Israel’s vaccine miracle

The answer one has to that question lies largely with one’s political affiliations. Supporters of prime minister Benjamin Netanyahu credit him with achieving the breakthrough in a serious of phone calls with Pfizer’s CEO, Albert Bourla, in which a large and early shipment of doses was agreed upon.

Those who are less enamoured with the prime minister cast the origins of the success a bit further back.

109 years ago, to be exact.

In 1911, Berl Katznelson, a young Zionist-Socialist ideologue who would go on to become David Ben Gurion’s main partner in the foundation of the Worker’s Party of the Land of Israel, forerunner of Israeli Labour, founded a workers’ health fund.

Within a few years it would become one of the most influential departments of the Histadrut trade union that he and Ben Gurion led. The promise of free healthcare attracted workers to become members of the union and its services were essential to the pioneering kibbutzim.

Over the next few decades other unions and political parties in Mandatory Palestine founded their own health funds. When Israel was established in 1948, they became the main vehicle for delivering medical treatment to the new country’s citizens.

By 1995, after a series of mergers, four of them remained with 95 percent of Israelis signed up as members. The Knesset finally passed a law regulating their operations, mandating that all Israelis must choose to belong to one, paying only nominal fees for services.

“Basically, Israelis have universal healthcare, just like British citizens,” says a healthcare administrator who has worked both in Israel and Britain. “But while in Britain you have one NHS that everyone loves, a monopoly. In Israel you have four NHSs and they compete ruthlessly for each other’s members.”

Any Israeli can move between the four health funds at will. But since most are naturally reluctant to leave their family doctors behind, on average just two percent move annually. The scope for increasing a fund’s budget through membership is therefore limited.

Professor Ran Balicer, head of innovation and research for Klalit Medical Services, the largest of the four, says this encourages new approaches: “Since the health funds get nearly all their budgets from the government on the basis of their membership share, we can’t cut back on services or close clinics as we’ll lose members. The best way for us to keep costs down is therefore to invest in outreach and preventative and predicative medicine.

“That means knowing as much as we possibly can about our members’ medical history and situation, by digitizing every medical file and making them accessible and then reaching out to members with preventive treatments and early awareness that will cut down their future need for more expensive treatments and hospitalisations.

“We’ve achieved a level of outreach and connection with our members that has made us the perfect vehicle for carrying out a nationwide vaccination drive.”

Over the last few weeks, as Mr Netanyahu has sought to portray himself as Israel’s great vaccinator in an attempt to boost his party’s standing in the polls before the 23 March election, his opponents have hit back saying that, if anything, Israelis should be giving thanks to their public health system, the legacy of Likud’s old socialist foes.

“The truth of course is that both should share the credit,” says Eyal Gabai, chairman of Meuchedet HMO, the third-largest health fund.

Mr Gabai served as the director-general of prime minister Netanyahu’s office between 2009 and 2013, making him both the leader’s right-hand man and one of the most powerful civil servants in Israel. “Without the four health funds, their advanced digital service and their need to compete with each other, Israel could never have delivered so many vaccines in such a short time.

“But it was Netanyahu who secured a large quantity of vaccines so early. Of course it could help him now before the election but, politics aside, Netanyahu truly believes he is Israel’s defender. I remember back in 2009, with the global outbreak of swine flu, he rushed to purchase vaccines, even though it didn’t eventually reach Israel.”

Early on in the pandemic, Mr Netanyahu pinned his hopes on vaccination. As early as February last year, in one of the first cabinet meetings on Covid-19, even before there were infections detected in Israel, he ordered the Biological Research Centre in Ness Ziona to develop an Israeli vaccine. For months, he repeatedly predicted that it would be a home-grown vaccine that would save Israel, and perhaps the world, from the coronavirus.

The only problem was that Ness Ziona’s scientists specialise in other fields and it took a while for them to get the Israeli vaccine, which has been called BriLife, off the ground. It is still only in the second-stage of trials and is having trouble finding Israelis willing to participate.

“It was a Bibi folly,” says one scientist. “There was no way Israel could have developed a vaccine faster than the pharmaceutical companies experienced in doing so. And even if Ness Ziona somehow succeeded, to make vaccines affordable you need to manufacture them by the billion, in specialised factories. We don’t have one of those in Israel. Instead, we’re wasting billions on a vaccine we may never use.”

While he continued to praise the Israeli vaccine, Mr Netanyahu was already working on a backup plan. In June Israel signed an agreement to purchase millions of doses from Moderna and in November signed another agreement with AstraZeneca, only to discover a week later that it was Pfizer that had progressed the furthest and was likely to be the first to obtain an emergency authorisation for use by the United States’ FDA. Israel then entered negotiations with Pfizer.

There are three versions of how Israel succeeded, despite coming late to the table, in signing an agreement with Pfizer for a total of 6.7 million doses - of which four million would be supplied in a first tranche in mid-December. All versions have some truth to them.

According to Mr Netanyahu, in the running commentary he supplied the Israeli public of every phone-call he had with Pfizer’s CEO, it was thanks to the personal rapport he established with Mr Bourla. He had appealed to his Greek-Jewish roots and apparently Mr Bourla, who had been impressed by the way Mr Netanyahu has improved the Israel-Greece regional alliance in recent years, was won over.

Then there is the version you hear from Treasury officials who maintain that it was largely down to numbers. Pfizer is producing hundreds of millions of doses a month for the United States, the European Union, Britain and dozens of other countries. Four million doses for early delivery to Israel didn’t put much of a dent in their plans, especially as Israel was prepared to pay double what the EU is paying for a dose.

And public health experts insist that it’s largely thanks to the Israeli health system’s long-standing relationship with Pfizer and, most crucially, the fact that Israel, a small country whose citizens’ medical records are all digitised, can provide the perfect real-time and real-life laboratory within which to assess quickly how well the vaccine is doing on an actual population. Whether, for example, there are any side effects and if it’s holding its own against new variants of Covid-19 which are already spreading.

“It’s all true,” says one senior official who was involved in the negotiations with Pfizer. “We paid a premium, the number of doses were not that significant for Pfizer’s capabilities and when Bibi got involved personally in the talks and ordered our lawyers just to hurry up and sign the contract, it all moved very quickly.”

The vaccinations have not yet had an impact on the coronavirus situation in Israel. Instead, daily rates of infection have sky-rocketed to 9000 this week, a per capita rate as high as Britain’s. Hospitals are packed with patients and at the end of the week a much tougher lockdown is to go in to force. But Mr Netanyahu is confident that the vaccinations will reverse both the pandemic and his political fortunes.

“The vaccinations and the feeling of emerging from coronavirus will change the economic and social mood dramatically,” he predicted in a meeting with Likud parliamentarians last week. “It will put everything to one side,” he promised. And the party would go on to win the election handily.

On Wednesday evening he echoed this message to the public in a short video on social media. He’d spoken this time with the CEO of Moderna, Stephane Bancel, and tomorrow, he promised, the first shipment of Moderna vaccines would arrive in Israel. “And I’m working to bring millions of additional doses for Israel’s citizens so we can escape, once and for all from the coronavirus plague.”

The future of Israel’s successful vaccination drive relies on the pace of these shipments. And with it, perhaps, also the future of Mr Netanyahu’s career.