In September, months after the coronavirus vaccine became widely available, the number of immunized Palestinians had plateaued. The shots’ late arrival — combined with anti-vaccine conspiracy theories and a bungled vaccine deal with Israel — was keeping interest low.
As a fourth wave of coronavirus loomed, Palestinian officials in the West Bank and Gaza began to utilize a system of both carrots and sticks in an attempt to encourage Palestinians to get vaccinated.
The result is far higher vaccination rates, rising across the board from 23 percent in late August to 50% vaccination for those over eligible to get a shot. Some areas, such as the West Bank governorates of Ramallah and Bethlehem, now see 80 and 70 percent of their eligible population vaccinated, respectively.
In the Palestinian Authority, which has limited self-rule in parts of the West Bank, officials put public sector employees who refused to get vaccinated on unpaid leave at the end of August. Anyone wishing to visit a school — including parents — was obligated to present a vaccine certificate. Travel between the West Bank and Jordan also became contingent on having been immunized.
“Not being vaccinated isn’t a matter of personal freedom. Your personal freedom ends when your freedom harms others’ health,” Palestinian Authority premier Mohammad Shtayyeh told the PA cabinet.
When the restrictions were announced at the end of August, just 34.2 percent of eligible West Bankers had been vaccinated. The number now stands at over 60% in the West Bank, according to health officials.
The Gaza Strip still has lower rates of vaccination than the West Bank. Only about 37% of Palestinians eligible for the vaccine — around one-quarter of the total population — has received a dose, according to health officials.
That figure, while still modest, is nearly twice what it was in August. Hamas, which rules Gaza, began imposing tight restrictions around that time: Anyone who worked in a public-facing business, including restaurants, taxis, and government offices, had to get a shot.
Palestinians also received increasing shipments of vaccines at the same time, including 500,000 doses subsidized by the United States.
But it was the restrictions that played the key role in getting Gaza’s Palestinians vaccinated, said former Palestinian Authority health minister Jawad al-Tibi.
“Now, in order to get into universities, you need to be vaccinated; to work as a taxi driver or in a government office, you need to be vaccinated. This ended people’s hesitation,” said al-Tibi, a member of a breakaway Fatah faction who collaborates with Hamas on Gaza health issues.
Palestinians have seen 417,966 total coronavirus cases and 4,317 deaths since the beginning of the pandemic, according to official PA Health Ministry figures.
The Palestinians’ vaccine rollout lagged for months, as doses trickled in from a number of different sources: the United Nations-backed COVAX project, Russia, China, and eventually Pfizer. Many Palestinians have been vaccinated with one dose of one vaccine type and a second of another.
In July, Pfizer, Israel and the Palestinians attempted a vaccine swap, in which the Palestinians would receive hundreds of thousands of soon-to-expire Israeli doses in exchange for a Palestinian shipment expected to arrive months later. Ramallah withdrew from the deal after a fierce public backlash.
Some Palestinian civil liberties advocates had expressed apprehension over the policies, saying officials should have incentivized vaccination rather than penalizing those who refused.
“There needs to be a balance between public health and personal freedoms,” said Ammar Dweik, who directs the semi-official Palestinian Independent Commission for Human Rights, in an interview with The New York Times.
In one initiative streamed live on the Gaza Health Ministry Facebook page, health officials randomly selected ten Palestinians a day for a month who had been vaccinated that day to give them a $200 reward.
The sum is around a month’s wages for the average worker in the impoverished enclave, which is blockaded by Israel and Egypt. More than half of Gazans are under the poverty line.
Opinion polling seems to indicate that a majority of Palestinians support tough measures to fight the virus. Around 63% of Palestinians would support a measure mandating coronavirus vaccination, according to a September survey by veteran pollster Khalil Shikaki.
Shadi al-Laham, the PA health ministry’s director for Bethlehem, was adamant that the measures were necessary.
“The greatest issues we’re seeing right now are with children — there’s no policy that forces them to get vaccinated, so they’re spreading the virus from schools to their families,” al-Laham said.
The Palestinian Authority Education Ministry issued strict rules at the beginning of the school year in September obligating students to wear masks and practice social distancing. But according to al-Laham, around half the cases in the West Bank originated in schools.
“When we inspect schools, they pretend everything’s according to the rules. But when we’re not there — there’s no adherence,” al-Laham said.