“Vaccination Nation“ Israel – A Role Model for Germany?

Menschen warten in einer Schlange vor einem Veranstaltungsort in Tel Aviv auf die Impfung für ausländische Einwohner in Israel
Schlange vor einem Impfzentrum in Tel Aviv © picture alliance / Kyodo | -

With over 100,000 vaccinations on Thursday with more than 4.6 Million people in Israel, half the country is vaccinated. Over 35% of the population already received their immunizing second dose. After the astonishment over the Israeli Start-Up boom of the last two decades, the international community awaits the “secret recipe” of the Israeli vaccination-miracle. However, Israel does not fully trust the success of the vaccinations just yet. For yesterday’s beginning of happy Purim festivities, a nationwide nightly curfew went into effect, as just a year ago infection rates exploded after Purim leading Israel into its first lockdown.  It does not surprise that the vaccination campaign and Covid-19 measures have become important topics for the coming Knesset elections on March 23rd. When vaccines arrived in Arabic neighborhoods, Prime Minister Benjamin Netanyahu for the first time publicly appeared campaigning to the Arab electorate, who he denounced still in 2015 as a threat. Netanyahu also already planned to send vaccinations abroad as a foreign policy instrument of soft power, which was stopped as announced by Attorney General Avichai Mendelblit on Thursday. There are a number of plausible explanations for the success of the vaccination campaign, despite its politization and despite the mixed results of the Israeli government’s Covid19-policy.

Netanjahu the poker player and resolute negotiator

While no head of government knew which vaccine with which success rate would be approved, Netanyahu already started negotiating with Pfizer on the purchase of vaccines. Scathed by the opposition for high risk high reward tactics, the shaky deal later proved critical for the early delivery of vaccines. Netanyahu’s abilities as a negotiator are said to have played a role. He is said to have argued about the significance of Israel’s limited population of around 9 Million as an ideal testing ground for the effectiveness of the new vaccine. Germany in comparison acted much later and focused on an EU-wide strategy for the purchase of vaccines in order not to outrival European partners.

Standardized electronic medical records

There are actually some lessons to learn from the organizational principles of Israel’s Health Care System during the vaccination campaign. Other than in Germany patient records of all insured are digitized in a standardized form, so called electronic medical records. Accessible through a centralized platform these electronic medical records create “transparent patients“ who can hide little, as their patient records can be accessed from each point of care as needed. This wide access contradicts German appreciation of data protection, but also Germany could implement standardized digitization of patient records - without centralized filling and limiting access. During today’s pandemic, this might allow quicker identification of high-risk patients and could support efficient coordination of a general vaccination strategy that seems lacking in Germany in recent months.

Decentralization and subsidiarity in the Health System

Some observers praise in this context the centralization of Israel’s Health Care System. This sounds understandable when arguing for the benefits of the electronic medical records platform, but I would argue that its benefits lie rather in its standardization than its centralized filling. However, a higher degree of success comes from the decentralized subsidiary structures of Israel’s Health Care System. Like with the German health insurance funds every Israeli citizen has the right to a basic basket of services. The four Health Maintenance Organizations (HMOs) currently active in Israel (Clalit, Maccabi, Meuhedet und Leumit) insure all citizens in the country, remaining independent of each other and decentralized. They run small medical centers all over the country, mostly organized on the municipal level, that can treat basic cases in a quick and efficient manner – releasing hospitals of congestion.  This decentralized network of municipal medical centers of the HMOs allows quick and flexible organization of the vaccination campaign across the country.

Die Mitarbeiter des Stiftungsbüros in Jerusalem haben sich bereits impfen lassen.
Die Mitarbeiter des Stiftungsbüros in Jerusalem haben sich bereits impfen lassen. © Privat

Digitized vaccination campaign and unbureaucratic communications

Based on the electronic medical records the HMOs municipal medical centers contacted high-risk patients via Whatsapp, SMS and phone. People wanting to get vaccinated can register via smartphone or computer on a website of their HMO to get instant offers for appointments in often mobile medical centers. Once confirmed the HMO sends confirmation and reminders via WhatsApp and SMS. By this quick allocation of appointments and unbureaucratic communication channels, medical centers can better plan and avoid congestion. Via the personal ID citizens can one week after their second vaccination receive via the website of the Israeli Ministry of Health a vaccination certificate or „green Pass“ that certifies immunization and relives restrictions to the freedom of movement (such as going to the gym or cinema).

Outlook of the vaccination campaign in Israel

Thanks to the impressively high vaccination rate, Israel is now providing important data for dealing with the pandemic in the rest of the world. A study by HMO Clalit already shows that the vaccines from Pfizer and BioNTech used in Israel guarantee a comparably high level of immunization, as the phase III clinical studies suggested. However, in order to reach the poor and the milieus distant from the state within its own population, awareness-raising work is still to be done in Israel. Market forces are working in this direction as employers start already making the employment for client serving jobs dependent on a “green pass”. So far, Israel has also only sent 2,000 of a promised 5,000 vaccine doses for health workers to the Palestinian Authority in the West Bank. With the many thousands migrant workers commuting between the West Bank and Israel every day, and the responsibility shared with the Palestinian Authority, Israel will soon have to do more to vaccinate Palestinians.

The political capital as the “vaccination champion” does not seem to fully pay into Netanyahu's account. Netanyahu emphasizes steadily his role in the success of the vaccination campaign throughout his election campaign, while his opponents from right and left criticize him for the mismanagement of lockdowns as well as of failing economic and social policy. According to polls, an end of the “Netanyahu era” seems more likely than in the previous elections. This seems astonishing at least in this context since his personal contribution to the success of the vaccination campaign also seems undisputed. Though the number of voters seems to have increased who have other priorities and, as in the quote from Albert Einstein, because of the carelessness with the truth in so many small matters in recent years, they think he “cannot be trusted” anymore “with important matters”.