Behind Israel’s Rapid Deployment of Covid-19 Vaccine Boosters

Days after the midnight vote to dispense a third injection, the first of millions of booster shots was given, months before the United States or any other country did the same.

“It was a really tough discussion,” said epidemiologist Gili Regev-Yochay, who presented key research on the effectiveness of booster injections. “[But] it was a decision that was taken essentially with one voice.

Throughout the global effort against Covid-19, Israeli public health experts have always been ahead of their counterparts elsewhere in the world. By securing an early supply deal with Pfizer for its vaccine, softened in part by a promise to share data from Israel’s vast network of health maintenance organizations, they had an advantage in understanding how the vaccine behaves in the real world.

They were also ready to act quickly when they saw this data, suggesting, among other things, expanding the vaccine to younger adolescents and adopting a Covid passport system to persuade holdouts to get vaccinated if they wish to visit places. cinemas, restaurants or other entertainment venues. .

Sometimes the country has moved faster than some other country might prefer. The World Health Organization, among others, has criticized vaccinating younger adolescents or giving third booster doses at a time when billions of people in poorer countries have yet to receive their firsts. injections.

But where Israel goes, others often follow. President Biden received a recall at the White House on Monday, days after the United States Food and Drug Administration cleared it for people aged 65 and over and adults in high-risk groups, a recommendation supported by the Centers for Disease Control and Prevention. The UK, which was quick to roll out vaccines, this month began offering reminders to people over 50 and vulnerable people, while the EU regulator will decide on its own. a third vaccine should be approved early next month.

Those involved in the decision-making process in Israel attribute a culture of debate and a willingness to improvise, instilled in part by long careers in the military, common to high-level medical professionals, and tested during security crises national.

Arnon Afek, doctor and member of the advisory group, was a senior medical officer and later director general of the Ministry of Health before becoming director of Sheba Hospital in Tel Aviv. When the pandemic first hit, he said he turned part of his hospital parking lot into a coronavirus ward.

“We are still living on the brink of an emergency,” said Dr Afek. “It can come from the Gaza Strip or Covid or cyber wars against our enemies. We know how to rely on ourselves and know how to manage emergency situations.

Since the members of the advisory committee all work on a voluntary basis, neither politicians nor government officials can prevent them from saying what they think when they meet with the Israeli cabinet.

“No one has any influence over me when I’m sitting in this room,” said Ran Balicer, head of the primary expert advisory committee on Covid-19, who said he does most of his advisory work. the night after his busy day job as a senior. official of Israel’s largest healthcare organization, Clalit.

Israeli leaders have listened widely to scientists, advisers say, despite a prolonged period of political turmoil that saw Prime Minister Naftali Bennett oust longtime leader Benjamin Netanyahu. One of the few times the government has strayed from the advice it was given was when Mr. Netanyahu hesitated last year to create a multi-tiered lockdown system like a traffic light: red , green and amber. Israel then had to impose another nationwide lockdown.

Healthcare professionals who voted to approve the booster shots – perhaps the most controversial issue they’ve faced – have been influenced by two studies.

One was a Health Ministry analysis of Israeli data that showed people vaccinated from January to March were much more likely to get sick than those vaccinated later.

The second study to sway the late-night debate behind a gunshot for over 60 years was presented by Dr Regev-Yochay and his team at Sheba Hospital. He pointed to the sharp increase in infections stemming not only from the virulence of the Delta variant, but also from the decrease in the prevalence of antibodies in those vaccinated.

His research has shown that resistance to the virus has been declining in test subjects for months. They also knew, from the booster shots given to immunocompromised patients in Sheba, that a third dose could successfully raise antibodies. The rest of the panel agreed to continue.

Pfizer said at the same time that its own research also showed that antibody levels decrease over time.

The decision quickly paid off. When the booster vaccination campaign began, the majority of Delta infections were detected in patients who had previously been vaccinated and believed they were safe from the virus. Per capita infection levels were among the highest in the world and it looked like the country was heading for another economically debilitating lockdown.

Since then, more than three million of Israel’s nine million people have received a recall, a majority of them from at-risk groups. Most infections are now among those not vaccinated, and talks about a fourth lockdown have been replaced by talks about learning to live with the virus.

There is a small minority of Israelis who think the country is moving too fast and don’t appreciate being at the forefront of how to deal with Covid. Eldad Yaniv, a leading political activist and critic of Mr. Netanyahu, has now criticized Mr. Bennett’s government for moving faster than the United States Food and Drug Administration to approve the boosters.

“An experiment is underway in Israel,” he wrote in a Facebook post on September 12, saying Israel’s vaccine deal with Pfizer pushes it ahead of other countries by approving the third injections for the new mRNA vaccines.

Israeli officials say their deal with Pfizer is not exclusive and does not require them to expand their vaccination campaign faster than other countries.

Most Israeli doctors and epidemiologists are not discouraged, turning their straightforward view of the effects of vaccines into research much of the world has turned to. Dr Balicer was the senior editor of a landmark article published in the refereed New England Journal of Medicine in February, showing that Pfizer was effective under real conditions. He then edited another article in the same journal which demonstrated that the risks of getting sick from Covid-19 outweigh the potential risks of receiving the vaccine.

As the FDA deliberated on whether to approve the recalls last week, an NEJM article supported by the Israeli Ministry of Health and peer reviewed said that the adjusted rate ratio of confirmed cases for Israelis of over 60 years at least 12 days after receiving a booster was 11-fold lower than those who received only two injections. The authors said they found that the rate of serious illness in people over 60 who received the booster was about 20 times lower, compared to those who did not receive the booster.

Already, the country’s scientific community is once again moving in front of its counterparts elsewhere in discussing the possibility of recommending further booster injections in the months and years to come.

“There will be a fourth, fifth, sixth or even seventh shot as long as Covid-19 continues to hit the world… we will continue to see variants increase,” Dr Afek said.

Write to Thomas Grove at [email protected]