain’s sizeable population of foreign workers who comprise half of the resident population – setting a precedent for other countries in the region where hundreds of thousands of Pakistanis, Bangladeshis, Filipinos and other foreign workers keep oil-based economies operating smoothly. Bahrain’s rapid rollout has been built upon pillars similar to Israel’s – early approval of the Pfizer vaccine by the country’s independent regulator’s; and thanks partly to that, Pfizer commitments of rapid delivery of large quantities of vaccine doses; and an excellent public and private health system which is also patronized by people from around the Gulf. Vaccine Nationalism & Vaccine Geopolitics The Israeli campaign has not been without criticism – it also reflects the pockmarks of the area’s broader regional disputes. Most of the nearly 3 million Palestinians in the Israeli-occupied West Bank and another 2 million people in Hamas-controlled Gaza, are not part of the vaccine drive – despite soaring rates of infection and serious illness. It’s a vivid illustration of the global differences between the world’s vaccine “haves” – and “have nots”. In the Israeli context, it’s also an example of how the geopolitics of vaccine nationalism are intertwined here with other deepseated national and territorial conflicts. Israel has said that the Palestinian Authority, is responsible for procuring its own vaccines for West Bank Palestinians – as it typically does for routine childhood vaccinations – often obtained in bulk through discounted UN procurement deals. But health activists say that leaving the matter to the budget-strapped PA is self-defeating – insofar as tens of thousands of Palestinians work in Israel – and continued high infection rates in the West Bank will inevitably spill over. And precisely because Israel doesn’t recognize the Palestinian Authority as a national entity – large areas of the West Bank aren’t even under the PA’s control – then Israel still holds ultimate responsibility for ensuring Palestinian access to COVID vaccines, legal and human rights advocates also point out. “You don’t have to be a licensed lawyer to understand the absurdity of a position by which [Israel claims that the West Bank] territory belongs to the Jewish people when it comes to settlement, exploitation and annexation, but that when its non-Jewish residents are ill, the territory is Palestinian,” opined human rights lawyer Sari Bashi, in a 2 December op-ed in the liberal national daily, Ha’aretz; she argued that Israel should purchase vaccines for Palestinians as well. Universal Health Coverage – Almost Then again, the nature of the vaccine distribution, is not precisely etched around national identity either. Rather it is anchored in the Israeli system of national health funds. Those funds do not cover Israelis living abroad. They do include hundreds of thousands of Palestinians in disputed East Jerusalem, who can thus obtain the COVID vaccines right away. At the same time, the remaining 2.2 million or so Palestinians living in the West Bank on the other side of the army checkpoints and stark concrete barriers that mark Israeli-defined Jerusalem city limits, must rely upon the health services of the Palestinian Authority – which doesn’t yet have access to any COVID vaccines. Foreign residents and workers living in Israel, on the other hand, generally belong to Israeli health funds and are eligible to get the vaccine under the same criteria as Israeli citizens – with foreign caregivers of elderly Israelis getting first priority this week. The situation is less clear, however, for Israel’s approximately 30,000 African asylum seekers, most of whom fled war-torn Sudan and Eritrea a decade or more ago, slipping into the country via Israel’s border with Egypt, after a tortuous trip through the Sinai desert, but have never been granted formal refugee status by Israel’s Interior Ministry. While in principle, asylum seekers are supposed to be covered with health insurance by their employers – in fact they have limited access to medical care. Some employers duck the rules, while those who are unemployed or unable to work because they are chronically ill, fall into an insurance void. Human rights advocates are hopeful that they may soon be able to make an arrangement, however, whereby vulnerable asylum seekers may also be immunized. Palestinian Authority Ordering Russia’s Sputnik Vaccine In terms of the current lack of Palestinian access to the vaccines, Israel’s deputy health minister Yoav Kish told Israel’s Kan Radio station last week that “should we see that Israel’s demands have been met and we have additional capability, we will certainly consider helping the Palestinian Authority.” However, the Palestinian Authority, which typically procures its own vaccines anyway for routine immunizations, is not waiting for Israel. Earlier this month, one PA health official Osama al-Najjar announced that four million doses of the Russian Sputnik vaccine would be delivered in early 2021. “We will begin to inoculate those most at risk [for the coronavirus],” al-Najjar said in an interview with Voice of Palestine Radio. Outside of Russia, only Argentina and Belarus have have so far approved the Sputnik vaccine, whose Phase 3 clinical trial results have not yet been fully completed – or independently reviewed. . The PA also hopes to vaccinate one-fifth of Palestine’s people under the WHO co-sponsored COVAX facility, starting with healthcare workers, another senior Palestinian health official, Ali Abed Rabbo told the Associated Press last week. “The remainder will depend on Palestine purchasing from the global supply, and we are working with several companies,” Rabbo said, naming Pfizer, Moderna, AstraZeneca, as other potential candidates, along with the Russian Sputnik vaccine. Israel also eyeing Sputnik The Palestinians are not the only ones eyeing Sputnik; some prominent Israelis have also given the Russian vaccine a nod. Zeev Rothstein, Director General of Jerusalem’s prestigious Hadassah-Hebrew University Medical Center, said last month that the hospital had secured an agreement to purchase 1.5 million doses of the vaccine from Russia – with the aim of becoming a regional vaccine distributor. However so far, the hospital, which also has a branch in Russia, has not secured official Israeli Ministry of Health approval for the move. Along with the imported vaccine options, an Israeli-developed one-dose COVID vaccine just began Phase 2 trials this week; if all goes well, Phase 3 trials will begin in the spring. With some 10 million doses of that vaccine slated for potential production, it’s possible that in the end, Israel might become a net exporter of COVID vaccines. The question, however, is how much time it may take? Said an Israeli Ministry of Foreign Affairs spokesperson in Geneva: “Israel, at this point, has made vaccine agreements with both Pfizer and Moderna, and plans to obtain vaccines for all its citizens. “At the same time, Israel is part of the COVAX facility, WHO’s instrument to insure that all citizens of the world will be safely vaccinated equitably. “Understanding that pandemics know no borders, Israel has strengthened its cooperation with the Palestinian Authority in order to prevent, mitigate and address the spread of the virus in the region. “The ongoing cooperation includes consultations, training and information sharing, cooperation with Palestinian medical teams, and delivery of COVID-19-related PPE. We encourage the international community and donor countries to help the PA with all aspects of dealing with the COVID-19, including access to vaccines.” Image Credits: Our World In Data . 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