Israel leads the world in covid-19 vaccinations. Here's how the country has inoculated more than a third of its population

• Israel leads the world in vaccinations, inoculating more than 3 million of its 9 million people.
• Experts say big data and collaboration between central government and its handful of HMOs were key.
•  Handing out leftover doses, controversial in other countries, is something others could learn from.
• Visit Business Insider’s homepage for more stories.

One Saturday evening in late December, media consultant Arieh Kovler, 39, went to an inoculation center at Jerusalem’s Teddy Stadium. He had heard a tiny number of leftover Covid vaccine doses were often handed out, usually because their intended recipients missed appointments.

Officially, only senior citizens and medical personnel were being vaccinated at the time. But doctors and nurses were unofficially spreading the word on WhatsApp and Facebook to let people know doses that would otherwise be thrown out were going spare. As long as this is done quietly on a small scale, Israeli authorities do not intervene.

Kovler showed up early to find only four or five doses were available for around 150 people who had come. He began organizing people into a socially-distanced line.

“From their point of view there was no system for extras. I sort of became a volunteer and tried to make myself useful,” he recalls. “Maybe that’s why I got it.”

Insider understands that health ministry officials had decided early on, in the interest of not wasting doses, to look the other way when leftover doses were given to people outside of priority groups.

While the Ministry of Health declined to comment on this, the practice is a small part in Israel’s extraordinary success with vaccination, in which it currently leads the world. The tiny country has 3.08 million of its nine million people at least one dose, including more than 80% of over-60s. The United Arab Emirates is a distant second. 

Prime Minister Benjamin Netanyahu’s government secured eight million doses of the Pfizer vaccine and six million of Moderna’s, in advance deals that reportedly offered double what European countries paid to ensure a reliable supply. He has promised full immunization by March.

In other countries, handing out leftover doses remains controversial. Even in Israel the authorities have intervened in a few cases where the handouts were too overt or big.

But, experts tell Insider, it reflects two facts about Israel’s success. It is willing to bend the rules when necessary and, thanks to incredibly efficient distribution, there are, by each day’s end, hardly any doses left over at all.

Unlike America’s patchwork of private Health Maintenance Organizations (HMOs) and local health departments, Israel’s centralized and socialized healthcare system compels every citizen to join one of a small number of competing HMOs. This greatly simplifies allocating and distributing the vaccine.

Once unloaded at Ben Gurion Airport, vaccines are stored at a central logistics center and shipped out three times a week to hospitals and HMOs. The cabinet approves prioritization plans for distribution, based on recommendations by a Health Ministry panel chaired by Dr. Boaz Lev.

Lev tells Insider that Israel’s unique mix of centralized authorities directing distribution and delegated HMOs carrying it out, combined with the use of big data, have been key to its success.

“There are four health funds in which every citizen is enrolled so we have all the data and all the access to information which is so important to reach these people,” he says, adding that using the preexisting infrastructure and digital records of the HMOs has allowed central government to know exactly how many doses to send to which vaccination center.

He explains how each HMO’s data tells them how many people are over a certain age and who has conditions such as hypertension and diabetes. “We have all this data and it’s pretty easy to make priority decisions and you allocate vaccines according to the plan.”

A Health Ministry spokesman praises how the country embraces “flexibility in how we use extra doses” and its “emphasis on not throwing out extra doses”. Of millions of doses administered, just 2,000 were wasted, they add.

Patients’ vaccinations are recorded only on their HMOs’ records system but also a national vaccine registry, which tracks who has or hasn’t yet been vaccinated. Within minutes, those who have been vaccinated are texted the date of their follow-up shot.

This tightly integrated system made Israel an attractive test-bed for Pfizer, which is using anonymized patient data from the rollout as part of post-trial research conducted with any new vaccine.

Even with the data, it still takes a lot of work to “make sure that it is a perfect match” between demand and supply, says Ido Harari, a spokesman for Maccabi Health Services, an HMO.

This, he adds, is much easier because 66% of patients already book their appointments through apps or websites.

The fact that followup appointments are made immediately after the first shot helps Maccabi project demand, he says.

“The four health funds are probably the most organized organizations in Israel,” Harari says, contrasting a recent day in which Maccabi — one HMO operating in a country of 9 million — vaccinated 53,000 patients while the entire State of New York — population 19.4 million — only managed 90,000.

Maccabi has been fully digital since the 1990s. Harari calls its data systems its “biggest advantage,” explaining how its smartphone app links back to a centralized, national database which automatically checks at any given moment who is eligible to receive a vaccine and can book an appointment.

Initial hiccups in distribution which led to extra doses were quickly fixed, leading to a “very efficient system,” a nurse at one HMO, who declined not to be identified, tells Insider. “All the kinks are worked out.”

Initially, Israelis were reluctant to get vaccinated, with just 40% saying they were willing to be part in the first round of shots, according to a poll by the Israel Democracy Institute think-tank in mid-December.

The government and HMOs invested significant effort in aggressive public information campaigns touting the vaccine’s safety and efficacy, including public vaccinations of high-profile figures including the prime minister and health minister.

These efforts seem to be bearing fruit, given the number of young people clamoring for extra doses and the propensity of post vaccination selfies on social media.

Professor Diane Levin-Zamir, a senior official at Clalit, the country’s largest HMO, says great efforts have been made to reach out to minority groups, including by distributing material in Yiddish, Russian and Amharic, with a special emphasis on adhering to the cultural sensitivities of Israeli Arabs and the strictly Orthodox.

 Israeli Arabs, who are historically less trustful of state authorities, are behind but are beginning to catch up. A total of 55% of Arabs over the age 60 have been vaccinated and the number is rising.

Israel has also been willing to disregard red tape, changing rules that previously only allowed doctors and nurses to administer vaccines so that emergency medical technicians and paramedics with Magen David Adom and United Hatzalah, two of the country’s primary first responder organizations, could join the effort.

Dov Maisel, United Hatzalah Vice President of operations, said his organization’s more than 500 volunteers were administering vaccines in the field and dozens more were transporting patients who struggle to leave their homes to vaccination centers.

Maisel also praised authorities turning a blind eye to handing out leftover doses, saying he knew of medical workers in New York “throwing out hundreds of doses because there’s a huge fine if they give them to someone unauthorized.”

Earlier this month, Netanyahu bragged that, life would soon return to normal, asserting that “we will open up the economy, we will return to work, to synagogues, to bars and restaurants and cultural life.”

Despite all of Israel’s accomplishments, the prime minister’s promises are “not realistic,” says Prof. Nadav Davidovitch, one of Israel’s most prominent public health experts and the director of the School of Public Health at Ben-Gurion University.

“We’re going to get to the highest vaccination rate in the world but we can’t get to herd immunity until we vaccinate children, especially now that the UK variant is spreading very fast among children.”

The coming months will likely see Israel enter a “new normal,” says Davidovitch, in which things will be more open but “not really back to what was before COVID.”

On Sunday, Netanyahu closed Ben Gurion Airport, effectively sealing the country off from the outside world while its vaccination campaign continues. 

On Wednesday, even he suggested a return to complete normalcy was no longer on the cards, telling the Davos Conference: “I expect we’ll have to inoculate ourselves at least annually. That’s my guess. I’m stocking Israel’s shelves.”

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