Israel, a world leader in COVID-19 vaccination rates, has the kind of problem most countries would love to be facing.
In November 2020, while the AstraZeneca COVID-19 vaccine was still in its trial phase, Israel contracted to purchase ten million vaccine units from the British-Swedish company. Jerusalem has since decided it will not use the vaccines, relying instead on the more expensive Pfizer and Moderna versions. But the millions of doses are on their way, and Israel is still not sure what it is going to do with them.
Coronavirus czar Nachman Ash said that Israel was looking into the possibility of diverting the vaccines to other countries, and has hinted that the doses might even be thrown away if they arrive. This talk of tossing the vaccines might well be bureaucratic posturing to send a message to other Israeli government ministries, but there’s no question that the fate of millions of doses remains up in the air.
Israel’s closest neighbor, meanwhile, faces the opposite problem.
The Palestinian Authority is struggling to vaccinate its population. As of last week, only 3.6% of Palestinians had received at least one dose, and less than 1% were fully vaccinated.
Those figures include the more than 100,000 Palestinian workers that Israel has vaccinated since March, as they come into regular contact with Israelis at their workplaces. But Israel has refrained from initiating a campaign to vaccinate the general Palestinian population, despite calls from Israeli nonprofits, a petition to the High Court of Justice, and senior health experts’ urgings that it do so.
Though Israel does not believe it is legally required to vaccinate the Palestinians, there are plenty of reasons why doing so would serve its own interests, not to mention the humanitarian reasons for initiating such a campaign.
With Israeli officials floating even the possibility that it might be forced to dump millions of COVID-19 doses, the question must be asked: Why not make them available to the PA?
Nepotism and short supply
The PA has begun receiving vaccines through COVAX, a global vaccine program for poor and middle-income countries backed by the World Health Organization. The program aims to provide enough free doses to immunize up to 20 percent of a participating country’s population; around 90 countries have signed up for the program.
The PA has received 271,000 doses for use in the West Bank to date, including 100,000 from China and 58,000 from Russia. Most of the remainder were AstraZeneca doses sent through COVAX.
Israel also donated 5,000 Moderna doses and 200 Pfizer doses for Palestinian medical workers.
The Hamas-run Gaza Strip has received 111,000 doses to date, including 50,000 from COVAX, 60,000 Russian Sputnik V doses from the UAE, and 1,000 Sputnik V doses from the PA.
In addition, Israel vaccinated 107,000 Palestinian workers employed by Israelis.
COVAX intends to eventually provide about 400,000 AstraZeneca shots to the Palestinians, according to UNICEF.
AstraZeneca’s vaccine rollout has been rocky, to say the least. The company is embroiled in controversy over its failure to deliver promised doses to the European Union, and over the shot’s efficacy and safety profile. Last week, the European Union’s executive branch said it had launched legal action against AstraZeneca for failing to respect the terms of its contract with the 27-nation bloc.
The AstraZeneca vaccine is cheaper and easier to use than rival shots from Pfizer and Moderna and has been endorsed for use in over 50 countries, including by the 27-nation EU and the World Health Organization. But US authorities have yet to approve the vaccine.
A British trial of the AstraZeneca vaccine on children was paused in April, as global regulators rushed to assess its possible link to rare blood clots in adults. Britain’s medicine regulator sees the vaccine as safe and effective, but has advised that individuals under 30 use an alternative vaccine.
According to an Army Radio report, Israeli officials have been in contact with the UK-headquartered pharmaceutical company about canceling the contract, but AstraZeneca is reluctant to comply, fearing the bad publicity that would ensue.
Plenty of upside
At first blush, it seems like a win-win for Israel to transfer unwanted AstraZeneca doses to the PA.
An outbreak in the West Bank poses a risk to Israel, where more than 35% of the population, especially children, still hasn’t been vaccinated.
The PA declared a state of emergency in areas of the West Bank under its control in March, which is still in effect. Many businesses are shuttered, and Palestinians’ movement is restricted.
The Palestinians suffered their worst COVID-19 wave in March and April, which peaked at almost 3,000 new cases a day. By late April, that figure had dropped to 1,000 new cases a day. Hamas-run Gaza, where figures are unreliable, reported record-high infection rates last month.
Though the security barrier separates most of the West Bank from Israel, and there is a near-hermetic fence between Israel and Gaza, the entire region is seen as one epidemiological unit. For instance, the US Centers for Disease Control and Prevention’s travelers’ health section lists “Israel, including the West Bank and Gaza.” Because Israel and the territories are grouped together, the US State Department last month included Israel among 116 countries on its “Level Four: Do Not Travel” advisory list, citing “unprecedented” risk due to a “very high level of COVID-19.”
Israeli epidemiologists told The Times of Israel in January that it is in Israel’s overall interest to ensure Palestinians are vaccinated as quickly as possible, as the populations are too intertwined to allow one to gain herd immunity without the other, despite some claims to the contrary by Israeli leaders.
“The message is very simple: We are one epidemiological unit. As much as we can, we have to help them address this matter,” the former Health Ministry Director-General Moshe Bar Siman-Tov told The Times of Israel at the time.
“It is in our common health and economic interest, as we live in a single epidemiological region, and we all need to take part in the effort to stop the spread of COVID-19 in the region,” said COGAT director Kamil Abu Rukun in a statement announcing the operation to vaccinate Palestinian workers. The same logic would seem to apply to the Palestinian population in general.
“They have to be part of the picture. We ignore them at our peril. We are really endangering our population if we do so,” said Dr. Manfred Green, an expert in vaccines who was the founding director of the Health Ministry’s Israel Center for Disease Control.
“There are Palestinians who come to work in Israel and movement of Israeli Arabs who go to Palestinian areas, something that is a lot more common than realized — for shopping, to hold weddings, and … to see family,” said Amnon Lahad, chairman of the National Council for Community Health.
“The rule is very clear with the coronavirus — if the virus is anywhere, it’s everywhere. We’ve seen how easily the virus jumps across the Green Line, to Kafr Qasim, Netanya, Haifa,” agreed former Israeli Health Ministry director-general Gabi Barbash.
The COVID-19 situation in the West Bank affects Israel’s economic recovery as well. As long as the virus remains out of control among Palestinians, other countries may recommend against or even ban travel to Israel. An effective Palestinian vaccine campaign could hasten the return of tourists to Israel’s hotels and restaurants.
There could be other benefits. Israel faces moderate but persistent diplomatic pressure over its policies toward the Palestinians. International organizations continue to target Israel for policies both real and imagined. Human Rights Watch released a scathing report last week, alleging that Israel is “committing the crimes against humanity of apartheid and persecution” and saying Israel had an “overarching” policy to “maintain the domination of Jewish Israelis over Palestinians.”
In March, the UN Human Rights Council approved four resolutions condemning Israel. France, Germany, the Netherlands, and Italy all supported the motion, which expressed “grave concern at reports of serious human rights violations and grave breaches of international humanitarian law, including of possible war crimes and crimes against humanity, in the Occupied Palestinian Territory, including East Jerusalem.”
Though the US Biden administration has rejected anti-Israel resolutions and the HRW report, its approach to Israel and the Palestinians is seen as far less in line with Israeli government policy than that of the Trump administration. Biden restored funding to UN Relief and Works Agency for Palestine Refugees in the Near East, or UNRWA, which his predecessor had severed; the Israeli government says the agency perpetuates the Palestinian refugee problem by defining millions of Palestinian refugee descendants as refugees. Shortly after Biden’s inauguration in January, the United States said it would restore the Palestine Liberation Organization’s liaison office that was shut down by Trump.
But Biden has held off on any major peace initiative, with supporters of a two-state solution expecting near-term chances for a breakthrough to be slim, especially amid turbulence in Israel following its latest election.
Though Israel enjoyed an unprecedented round of diplomatic breakthroughs as it signed normalization agreements with Arab states in the Gulf and North Africa, some of its new partners seem to want to move slower than Israel does, other potential partners are holding back, and it remains unclear when the ties will reach their full potential.
In this environment, an Israeli initiative that significantly contributes to the Palestinians gaining control over the pandemic — especially as the international community proves slow to act — can only help Israel diplomatically. No one is under the illusion that the UN and other international organizations will stop targeting the Jewish state, but it might be easier to persuade European partners and the US to push back against such efforts if Israel is the one saving hundreds or thousands of Palestinian lives while the UN fails to deliver. Moreover, if the Biden administration does choose to throw its muscle behind a fresh peace initiative between Israel and the Palestinians, it could cause significant tension with Israel. Transferring large quantities of vaccines it can spare to the PA could buy Israel some goodwill in Washington before the sides reach such bumps in the road.
And, of course, there are the pure humanitarian reasons to help the Palestinians fight the pandemic. Yes, Israel argues that this is not its legal responsibility. And yes, the PA government, widely seen as corrupt and ineffective, may be exacerbating the COVID crisis in the West Bank, not to mention Hamas’s rule of the Gaza Strip.
But Israel has shown that it sees saving lives around the world as one of its missions as a nation, regardless of politics. It sent 60 tons of aid to Indonesia after the December 2004 tsunami, even though the two countries do not have diplomatic relations. The next year, Israeli organizations were on the ground in Pakistan after an earthquake in Kashmir. MASHAV, Israel’s international development organization, saves countless lives in Africa and elsewhere with its agriculture and public health initiatives. IDF missions have operated in Turkey, Nepal, Haiti, and beyond, totaling 27 humanitarian missions since 1953.
Even when civilians in enemy countries are in need, Israel has proven willing to devote its expertise and resources to save lives. Groups such as Save a Child’s Heart and Shevet Achim bring children from places like Syria, Iraq, and the Gaza Strip to Israeli hospitals, where Israeli doctors work overtime to treat them. After Syria, Israel’s bitter enemy, descended into bloody chaos in 2011, Israeli medical teams treated wounded Syrians at field hospitals near the border and at hospitals across northern Israel.
And Israel has already contributed meaningfully to the Palestinian effort to combat the pandemic. Much of Israel’s aid to the Palestinians went through the IDF.
“With the outbreak of COVID-19 in Israel, Judea and Samaria and the Gaza Strip, the Unit for Coordination of Government Activities in the Territories (COGAT), in cooperation with the Palestinian Authority, initiated a wide range of activities to stop, to the extent possible, the spread of the virus, ” a COGAT official told the Times of Israel. “As part of these activities, the entry of test kits for detection of COVID-19, along with ventilators and medical equipment, all donated by the international community, was coordinated by COGAT.
“Moreover, joint training of Israeli-Palestinian medical teams took place, out of the understanding that these measures are necessary for the common interest of protecting the health of all of the residents of the entire region,” the official said.
Diverting the AstraZeneca doses to the PA would be in keeping with the values that have guided Israel’s policies since its founding, at almost no cost to the Israeli taxpayer.
It’s not that simple
Israel’s guiding principle is that the Palestinians are responsible for vaccinating their own people according to the 1993 Oslo Accords between the two sides, although some officials have said that Israel would consider providing doses once all Israelis are vaccinated.
There are other significant obstacles besides the legal one.
Many Israelis don’t see sending COVID-19 doses to the PA or Gaza as an ethical act at all. “I think we have to admit that they are not nice neighbors,” said Efraim Inbar, president of the Jerusalem Institute for Strategy and Security. “We don’t have any moral responsibility to care for neighbors who pay money to terrorists, who turn to international organizations like the ICC in order to fight against us. We are in a war with them. I don’t remember the Americans sending vaccines to the Germans in World War II. I think the demand on Israel to aid its enemies is immoral.”
“I prefer to send them to India, not to the PA,” he continued. “India doesn’t pay terrorists.”
Even if Israel did decide to transfer millions of doses, it is unclear that the PA has the necessary infrastructure to safely store and transport the vaccines, even though the AstraZeneca vaccines do not need the ultra-cold conditions that the Pfizer doses do.
This might also be part of the reason why the vast majority of the doses pledged to the Palestinians by the international community have yet to arrive in PA areas. “If it was so simple, then they would have received many thousands of vaccines from multiple sources, and would have vaccinated,” said Kobi Michael, senior research fellow at INSS and former head of the Palestinian desk at the Ministry for Strategic Affairs.”The fact that it hasn’t happened means there is some difficulty, on the level of infrastructure, on the technical level, and also on the political level.”
With the logistical challenges, the PA would need significant cooperation with Israeli officials, something the Palestinian leadership would likely be uncomfortable with. The PA twice last year rejected cargoes of medical supplies from the UAE because they were flown into Israel’s Ben Gurion Airport.
“In the West Bank, the Palestinians prefer relatively limited cooperation,” argued Michael. “There are implications for the political leadership in terms of public opinion: ‘Look, Israel is doing what the PA is incapable of doing. Once again the PA proves it doesn’t know how to operate, that it needs Israel to deal with the health issue as well. So what do we need the PA for? Let’s dismantle it.'”
The PA, which has put great effort into delegitimizing Israel internationally, also sees benefits to its position against Israel when its neighbor faces criticism for not doing more to help, Michael said.
“Even if Israel wants to do more, the Palestinians will limit it,” Michael posited. “In their eyes, it legitimizes the occupation.”
PA officials did not respond to repeated requests for comment.
There is also the question of how many complex issues Israeli decision-makers can focus on at one time. Israel has been facing an extended election season since 2019, one that doesn’t look like it’s about to be resolved soon. It has its own COVID-19 challenges, while fighting a shadow war with Iran as its closest ally, the US, works to re-enter an agreement with Tehran. On top of those issues, Israel suffered its worst peacetime tragedy last week when dozens of worshipers were crushed to death at a religious celebration on Mount Meron. “Was [Israel’s] approach to the [sensitive issue of the now canceled] elections in the Palestinian Authority serious?” Michael also asked, rhetorically. “We didn’t do what we were supposed to do there either.”
Even without formally and publicly transferring the doses, Israel could certainly do more to help the Palestinians battle the pandemic, and specifically with vaccinations. It could, for instance, open vaccination centers on the borders between Israeli and PA-controlled areas. These could be staffed by both Israeli and Palestinian health workers in order to protect the PA’s image in the eyes of the Palestinian public. Sharing Israeli computer programs and AI would also be a quiet way to meaningfully assist the Palestinians without causing too much of a stir.
“This type of cooperation can also create momentum,” said Michael, “a feeling that there is significance to cooperation on all sorts of wider regional issues, around health, environment, water, and energy.”
Right now, at least, it would appear that the decision-makers have other priorities.
Aaron Boxerman and Nathan Jeffay contributed to this report.
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