COVID-19 Surge In Israel Opens A Pandora’s Box For The World

The rollout of Pfizer booster shot in the wake of high infection rates among the double-vaxxed has been emulated by rich countries to stay ahead of the virus, while the same has reduced the purchase power of poor countries looking for their first dose.

Israel has seen it all. From basking under the glory of its ‘highly vaccinated’ tag to the highest daily infections per million population, the country is fast turning into a laboratory of sorts identifying what works and what doesn’t when it comes to COVID-19 vaccination. In February-March, when the rest of the world population was yet to warm up to the idea of a jab, Israelis proactively lined up to get a shot in the arm. Resting on its laurels, the Jewish State in April reverted its year-long practice of using masks in outdoor settings. By June, indoor masking was also scrapped.

Israel’s success story was such a hit that everyone wanted to emulate it until the country began to register a high number of cases in mid-August. Several new questions began to do the rounds: did the country actually vaccinate 78% of its 9.3 million population as claimed? Didn’t the Pfizer-BioNTech vaccine they all were jabbed with offer effective protection? Can the more infectious Delta variant, now spreading vigorously in the Middle Eastern country, be defeated? Questions were many, but answers far and few.

Data is king

The adage ‘early bird catches the worm’ doesn’t seem to hold significance in the COVID-19’s scheme of things. Israel was the first in the world to fully vaccinate (two doses) over half of its population. That was March-end. As infections went south, people soon abandoned social distancing rules and several went on a much-needed vacation abroad, but came back carrying the virulent Delta variant.

According to Oxford University-based Our World in Data project, the rolling seven-day average of daily new confirmed cases peaked at 10,049.71 on September 3, higher than the 8,624.29 of January 17 during the peak of the third wave. Thankfully, it has dipped since then to 8,129.43 on September 8. When considering the per million people data, the country recorded a rolling seven-day average of 1,143.34 cases on September 3, though it came down to 924.87 on September 8. The present scenario is very different from the last recorded highest of 981.17 per million people on January 17, less than a month since the country began its vaccination drive.

Israel’s vaccination program covered 50% of its population by March 17. However, it touched the 60% mark only on July 21. Inoculation tapered down to such an extent that it stood at 62.7% as of September 5. One of the main reasons for the sluggish progress was the reluctance of those outside the at-risk groups to get vaxxed. Israel has a young population, and over one million out of its vaccine-eligible group, mostly aged between 12 and 20 years, have refused to take even one dose. In short, Israel’s projected 78% vaccination did not materialize in the manner it sought to. Coupled with it were millions of children aged below 12, for whom no vaccine has been approved anywhere in the world. So with the present vaccination rate, Israel is unlikely to reach herd immunity.

The vaccine is free and the centers are well-equipped. But fake news, often in the form of street posters, has marred the campaign. Religious leaders of ultra-Orthodox communities have added fuel to the fire by asking worshippers to steer clear of the vaccine. Many youths believe only senior citizens are prone to coronavirus and do not understand that their non-cooperation could wreak havoc in society as a whole. In a bid to get them to the vaccination points, the authorities have resorted to offering freebies in the form of pizzas, beef, bean stew and more, while simultaneously reminding them of the ‘green passports’ that only the inoculated could get hold of. The naysayers are frequently reminded about how they would miss the holiday fun, outings to nightclubs, and visits to malls and bars if they don’t get jabbed.

The recent COVID-19 surge triggered a flurry of data mining, which brought to the fore some chinks in the vaccine armor. Pfizer did admit that their data showed a dip in the vaccine’s protection around six months after the second shot. Most of the fully vaccinated Israelis were jabbed around five months ago, and hence the present high rates of infection had to be addressed with a booster shot that was first offered to adults with weak immune systems and those aged above 60 in July. The country further expanded the campaign to 50, 40, and 30-plus in three phases next month, before announcing last week a possible approval for the third dose to anyone who received the second dose at least five months ago and is aged above 12 years. Those who fail to take the third shot would lose their ‘green passport’, which stands for hassle-free travel and outdoor/indoor activities.

The country’s fervent appeal for getting booster shots stems from the Ministry of Health’s study report that showed an extra dose reduced a recipient’s risk of testing positive by more than 10 fold. At the same time, not all is lost for those with two inoculations. According to the ministry, serious cases among the unvaccinated aged above 60 were nine times higher than those who took two shots in the same age group. Unsurprisingly, the unvaccinated seriously ill patients in the fourth wave were mostly young people.

While the weekly new ICU admissions as per the Our World in Data website was 1,180 at the third wave’s peak on January 17, the highest number this time was 727 on August 30. It has since then fallen to 625 on September 6. The rolling seven-day average of daily new confirmed deaths peaked at 64.86 on January 25 and slid down to zero deaths on July 1. Fatalities during the fourth wave have been comparatively low at a maximum of 30.86 on September 5, before dipping to 25 on September 8. The data show how vaccination played a role in reducing both the number of serious cases needing ICU admissions and deaths.

The way forward

Vaccines do not offer cent percent protection and their coverage is very much dependent on the number of antibodies they produce in a recipient. For example, antibodies won’t be formed in a person taking medicines that suppress the immune system. When antibody production is low, the chances of infection in the fully vaccinated spikes. So what is the way forward? Will a new shot be required during each and every new wave? In such a case, is there any validity for the term ‘fully vaccinated’?

Israel’s booster shot hasn’t passed the ethical test as many poor countries across the globe are yet to get their hands on enough stock to complete at least one round of vaccination. A third dose reduces the chances of such countries as well-off countries won’t be inclined to donate their extra shots anymore. Scientists have also questioned the move, especially after the US push for booster shots of Pfizer and Moderna vaccines eight months from the second dose, saying the data weren’t compelling enough in the wake that two shots were good enough to prevent severe infection.

But many countries in the world are pitching for booster shots as a way to stay ahead of the virus. Turkey, which had an early launch of Chinese-made Sinovac, has urged the people to take either the third shot of Sinovac or Pfizer vaccine. France began giving booster shots to those above 60 years and people with health issues on September 1. Germany’s independent vaccine advisory panel head Thomas Mertens said last month that all citizens would need another shot next year. The UK, Austria, Hungary, Belgium, Malta, and many more are in the process of rolling out a third dose, despite serious concerns raised by WHO Director-General Tedros Adhanom Ghebreyesus.

If vaccinations never end, then countries would require permanent facilities and full-time manpower to keep track/facilitate the process, despite there being no clarity on whether boosters served the purpose fully. However, what has been proven beyond doubt is that proper masking, hand hygiene, and social distancing keep coronavirus at bay. So let’s do it, the war is still on. As Israel’s coronavirus czar Prof. Salman Zarka recently told The Times of Israel, “COVID-19 is here and will stay here, and we may have to take a mask for many months and maybe years… It seems that some mistakes were made when we thought we won the war, and now we understand we only won the battle, the war is still here.”

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