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Analysis

Israel is buying up COVID vaccines — but faces huge challenge in deploying them

Country is poised to clinch millions of Pfizer vials, but the devil’s in the details: The shots require unique, unprecedented storage and transport conditions. Will we be ready?

Nathan Jeffay

Nathan Jeffay is The Times of Israel's health and science correspondent

A medic in a protective suit and mask holds an injection syringe and vaccine. (oshcherban via iStock by Getty Images)
A medic in a protective suit and mask holds an injection syringe and vaccine. (oshcherban via iStock by Getty Images)

Israel is poised to sign a deal to buy millions of coronavirus vaccine shots, to be delivered within months. But will the country be ready to receive them?

In a jubilant message to the Israeli public on Thursday night, Health Minister Yuli Edelstein said he expects to sign an agreement Friday for Pfizer shots for almost half of Israel’s population. His statement came a day after Prime Minister Benjamin Netanyahu first triumphantly announced the emerging deal.

Jerusalem had been pushing hard for an agreement since Monday, when Pfizer announced that its vaccine appears to be 90 percent effective.

Netanyahu has said that vaccines will start arriving as early as January. Other top officials say it will be later, but still in the first quarter of 2021. The plan is for them to be available in clinics almost immediately after regulators give the vaccine the all-clear for injection.

It sounds like a dream come true. But there are serious caveats.

First, it bears mention that Pfizer’s vaccine is still not ready or approved, and some experts have urged caution as crucial data is still needed.

But even if everything checks out, the vaccine’s arrival will introduce serious difficulties.

Pfizer’s vaccine needs to be kept at minus 70 degrees Celsius (-94 F) or colder — a far lower temperature than virtually any other vaccine. This will require an unprecedented infrastructure for receiving and storing the vaccine, not to mention the mammoth challenge of distributing it. Shots are expected to last in refrigerators for just a few days after thawing.

A nurse collects vaccines from a cool facility. (Natalia Kokhanova via iStock by Getty Images)

There has never before been a need to provide so-called “cold chains” for such a huge amount of vaccine at such low temperatures. Health officials who previously began considering it were largely focused on the Moderna vaccine, which Israel expects to receive by mid-2021 due to a preliminary deal it signed in June. But that vaccine stays good at minus 20 degrees Celsius (-4 F), a full 50 degrees Celsius warmer than Pfizer’s, and within the capability of regular medical freezing facilities.

Israel has rushed for a deal with Pfizer so that, should the company’s vaccine get approved first, the country will waste no time in starting its vaccination operation. The sooner clinics start administering shots, officials reason, the sooner citizens and the economy can return to a more normal life. The anticipated deal so soon after the optimistic reports from Pfizer is a significant coup, and a morale boost for the Israeli population. It was the announcement that Health Ministry officials had been looking forward to making for months.

But significant questions remain about the matter of logistics. And there is currently no detailed plan in place that addresses cooling and transportation.

Acknowledging the complexity of the issue, Pfizer is itself planning impressive-sounding cool boxes, which will feature GPS tracking and keep the shots cold for days (current reports suggest “up to” 10 days, which is somewhat vague, and will be subject to environmental factors like outside temperature). These boxes will rely on dry ice, which loses its effectiveness over time. In the US, where Pfizer can closely control its own distribution operation using road transportation, it’s conceivable that it will be able to deliver shots from its depots to final destinations so that no storage is needed beyond the boxes.

Illustrative image: dry ice. (nikkytok via iStock by Getty Images)

In Israel, it’s a different story. People live in smaller locales and local clinics will need smaller numbers of shots than the 1000-capacity dry ice containers. Supply will be reliant on flight schedules, and it is impractical to attempt to sync delivery and vaccination schedules so that all shots can be administered within about two weeks of the date they left Europe (a best-case scenario of 10 days in the cool box and another five days in a medical fridge).

Such a syncing operation would be made even more difficult given that each person requires two doses, with the second 21 days after the first. It would also leave no room for disruptions due to unexpected factors.

Cooling time in the boxes may be extended, but this would require copious amounts of dry ice, which Israel doesn’t currently have. One possibility is that the state would begin massive investment in dry ice production facilities, strategically placed throughout the country.

Pfizer headquarters in New York City, on November 9, 2020. (David Dee Delgado/Getty Images/AFP)

Still, experts question whether the boxes, constantly replenished with dry ice, are a solution. For storage over weeks or months, Pfizer’s boxes are unlikely to provide the same level of reliability as super-cold freezers, and any glitch with dry ice supply could lead to entire batches of shots spoiling.

Israel’s safest path is to start immediately developing dry ice production, building special freezer facilities, and developing the infrastructure for delivering shots to their final destination.

In the UK, Public Health England has said that “national preparations” are underway regarding both central storage and distribution of the vaccine across the country.

Now it remains to be seen whether Israel will rise up to the planning challenge, or follow an increasingly-ingrained pattern of championing important moves while failing to follow through.

When the world was talking about the high potential for serological testing in preventing the disease’s spread, the Health Ministry bought 2.4 million kits to test citizens for past infection, at a cost of NIS 112 million. But Israel’s state comptroller recently reported that months later, there is no clear plan for how they will be deployed, and only 60,000 have been used.

An Israeli laboratory worker conducts serological tests for coronavirus at the Leumit Health Care Services laboratory in Or Yehuda, near Tel Aviv on June 29, 2020. (Gil Cohen-Magen/AFP)

And while medical professionals have been stressing for months that contact tracing for diagnosed patients is critical in cutting infection chains, development of the capacity to do so has been slow. Virtually everyone in the medical community agrees that effective tracing is a tool that saves lives, but the state comptroller found that this too has been badly deployed, with too few patients traced and investigations often done too late to be effective.

If Israel fails to properly prepare to receive the vaccines, it may lead to bottlenecks, holdups and countless wasted vials.

With its poor organizational track record and a trend of decisions getting caught up in red tape, it’s quite possible that the government could end up being the cause of Israel’s vaccination delay. Deals for life-saving syringes are all well and good, but beyond paying pharmaceutical giants in cash, Israel must be able to keep up its end of the bargain.

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