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Israel has managed to successfully control the Covid-19 pandemic, whereas India is battling a second wave of the pandemic. Mutations of the virus have perplexed the scientists in the country and raised concern over the efficacy of vaccine against Covid. Israel’s story is important for their approach. Dr. Boaz Lev, Israel’s head of Advisory Committee for Corona Vaccines and Epidemic Control and former Director General of its Administration of Health, in an exclusive interaction with BW Businessworld’s Manish Kumar Jha, talks about his country’s approach and it managed overcome the issues surrounding the pandemic. Excerpts:
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Israel has managed to control the second wave, but India has been hit very hard by it. How did you manage to control the situation?
The pandemic caught us unprepared, and our first reaction was to close the borders and the airports and to make sure the virus doesn’t enter the country. This was a good response for the first wave as the virus was a little less virulent but looked worrisome because of the high numbers — the infection rate was very high, still the numbers were low compared to the second wave. This bought us sufficient time. The hospitals as well as the community had enough time to prepare for and cope with severe disease. There was learning along the way as well, like giving steroids and oxygen rather than using ventilators to treat the people.
But the big turnaround was when the vaccines became available, now one thing I would like to tell you that a lot of effort is being made to purchase large amounts of vaccines so that the whole community can be vaccinated, once the vaccines are registered and formally approved for use on the public. Actually, it has been somewhat hazardous because we didn’t know which vaccine will actually work. The Pfizer and Moderna vaccines have proved to be effective and safe. We have been lucky in many ways. We found out early that the Pfizer vaccine was presented to the USFDA for emergency use. Following a deal with Pfizer, we received large amounts of vaccine which could then be rolled out to the public.
In the beginning we had some hundred thousand immunization program and we were to decide how to roll them out, very shortly, it has been actually in our heads to move it to millions and vaccines which were very promising and the rest is history. One thing is that we had a lot of vaccines that were approved and that we were sure that they are safe.
The second big thing was that we have a very good and big system of community healthcare, every person in Israel is enrolled to a insurance provider company, so we have the records of all digitalized so that each of these providers of insurance knows where their patient are and what are their problems and now you can reach them to vaccinate them. Then we also geared to provide these vaccines in the central area where the population came to receive in very quick pace. So this was the second thing which was important and successful. They actually recruited all their personnel in order to give the shots and also a cue towards the regulations as how to register them, who should receive it and who should not. We used most of the vaccine and we did not waste any of the vaccines especially Pifzer because as you know you have to store it under very cold temperature, once you take it out the life span is very short so that was another thing which we had to take care of.
The third thing was very thorough and successful logistic system in which the vaccines came to the airport and was stored in deport not far from the airport. Actually they were provided to the sites where vaccine was injected on a daily basis, so there was a very efficient way of utilizing this.
Obviously, there were problems and there were [part of ] population who did not want to receive it. There were anti vaccine movements and there were people who were not able to mobilize to the sites where the vaccines were given because they were old, etc. So there was a very good logistic system already in place when this whole thing had to be started.
The next thing was a very efficient and reasonable program of prioritization of who should receive the vaccine, and the program actually said medical staff first. Then, it was the elderly at home because they were liable and susceptible and can put burden to the hospitals and community. The next group of priority was the teachers, people who have background diseases and further the police and other people who were close to the population. So time went on and they received more vaccines. We actually went down from the age of 60 to 50 and then to 40 and eventually everybody from the age of 16 and above were eligible and soon everybody in the population within a very short time have received the vaccination more so in the elderly group but also the age group of 16-18 received currently about 50-70 % of them have been immunized.
We haven’t started immunizing the younger age group 12-15 because the Pfizer and the Moderna have not yet presented the data consulting the clinical trial that has been done on them but once this is over and the regulatory authority in Israel will approve the vaccine we will probably launch also a vaccination program for the lower age group.
So this is the fourth thing that created the infrastructure to roll out this very successful scheme. At the same time we had tremendous amount of laboratory test to see who is currently ill and how to actually mitigate the number of people transferring the disease to others. So all these together has brought us today to almost a 100 people infected on daily basis. It used to be 7,8, 9 thousands on a daily basis.
You have to realize that Israel is a small country of around 9 million people so this has been very worrisome with the second and third wave but currently you can see that life has returned to almost normal with everybody going out and outside, you can take off your masks, so there are some limitations but it is all good.
Does Israel have its own vaccination program? Is there any research going on to develop your own vaccine beside Pfizer and Moderna?
Israel is at this point at a clinical trial of a vaccine that has been developed in Israel. We still don’t know how successful and efficient and safe it is because the second stage of the trial is being done presently. And I think in the next stage if it turns out to be successful, if it is effective and safe, we will probably be testing it in somewhere else because the population in Israel is already vaccinated. Obviously, we have had communications with companies like Jhonson and Jhonson and Astra Zeneca and others but currently the big chunk currently is Pfizer.
In India a new variant has been discovered and doctors and researchers are worried that the vaccines might not work, not even AstraZeneca’s Covishield. Why do you think this is happening in India?
Well here I can tell you what I think is going on in the countries where the rate of immunization is low and the rate of infection is high this is a good ground for the production of new variant and this is something to worry globally.
In Israel we are obviously worried that we will see these new variants that the vaccine maybe failing, and hence we are following very closely the rate of people who have been infected by these other variants. We are actually mapping sequence of this virus to see what kind of variant they have, currently I think the vaccine that we are using were able to cope but we have to realize that probably it is not a 100 percent but it is very strong. Till now we are not seeing people getting affected by it or falling sick, once we will see that I think we will be worried and we will turn to the producers in order to manipulate the vaccine so that the vaccine will be more adequate to the challenges the virus bring to us.
The vaccine was developed with the gene mapping of the previous mutations and the present mutation of the virus is even stronger, so how do the vaccines work and what is the science behind it?
I don’t have a crystal ball to tell you what will roll out specifically, but we think that every virus go through mutation and that is a natural history of a virus and that is how they evolve, and I am sure you might find a variety of variant that may not be susceptible to the action of the vaccine, but what we do is look at the neutralizing antibodies that have been produced in people who are sick and to see that these neutralizing antibodies neutralize various variants of the virus.
What we have seen so far that the reaction of the people in fighting against the virus even the variants. So we know that there are other ways of combating the virus which is cellular immunity and the way the immune system remembers the virus, so it’s a war and so far the virus has its affect and now might be our turn. But if you ask me that the war is over or not, I don’t think so it is.
Earlier, many countries were overwhelmed with the pandemic, their health sector was overwhelmed. So how did Israel cope with the situation?
I think this is a matter of decision every government has to make. Resource allocation is something that the government does. In the beginning of the Covid we bought large amounts of ventilators, one of the main ways to combat the disease, because we had seen what was happening in Spain, Italy and other countries. Then a lot went into that, and a lot of money was wasted. Even the vaccines we brought, I am sure a lot of money there will also be wasted. But you have to keep in mind that these are the things that you have to actually take into consideration and you have to gamble, but the gamble is here on lives and one’s lives are at stake, so you still need to make the right decisions and at this point the right decision has been made. At this point we can’t make any mistakes. Every country, every system makes mistakes— whether we should have closed the education system or not, whether the right way was to put mask or not, so there are questions. But by and large, the big ventures I think were the vaccines.
Do you think that India should have a lockdown strategy as its huge population will not allow it to immunize people so quickly?
If you see that in some places there are epidemic behaviour and the most numbers are rising you don’t have much choice. So you can’t leave everything to be natural as it used to be, there will be lot of dying people and you will not have the resources and the medication to treat them.
So in many situations there are not much choice and I am very sad to hear the numbers from India. I think that in such situation there is not much of a choice and you need to do something and you need to vaccinate population as quickly as you can and in the mean time, you need to impose lockdown.
How can Israel help India?
This is something that the foreign ministry and ministry of external affairs will be dealing with and I am sure these things are on their table. I am not part of these circles basically at this point and our advice is giving lovingly and every material help should be considered within the communities and ministries.
But you know there are problems within the population around us, who don’t have enough vaccines and don’t have enough resources like the Palestinians and other Arab countries.
There is also a huge mismanagement in our community, but obviously this is something that is being dealt at the ministerial level.