There are straightforward explanations as to how Israel has managed to vaccinate 1.25 million people in a little over two weeks - 13.5% of the population including 52% of people aged over 60. Israel's four community-based Health Maintenance Organizations (HMOs or health funds) are efficient, highly digitalized units that have mobilized with enormous effectiveness, backed up in recent days by hospitals, pop-up and even drive-in vaccination centers.
What is much less clear is how Israel has managed to get its hands on so many vaccine doses so quickly in a sellers' market.
What we do know is that on November 18 when Pfizer announced that its vaccine was 95% effective against Covid-19, Israel's senior health officials were left red-faced because the country had backed the wrong horses. Israel had ordered millions of doses of Moderna and AstraZeneca vaccine but zero doses of the Pfizer-BioNTech vaccine.
Prime Minister Benjamin Netanyahu was almost immediately on the phone to Pfizer CEO Albert Bourla for the first of several calls. Ultimately, Israel received an estimated four to five million doses of Pfizer vaccine before the end of 2020 - enough to vaccinate at least two million people.
With elections looming, Netanyahu is trying to give the impression that he single-handedly saved the day. It certainly cannot be ruled out that Netanyahu's intervention led to the procurement of so much vaccine so soon, but there are some intriguing questions.
Netanyahu has also played up Bourla's pride in his Greek Jewish heritage. But it seems unlikely that the head of a huge public company would have stuck his neck out to divert vaccine to Israel and risk charges of ethnically influenced corporate favoritism, not to mention potentially stoking up anti-Semitism.
A more likely explanation is the price being paid. Although Israel is refusing to disclose any details about the number of doses ordered from Pfizer or the price being paid, some reports have suggested that Israel is paying $59 per two doses, compared with the $40 per two doses being paid by the US. Israel would probably even be happy to pay far more, if it means that the economy can be fully reopened sooner rather than later.
Israel's ability to outbid other countries was assisted by the fact that many, perhaps even most, of the contracts signed with the drug companies did not stipulate delivery dates. The German media has reported that as late as the start of November, Germany signed a binding contract for 30 million Pfizer vaccine doses (above and beyond the general EU procurement) and that the country would only get the first four million of these doses by the end of January. Yet by the end of December, an estimated four to five million doses of Pfizer vaccine had been delivered to Israel, while Germany, for example, had seen few of the 40 million doses, it ordered several weeks before Israel.
Interestingly, while Israel has ordered millions of Moderna doses, none are expected to arrive before March. Maybe Israel also signed a contract that did not include a delivery schedule. One would have thought that lawyers would have put clauses in these contracts that would have stipulated within 30 days, 60 days or whatever from receiving FDA approval. Perhaps it was such a sellers' market that the pharma companies were having none of it.
Israel has also ordered millions of doses of the AstraZeneca vaccine. But the FDA, in contrast to the UK regulator, is unlikely to approve the vaccine without clarifications and probably further trials because of the dosing errors in the Phase III trial, and Israel will only use FDA-approved vaccines.
The question now is whether Israel will get more vaccine in the coming weeks, so that it can seamlessly continue inoculating the rest of the country. As things stand at the moment, Israel will run dry of vaccine by the end of this week and will be forced to wait until the beginning of February for more consignments of Pfizer vaccine.
But don't bet against Israel getting more vaccine before that. There is speculation that Pfizer agreed to supply so much vaccine to Israel because it received assurances that the entire country could be vaccinated swiftly and Pfizer would be left with a marvelous advertisement and marketing example of how it had beaten Covid-19 in Israel. Others suggest Pfizer is now slowing shipping to Israel because there is such intense pressure for its product worldwide and Israel's rate of vaccination has left other countries envious.
There are now also unconfirmed reports that Moderna may be sending several million doses to Israel this month, earlier than planned. Perhaps these reports are also designed to provoke Pfizer, which would presumably prefer that its own vaccine was exclusively responsible for any Israeli triumph over Covid-19.
Of course all this speculation assumes that the vaccine will eventually vanquish the virus, as trials have indicated. One thing is certain, the eyes of the world will be on Israel in the coming few months, to see whether the vaccine does the job, or whether Covid-19 has more surprises in store for us.
Published by Globes, Israel business news - en.globes.co.il - on January 4, 2021
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