40% of vaccinations going to eligible walk-ins in some areas

Israel’s vaccine dash is swamping nurses, and some officials couldn’t be happier

Clalit vaccine chief says army to send in medics to help out; hopes that immunization fever will spread to Palestinian parts of Jerusalem as well

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

A woman receives a COVID-19 vaccine at a Clalit clinic in Jerusalem on December 24, 2020. (Yonatan Sindel/Flash90)
A woman receives a COVID-19 vaccine at a Clalit clinic in Jerusalem on December 24, 2020. (Yonatan Sindel/Flash90)

Israel has exceeded its daily target for its vaccination drive, despite the fact that most facilities haven’t yet opened their doors. Those that are operating are being swamped, with nurses working 12-hour days to keep pace with demand, which includes high numbers of eligible walk-ins in some places.

“I want to inform you that just today 65,000 people were vaccinated,” declared Health Minister Yuli Edelstein on Wednesday evening. “We already have 140,000 vaccinated in total.” Another 74,000 were vaccinated Thursday, with the drive first inoculating healthcare workers and now over-60s and at-risk groups.

Israel didn’t expect to hit its 60,000 shots-a-day target in the first week of vaccination, but Wednesday’s announcement meant it had managed to hit it only four days into the drive. This was done using only the large vaccination centers in central locations. The smaller stations, which are a key part of the inoculation strategy, haven’t opened yet.

Even before the record numbers Wednesday and Thursday, Israel was already getting shots to the population much faster than the United Kingdom, which was the first Western country to ask citizens to roll up their sleeves.

Edelstein said he expects the pace of vaccination to continue to rise and all indications suggest that it will, according to infectious diseases expert Ian Miskin, head of coronavirus care and vaccination for the Clalit healthcare provider in Jerusalem.

He anticipates Health Ministry directives will allow smaller batches of vaccine to be delivered, enabling neighborhood centers to open, and said that clinics received an unexpected boost on Thursday, learning that there will be assistance from the military.

Officials had expressed concerns ahead of the drive regarding vaccination fears dampening enthusiasm, and while those worries have not come to pass in most places, in East Jerusalem the subdued response has sparked concern, said Miskin,

But Miskin is hopeful that the enthusiasm of Israelis for the vaccine will convince East Jerusalem Palestinians, the vast majority of whom are served by Clalit as non-citizen residents.

“Once they see people rushing to the stations in West Jerusalem they will be rushing to the stations in East Jerusalem,” he said. “They will say that 500,000 West Jerusalemites can’t be wrong.”

An Israeli medical worker displays an international certificate of vaccination for coronavirus at the Sheba Medical Center in Ramat Gan, on December 19, 2020. (Jack Guez/AFP)

Hospital doctors are also optimistic about Israel’s campaign. Prof. Yitshak Kreiss, director-general of Sheba Medical Center, announced on Thursday that by the end of Friday, his institution will have vaccinated more than half of its 9,000-strong staff, as well as many officers from the Israel Police, who are also being inoculated ahead of the general population.

Its efforts will “accelerate the State of Israel’s ability to be amongst the first nations in the world to emerge from this medical crisis, and return the people of Israel to a sense of normal daily life,” he said.

Vaccines are currently offered in Israel to health workers, people aged 60 and over, and people who are considered high risk, either due to their jobs or medical conditions. Many clinics are also serving foreign workers who care for elderly Israelis.

Dr Ian Miskin, head of coronavirus care and vaccination for the Clalit healthcare provider in Jerusalem (courtesy of Clalit)

Once these groups have been vaccinated, the Health Ministry plans to open appointments to anyone aged 16 or older, including women who are pregnant or nursing. Vaccine trials did not include volunteers who knew they were pregnant, but the Health Ministry now considers the shots to be safe for them.

On the front lines of the vaccination drive, nurses are working 12-hour days, and struggling to give shots to all who booked appointments. Adding to the strain are the many people showing up on the off-chance that vaccines are available, which are often provided, assuming they are eligible. In some clinics, up to 40 percent of people vaccinated are turning up without appointments.

Miskin spoke to The Times of Israel on Thursday about the success so far, the urgent need to overcome the hesitancy of Palestinians in his care, and the changes he hopes to see that will further boost vaccination rates.

You’re coming to the end of the first week of vaccination. What is your experience so far?

“It has been very smooth and we’re vaccinating faster than the country thought would be possible. It’s astounding to see, and with this start we really do expect to see the vaccine given to all over 60s who will accept it within a few weeks.”

Are you concerned about supply?

“No, we’ve been told to open up our appointments widely, and got the message [from the Health Ministry] that as long as we can see the patients, there will be vaccines to give them.”

Your organization provides healthcare to a big proportion of Jerusalem’s Palestinian population, and one of your three Jerusalem stations is in the East Jerusalem neighborhood of Sheikh Jarrah. What is the situation there?

Doctors and medics take test samples of Jerusalemites to check if they have been infected with the coronavirus, in Sheikh Jarrah, Jerusalem on October 08, 2020. (Olivier Fitoussi/Flash90)

“People aren’t rushing to the station. They are [suspicious] of the vaccine, and this is important to address because the elderly Arab population has lots of health conditions [in comparison to Jerusalem’s elderly Jewish population], including obesity and diabetes, so this is a real priority as they are at risk from the virus. Lots of the people in coronavirus wards of Jerusalem are from East Jerusalem, as a priori their health is often worse than those in the west of the city, which highlights the importance of vaccinating them.

A Palestinian medical staffer at the Dura hospital in the West Bank city of Dura, near Hebron, on July 9, 2020. (Wisam Hashlamoun/FLASH90)

Israelis are confused as to why, for many, vaccination isn’t available close to their homes, but only in larger central locations. Is there an explanation, and will this change?

“It relates to vaccine supply. The bottles, which come from a very cold deep freeze, are delivered to us in batches of 195 bottles, which is a total of 975 doses. To protect bottles, this is how they are packed, and we aren’t allowed to move them after delivery. But as they can only be kept after defrosting for four days, every place the vaccine goes it needs [to] be given to almost 250 people a day, which is why we’re operating in large central locations.

“But we need to be able to give the vaccine in neighborhoods, and in some cases in homes, so we’re waiting for Ministry of Health permission to receive smaller deliveries, and when this happens, which I hope will be soon, I hope to go from three stations in Jerusalem to 50.”

A phial of the Pfizer-BioNTech COVID-19 vaccine at the Royal Victoria Hospital, in Belfast, December 8, 2020. (Liam McBurney/Pool via AP)

Why is this so important?

“The vaccine is currently available for Israelis aged 60-plus, and lots of the younger eligible people have cars, but when you get to the older populations it’s more difficult, and we want to ensure they have access close to home. We need to get to this population, and get to them quickly.”

Is manpower a challenge?

“There is a huge shortage of people to give these vaccinations, but we have heard today that 700 medics from the army have been called up, and this will make a big difference. Just 20 medics for our operation in Jerusalem could increase the number of vaccinations we are managing by 20%.”

What level of skill is needed by the people preparing the vaccines?

“It isn’t a package you can just tear open and jab into your arm. It has to be very carefully opened, reconstituted and shaken with exactly 1.8 milliliters of saline, and then put into five syringes. It requires a medic, but I can teach any medic, including an army medic, to do it within an hour.”

Jerusalem has a young population, but as the initial vaccine trials didn’t involve youth, under-16s aren’t currently approved for vaccination. Are you concerned about this?

“We would like to vaccinate them but there is no screaming hurry, as they are less likely to develop the disease seriously than older people, who are the big concern at the moment. The priority for now is protecting those who are likely to develop the disease seriously, those people who will respond very badly, and this is progressing well.”

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