Despite the stunning success of Israel's Covid-19 vaccine rollout, it is rapidly becoming clear that the country cannot reach herd immunity.
To date Israel has vaccinated 3.2 million people - 34% of the population of 9,300,000 including 1.8 million who have already had their second Pfizer dose. 655,000 Israelis, or 7% of the population have been officially diagnosed with Covid and even if the real figure including undiagnosed cases is double that, then less than half of the population is immune.
Herd immunity for Covid has yet to be clearly defined and the hope has been that Israel would be the first to discover the threshold. According to the World Health Organization (WHO) measles requires 95% of the population inoculated for herd immunity, polio 80%, and Covid-19 is not known.
In the early stages of Covid-19 when everybody, including scientists, was under-estimating the virus, the general consensus was that herd immunity would be between 60-70%. But now scientists are raising the bar towards 90%. US infectious disease expert Dr. Fauci told the New York Times last month "We really don't know what the real number is. I think the real range is somewhere between 70 to 90%."
Israel is unlikely to reach even 70%. For a start, 28% of Israelis are under 16 and current instructions are that the under 16s should not be vaccinated. In other words, Israel would be required to vaccinate the entire population over 16 to reach the low threshold of herd immunity.
In recent days, it has become clear that this is not going to happen either. If in the first few weeks of the vaccination drive, demand outstripped supply, since the data-for-doses deal between Israel and Pfizer, supply has begun to outstrip demand. Only 117,000 people were vaccinated yesterday - about half of Israel's proven capacity - with some clinics reportedly compelled to dump excess doses due to lack of customers. Officially only over-35s and 11th and 12th graders can be vaccinated but anybody turning up at a clinic is unlikely to be refused.
It is not only the young and middle-aged who are reluctant to be vaccinated. While about 90% of over-60s have been vaccinated in mainstream Israel, in the haredi (ultra-orthodox) and Arab communities the percentage of over-60s vaccinated is far lower.
The failure to achieve herd immunity will especially irk Prime Minister Benjamin Netanyahu who has built his election campaign around Israel's victory over Covid-19. In December, when he became the first Israeli to be vaccinated, he declared that through the vaccinations Israel will become the first country to defeat Covid and completely open up its economy. He promised that every Israeli would be vaccinated by March - Israel goes to the polls on March 23 - and has portrayed the securing of enough doses to do so, as a consequence of his "17 conversations with Pfizer's CEO."
But matters haven't exactly gone to plan. The third lockdown, which was meant to be the last, together with the vaccination drive, have failed to significantly lower the numbers, of either new infections and those who are seriously ill, as well as fatalities. There is still cautious optimism that the situation will improve but the government will be left with difficult choices.
In essence there are three choices.
The first option is to continue and even tighten the lockdown. But the third lockdown has been the longest and most lax, with the public having little appetite or respect for the restrictions. The haredi sector has been flouting the instructions with impunity but the fact is that there has also been widespread breaking of the rules in mainstream Israel, albeit more discreetly. Lockdowns are unpopular and with an election on the horizon, governments tend not to do the unpopular.
The second option is to simply open up the economy and let the virus do its worst, unchecked. After all most people in high risk groups have been vaccinated and everybody has been offered a vaccination. The virus will proliferate among the young, especially the British mutation, but all the evidence so far is that Covid does not seriously harm the young, fit and healthy. The vaccine is reportedly less effective against the South African variant but that mutation has been contained here and for this reason Ben Gurion airport and the land borders could remain closed for a long time.
But the mathematical models of Prof. Eli Waxman of the Weizmann Institute may have dampened enthusiasm for this option. He calculates that even if 95% of the elderly are vaccinated and the vaccination proves to be 95% effective, then there would still be 7,000-14,000 more deaths in the coming months and up to 40,000 severe cases of Covid. Aside from the suffering and loss of life, that would also be politically unpopular.
So the government will be likely to choose a third option - a gradual opening of the economy, or in other words the muddled, inconsistent approach we have had for much of the past year.
The world has watched on with a mixture of admiration and envy as Israel has implemented its impressive vaccination rollout. But most of all, the world is curious for its own sake and own future. How will Israel exit from this mess? The world will be able to learn from our mistakes.
Published by Globes, Israel business news - en.globes.co.il - on February 2, 2021
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