Vaccine roll out: Israel's circumstances aren't special

Israel has become a world leader in vaccine roll out. Based on my first-hand experience, I want to dispute all the claims that this is due to some special circumstances of Israel's demographics, geography, or healthcare system. Rather, Israel is just getting on with the job. If supplies of the vaccine hold up, every Israeli citizen who desires a vaccine, which is the vast majority, will receive one by around the end of March, and Israel should then reach the threshold for herd immunity, preventing further COVID outbreaks, at least until there is a vaccine-proof mutation. If that happens, the vaccines will be tweaked and Israel knows how to vaccinate the population all over again in three months.

Personally, I got my first vaccine shot two weeks ago, and am scheduled to get the second in a week. Everyone I know in Israel over 60 has received theirs, most people I know over 40 have too, and quite a few youngsters have received a shot, mostly by queueing up for end-of-day leftovers.

The world is in a medical and economic emergency, and I really hope other countries can follow the example; I do not see any reason why they cannot.

First the data: at the time of writing Israel has given the first vaccine shot to 19.5% of its population, followed by UAE and Bahrain. US and UK have vaccinated about 2%, Germany 0.6%, France just 0.12%. To put that in perspective, on a single average weekday, Israel vaccinates 1.5% of the population. My only interest in writing this is not to praise Israel, although on this occasion they're doing a great job, but to encourage other countries to catch up (in the unlikely event that they read my posts, that is).

Here are the explanations I've read, partly from European journalists and politicians trying to explain the vast gap: Israel has a small population, small geography, high population density, unique healthcare system, electronic medical records, experience with crises.

I actually don't believe any of these are terribly relevant. At most they are slight advantages, nothing justifying 10x.

Firstly, countries with bigger populations have proportionally more doctors and nurses and hospitals and clinics. Relative to its population, Israel has fewer doctors per 10,000 people than Germany and a similar number to other countries. A small population is not a clear advantage.

It's true that Israel has high population density and no place is more than an hour or two drive from a city. But all developed countries, even those geographically spread out, have about 75-90% of their population living in cities. They could start by vaccinating those, plus all the people who live in city suburbs and large towns. And many of the remaining rural residents are perfectly capable of arranging a visit to a city or town.

Israel's five competing publicly funded healthcare providers do all use electronic medical records which is advantageous. But its really not critical to have a patient's medical records when vaccinating them. You pretty much just need to ask them if they have ever had an allergic anaphylactic shock.

Once you have vaccines in a freezer, all that is required is a syringe, two minutes from a secretary to check ID and age eligibility, and two minutes from a nurse or medic with minimal training to inject the shot. You don't need a doctor, or at most one doctor overseeing multiple nurses or medics. My wife and I received our shot from a retired nurse who came out of retirement to help out. Others in Israel received their shots from young medics who help out in the ambulance service.

Since I have electronic medical records, the nurse updated my records immediately, but even if I didn't, they could have just given me a letter, or a computer could have emailed my doctor to update my medical file manually at a later date. Some may feel its not ideal to administer a vaccination in a makeshift tent clinic without a doctor checking and updating medical files. Well, its not ideal to have thousands of people dying every day, and millions unemployed. It is far more important to vaccinate people than to be 100% sure that this is recorded in their medical file instantly.

In Israel, fortunately, a large majority of people do want the vaccine, although fewer in the Arab communities. France is dealing with 40-60%, depending on the survey, of people who don't want the vaccine. This will require a significant public education effort. But in the meantime, I do hope they vaccinate the 40%+ that want it, at full speed.

It is helpful to have digital population registries which allow scheduling organized appointments. Some countries like Germany have much stricter privacy laws than Israel. But this is not critical. In Israel, people in high risk groups can book an appointment online or by phone. But younger people can turn up at the end of the day and queue to get a leftover dose. Standing in a socially distanced line for an hour or two, if that is necessary, is not ideal, but it's a lot better than waiting months. The vast majority of people are quite capable of self-booking appointments or standing in line if necessary, and most elderly people, if they need assistance, have a younger relative or caregiver who can help. Only a small minority must have a home visit, and that too is not so difficult to arrange. If a country doesn't have the digital infrastructure to schedule vaccine appointments for each age group, the vast majority of the population is quite capable of booking for themselves on a website.

Obviously, there are challenges. The biggest challenge is that there is going to be a global shortage of vaccines for a while as production ramps up. Israel probably paid a premium price and certainly offered patient data in return for getting early supplies; not every country can do that. Its sad to see that, as usual, people in wealthy countries, even young ones, will be getting their vaccine long before more vulnerable people in less wealthy countries, including Israel's Palestinian neighbors. That's the reality of the world, but its not right and I certainly hope the WHO COVAX initiatives goes some way to righting this, especially with the availability of the Oxford AstraZeneca vaccine which is cheaper to produce and distribute. I would love to see Israel actively supporting these efforts.

But this particular post isn't about that. I just wanted to say that I have witnessed first-hand that once you have the vaccines in a freezer or fridge, its really not that hard or expensive to get them into people's arms safely and rapidly. There really is nothing terribly special about Israel in this respect. In fact, from what I witnessed, I bet Israel could still 2x its rate of vaccination by training the nurses and clerks to progress from patient to patient more efficiently.

The economic cost of not rolling out quickly is much much higher than any cost of a rapid vaccination program. The world has had a year to prepare, and now its showtime. We're in a race against COVID-19's more aggressive mutations, and so I do hope that all countries will step up their game.