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Op-ed

Israel’s vaccination stagnation: Why we’ve caught it; how to cure it

With plenty of vaccines and efficient HMOs to deliver them, we could’ve been in the final stretch for 1st doses. Instead, doctors are reduced to imploring patients to get the shot

David Horovitz

David Horovitz is the founding editor of The Times of Israel. He is the author of "Still Life with Bombers" (2004) and "A Little Too Close to God" (2000), and co-author of "Shalom Friend: The Life and Legacy of Yitzhak Rabin" (1996). He previously edited The Jerusalem Post (2004-2011) and The Jerusalem Report (1998-2004).

Jerusalem's near-deserted Arena COVID-19 vaccination center on February 8, 2021. (Olivier Fitoussi/Flash90)
Jerusalem's near-deserted Arena COVID-19 vaccination center on February 8, 2021. (Olivier Fitoussi/Flash90)

Israel’s world-beating vaccination drive has slowed, dramatically.

Anyone 16 and over has been eligible for vaccination for the past week and, by all accounts, Israel has both plentiful supplies and medical staff waiting to inoculate all comers — an extraordinary privilege, when most of the rest of the world has neither.

Our health maintenance organizations say they have the combined capacity to deliver well over 200,000 shots a day; on January 21, in fact, 230,000 Israelis got their first or second doses, the Health Ministry’s Hebrew statistics dashboard shows.

But as eligibility has widened, demand has stalled: Fewer than 700,000 shots were administered in the past seven days (to February 10), which was down from some 850,000 the week before that (to February 3), which was significantly down, in turn, from over 1.25 million the week before that (to January 27).

As of Thursday morning, some 3.7 million of our 9.3 million population (about 40%) have had their first shots, and 2.3 million of those had also had their second. Those numbers could and should have been significantly higher. We could have been entering the final stretch for first doses for eligible Israelis; instead, this week, we’re averaging only 50,000 a day getting their first shots.

The HMOs say they’re baffled and don’t know what to do about it. “We have no explanation for why people are not coming,” medical provider Clalit’s Dganit Barak said on Monday, as TV footage showed Jerusalem’s spacious Arena inoculation center nearly deserted. “We send out messages telling people to come and get vaccinated, but still the response is low.”

We send out messages telling people to come and get vaccinated, but still the response is low

Echoed her colleague Dr. Orly Weinstein, on Tuesday, “We’re even calling people now. People’s GPs are phoning them up and telling them to go get vaccinated.”

Given the demonstrable lack of enthusiasm, you might be forgiven for concluding that Israel has basically beaten the pandemic and/or that the vaccines are proving ineffective or dangerous.

None of that is true.

High contagion

Israel has lately “boasted” the highest contagion rate in the OECD, though there’s been a slight improvement in recent days. There were “only” 5,540 new cases reported Wednesday, compared to the recent average of around 7,000 a day. We’re still seeing almost 150 new serious cases a day, and close to 50 deaths a day — despite the fact that we’ve been under a national closure for weeks, with the private and public sectors largely shuttered, and what was supposed to have been a particularly stringent lockdown for part of that time.

Meanwhile, our early vaccination start means we have the world’s first research of its kind showing that the shots are as effective as Pfizer’s trials showed, and that the side effects are broadly negligible. Barely a quarter of a percent of our millions of vaccinated Israelis have reported any side effects to their doctors. Health Ministry statistics released Tuesday, compiled on the basis of some 4.7 million first and second dose vaccinations, showed a total of 43 hospitalizations, most of them for people with preexisting medical conditions, 28 of them in the 60+ age group, just four of them among under 40s.

Dr. Tal Brosh, the head of the infectious diseases department at Ashdod’s Assuta Hospital, told Israel Radio on Thursday morning that, as far as he knows, there has not been a single death attributable to the vaccine since Israel began vaccinating.

Younger people, I am still capable of recalling, unsurprisingly often think of themselves as invincible

So if we’ve manifestly not gotten COVID beat, and if the vaccinations are manifestly central to beating it, why aren’t Israelis flooding to the inoculation centers?

Plainly, the demand has ebbed as older Israelis have vaccinated and younger Israelis have been first invited, and now somewhat unsuccessfully implored, to follow suit. Younger people, I am still capable of recalling, unsurprisingly often think of themselves as invincible. And that sense may have been exacerbated, when it comes to COVID, by months of data showing that the elderly and those with preexisting medical conditions were most at risk from the pandemic. Lately, though, due in part to the British variant, serious cases among younger Israelis are on the rise.

Furthermore, getting vaccinated as an adult is an atypical experience. We get most of our vaccinations as kids when parents make decisions for their children. Sure, travelers generally don’t think twice about getting the shots needed to visit certain countries — but that’s a situation in which direct, narrow self-interest holds sway. The conviction that there is a narrow, very personal self-interest to get the COVID vaccine is evidently not yet resonating sufficiently.

High mistrust

And then there are two other factors, related factors, both of them global but with particularly Israeli aspects: the staggering incapacity in our era of distinguishing truth from fakery, and the immense public skepticism about what people in authority are telling them — about pretty much anything.

The science of the COVID vaccines is solid. But public faith is clearly being undermined to some extent by the welter of fake news asserting that the vaccine is dangerous — with a deluge of social media messaging, including from “celebrity rabbis,” despicably claiming that the vaccine causes infertility, severe allergic reactions, and even death. Social media platforms have been slow to take down the lies, and mainstream media has not always been effective in highlighting the hard science.

On Israel’s most-watched Channel 12 TV on Monday, for instance, the organizer of a now-removed Facebook group that featured a post urging Israelis to make appointments for the shot and not turn up — so that the doses would have to be thrown away — was given long minutes to peddle her arguments by a clearly underprepared anchor, and then “countered” by a mild-mannered expert whose gentle demurrals, when he was allowed to get a word in, were no match for her ferocity. She wasn’t telling others not to vaccinate, she said several times, but she wasn’t going to do so herself, and she insisted it was unfair for her to be punished as a consequence.

Social media platforms have been slow to take down the lies, and mainstream media has not always been effective in highlighting the hard science

That those who don’t vaccinate put others at risk (including those who have vaccinated, since the shots offer some 95% protection, not 100%); that they increase the burden and risk for medical staff if they get sick; that they deflect health service resources away from other vital care — none of these points were made in the segment.

On Israel Radio Wednesday morning, by contrast, Assuta’s Dr. Brosh was invited to answer questions about vaccine concerns, and given plenty of airtime. He was able to calmly explain that vaccine side effects overwhelmingly emerge right away rather than years later, and to invite listeners wondering whether to vaccinate to reach their own conclusions about the balance between a theoretical and highly unlikely risk of side effects down the line and the manifest danger of COVID-19 here and now.

An opinion poll published Tuesday night by Israel’s Channel 11, meanwhile, underlined the degree to which Israelis’ mistrust of our government’s handling of this crisis may be undermining public confidence in the COVID battle. A dizzying 56% of respondents said Prime Minister Benjamin Netanyahu’s corruption trial was influencing his handling of the pandemic, and another 17% said they didn’t know if that was the case, with only 27% convinced his COVID policies were unaffected by his legal troubles.

That high level of mistrust does not directly explain Israelis’ declining vaccination interest, but it shows how muddy the waters are: Many Israelis believe the prime minister’s lockdown policy has been shaped by his reliance on his ultra-Orthodox coalition partners, and his need for their support in next month’s elections, and thus that the whole country has been kept at home because he dare not alienate the ultra-Orthodox electorate, in whose community many schools have stayed open in defiance of the laws and where contagion has often been disproportionately high.

Ultra-Orthodox men hold a rally against the coronavirus restrictions, in Jerusalem’s Mea Shearim neighborhood, February 9, 2021. (Noam Revkin Fenton/Flash90)

The coalition’s entire COVID stewardship has been skewed by narrow politics, Moshe Fadlon, the veteran mayor of Herzliya, complained on Army Radio Wednesday morning, as he announced that he along with two other nearby local authorities were planning to defy national government and reopen schools in the next few days. Hotel groups have also announced plans to reopen, whether or not the government lets them.

Shops and restaurants have been routinely defying specific lockdown restrictions in recent weeks — with the rebellion gathering pace on Thursday — protesting that they simply cannot bear the financial costs of staying closed any longer, and complaining that it is unfair and untenable for them to be held to the letter of laws, again, that are so blatantly and indulgently defied in the ultra-Orthodox sector.

People shop at a mall in Bat Yam that was partially opened against government COVID-19 regulations, on February 11, 2021. )Avshalom Sassoni/Flash90)

Where a government is greatly mistrusted in its overall handling of a pandemic, and where hitherto law-abiding citizens feel compelled to break laws designed to save lives, it is not surprising that public confidence and interest in a government-urged vaccination drive is also not as high as it needs to be.

Vaccination incentives

Yuval Steinitz, a minister in Netanyahu’s coalition, reportedly suggested last week, at one of the routinely leaked, interminable bickering sessions that pass for cabinet meetings these days, that Israel should make vaccination mandatory. He was, we are told, quickly shot down.

Such a move would almost certainly be deemed illegal, but it’s also ill-conceived.

Incentivization, rather than punishment, is the way ahead. The hotel group rebels are planning to open only to guests who have been vaccinated or have current negative COVID tests. Rebel restaurants are doing the same. The cabinet is now being dragged in the same direction — looking toward reopening gyms, cafes, cultural events and more, but only to the vaccinated and to those with a negative coronavirus test, while charging for testing in order to further encourage vaccination.

In her Channel 12 appearance on Monday, the woman behind the banned Facebook group protested that it was unfair that she faces being treated “as a second-class citizen” by being barred from malls because she does not want to vaccinate. Hopefully, her preemptive bitterness suggested, a gradual reopening of Israel only to those who have had their shots should constitute a powerful incentive.

From an ‘Eretz Nehederet’ satirical skit: Traffic light pedestrian signals? Just say no (Channel 12 screenshot)

Mockery of the anti-vaxxers can help too. Channel 12’s “Eretz Nehederet” (“Wonderful Country”) satire show this week recycled an old skit featuring the founding mother of an “anti-traffic light group,” dedicated to teaching children to ignore pedestrian crossing signals when crossing the street. “Hitting the bumper is the informed choice,” she declared. “Who said you should avoid being run over?”

Right. Skipping the life-saving vaccine is the informed choice. Who said you should avoid a deadly pandemic?

Sadly, in any case, the sheer weight of direct evidence showing the ongoing vulnerability to COVID of those who are not getting vaccinated will gradually come to shatter all but the most entrenched skepticism. Anti-vaxxer extremists will still not be persuaded, but one has to believe an overwhelming majority can still muster life-saving common sense.

** An earlier version of this Editor’s Note was sent out Wednesday in ToI’s weekly update email to members of the Times of Israel Community. To receive these Editor’s Notes as they’re released, join the ToI Community here.

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