Israel and the fight against Covid-19: a model for the world?

The corona pandemic did not pass over Israel, and like other countries of the world it was hit hard. 4,667,287 Israelis have been infected by the disease (out of a population of approximately 9.2 million) and the number of dead reached 11,710 (as of October 2022).

Along with health consequences, some of which are still unclear (after all, post-corona research is only in its beginnings), the pandemic also had far-reaching economic consequences, since during the first two years of the outbreak of the pandemic, the government in Israel adopted a strict policy of social distancing that included prolonged closures. This led to the paralysis of major sectors of the country’s economy and at the same time damaged the fabric of life, starting with the welfare system, education and higher education and ending with cultural life.

Israel was, however, in a good opening position compared to many other countries in the world, and this gave it an advantage in the fight against the disease. Its population and its government systems are practiced and have experience in dealing with emergency situations, although mostly security ones. In addition, the health system in Israel is considered an advanced system whose services are spread out and accessible to the entire population. All of this allowed Israel to become a pioneer in many aspects of dealing with the pandemic and, above all, performing mass tests to detect the disease, the ability to obtain a reliable and comprehensive picture of the state of morbidity and patients, and finally, a rapid mass vaccination operation of the entire population while monitoring of the results and effectiveness of the vaccinations. Israel was also a pioneer in formulating a policy of exiting the lockdowns in a way that allows the entire population to continue a normal life as much as possible. It is also worth adding that the fact that the population in Israel is relatively young eased the severity of the damage since the disease mainly affected older populations at risk.

However, Israel also had weak points, including the fact that political instability prevailed in it due to frequent election campaigns in those years, which often led to decisions that were based on political considerations rather than factual considerations. In addition, parts of Israeli society, such as the residents of the periphery, the ultra-Orthodox population and the Arab population tended to cooperate less than the general population with state institutions and follow its instructions, and their access to the health systems was also lower. This, alongside the fact that Israel controls the territories of the Palestinian Authority where millions of Palestinians live who are not its citizens but citizens of the Palestinian Authority, and therefore do not enjoy the same accessibility to health services.

After all this, it should be remembered that the disease was found to be deceptive, and thus for example the vaccines produced against it were found to be of limited validity since the body’s immunity weakens within a few months. In addition, new variants of the virus have been found to be resistant to the vaccine. Of course, all of this made it difficult to manage an orderly policy and to provide an intelligent long-term response to the pandemic.

But looking back, it can be stated that the Israeli system reacted quickly, functioned well within the limitations of the limited knowledge the world had about the pandemic, and gave a benevolent response to protect its population and this at the cost of only limited damage to the economy. And so, among the developing countries, Israel leads in all of the aforementioned growth rates recorded by the Israeli economy with the decline of the pandemic.

The outbreak of the Corona pandemic

At the end of December 2019, the corona virus that causes the disease COVID-19 began to spread in China, originating in the Wuhan province in the center of the country. In mid-February 2020, the virus began to spread rapidly throughout the world and soon, on 11 March 2020, it was defined by the World Health Organization as a global pandemic.

In Israel, the first patient was located on 27 February 2020, after he returned from a visit to Italy, and within a few days, the number of those infected by the virus began to climb to dozens and hundreds, and by the end of March 2020, there were already about 10,000 infected people. The first Israeli, an 88-year-old man, died of Corona on 20 March 2020.

Israel responded very quickly to the challenge, and certainly in comparison to many other countries, even though in the first stages of the outbreak of the pandemic, very little was known about it – how an how quickly does it spread? What are its dangers and how deadly is it, and finally, what is the right treatment for it. It should be noted that at this stage there was no vaccine for the pandemic or even a medicine that would relieve or even save the patients.

Israel and the corona – a good starting point 

Israel enjoyed a series of advantages that gave it a good starting point to deal with the dangers of the pandemic:

First, due to the political reality in the Middle East, Israel is actually a sort of isolated island cut off from its surroundings, with almost no entry or exit from the neighboring countries. This, in contrast to, for example, the European Union countries that cannot prevent transit between them and are limited in their ability to control entry or exit within their borders. This of course  facilitated the hermetic closing of the country to tourists, workers and immigrants who were perceived at the time as those who might bring new variants of the virus to Israel. It should be noted, however, that this was not a hermetically sealed and absolute closure of the borders, since Israel allowed holders of Israeli citizenship to return to it and in many cases, for example on humanitarian grounds, also to leave it and return to it later. This, of course, contributed to the spread of the virus and the arrival of new variants, Delta and Omicron, in the country.

Second, the governmental systems in Israel, with an emphasis on the health system, but more generally the population in the country, are used to a quick transition to an emergency situation, in view of the security challenges and even the military conflicts in which the country has repeatedly been subjected. For example, the IDF’s Home Front Command took responsibility for caring for vulnerable populations when lockdowns were imposed in the country and assisted the police in enforcing them. The army also took on the management of the effort to break the chains of infection by asking each infected man about the people with whom he came in contact. Military intelligence directed resources to collect information about the disease and to assist in the analysis of the data about its spread in Israel, and finally, the General Security Service was entrusted by a government decision to monitor isolated and infected people to make sure that they do not violate the isolation instructions they received.

Thirdly, Israel has an efficient public health system and according to many international rankings it is seen as one of the best in the world, in terms of its accessibility and the quality of service it provides to citizens. Next to an array of government hospitals in Israel there are several big health maintenance organizations with a spread of clinics all over the country. According to the law, every citizen must be registered in one of the health organizations. This reality makes it possible to receive reliable information in real time about the health status of all citizens and the spread of diseases and pandemics. This fact made it possible to quickly use the health system for the purpose of transmitting information to the population, in order to carry out tests on a mass scale to detect the virus or to control the state of the disease, and later also made it possible to have a vaccination operation that encompassed the entire population, and of course everyone who was interested in vaccination.

Fourth, Israel’s population is relatively young compared to the population in Western countries. In 2020, the rate of children up to the age of 14 in Israel was about 28%, and in contrast, the rate of people aged 65 and over was about 12% compared to double the rate in many European countries. Studies have revealed that the adult population in Israel is more active compared to other countries in the world, less isolated and cut off from family members, and therefore showed greater immunity to deal with the consequences of the pandemic.

Israel and the corona – the weak points

Alongside all this, it must be remembered that there were also shadows in Israel’s preparation for the fight against the pandemic.

Political instability – Israel fell into a prolonged political crisis at the end of 2018. In the reality of repeated election campaigns, Israel lacked a stable government and this had consequences for some of the decisions it made. Along with the many praises that Prime Minister,  Benjamin Netanyahu, received at the outbreak of the pandemic, for quickly diagnosing the danger and quickly mobilizing to fight it, it was argued against him that in many cases he worked to leverage the pandemic for the purpose of spreading fear among the population in order to mobilize support for him and that he avoided making decisions to impose policies of strict closure among the ultra-Orthodox population so as not to damage the support it gives him.

A health care system that has suffered continuous cuts over the years – in the transition that Israel has experienced in recent decades from a welfare state policy to a market economy has led to continuous damage to the public health and welfare systems. These affected the scope of the medical services and also their accessibility mainly in the peripheral areas. This undoubtedly created a burden on the health care system in the early stages of the pandemic, although there was no collapse and the hospitals were also able to cope with over a thousand seriously ill patients at the height of the disease.

And finally, Israeli society is characterized by heterogeneity based on class, religion and ethnicity. There is a clear gap between the center – the Tel Aviv area – and the periphery in accessibility to health, welfare and education systems. Alongside this, in Israel there are two communities whose integration into the social fabric is partial. One is the ultra-orthodox population, which makes up about 13% of the total population. This population is often of low social status and its birth rates are high, i.e. this is the population living in a particularly high density and this of course had an effect on the spread of the pandemic. In addition, it is characterized by obedience to the rabbis and suspicion towards the state institutions. And so, the enforcement of a policy of closures and social disconnection on the ultra-Orthodox education systems and on religious ceremonies – prayers in synagogues, weddings and funerals, etc. – turned out to be only partial. On the other hand, the religious leadership mobilized to encourage vaccination against the virus, and this was an important contribution to high vaccination rates among this population.

It is also worth noting the Arab population, which makes up about 20% of the total population in Israel. This population also belongs to a low socioeconomic status and in addition lives mostly in villages and towns in the periphery. Of this, the Bedouin population in the south of the country, which makes up about a quarter of the Arab population, partly lives in nomadic settlements that are not connected to electricity and water infrastructure and do not enjoy full access to health services. This population shows great suspicion towards the state institutions. The result is difficulty in maintaining and enforcing a policy of closures and social distancing as well as difficulty in convincing this population to get vaccinated.

Alongside these, we must of course mention the Palestinian population living in the territories of the Palestinian Authority in the West Bank and under the rule of Hamas in the Gaza Strip. These are close to four million people and maybe more who are not citizens of Israel but are practically under its control as the occupying force in these areas. Israel did not see the Palestinian population as being under its responsibility but under the responsibility of the Palestinian Authority and Hamas and therefore provided only indirect aid of testing and vaccination kits. It is worth noting that the Palestinian population comes into daily contact with the Israeli population – in the labor market, for example – and therefore the state of the disease among the Palestinian population had an inevitable impact on the state of the pandemic in Israel.

Israel is struggling with Corona

The corona pandemic was characterized by waves of infections that were characterized by the rapid spread of the disease to hundreds and thousands of infected people on a daily basis in the first waves and to over ten thousand infected people a day in the following waves. At the height of the disease in early 2022, when the Omicron virus became dominant, tens of thousands of people were infected every day, although most of them with mild symptoms.

As the familiarity with the disease became better, emphasis was placed on monitoring the number of seriously ill patients in need of treatment and even ventilation in the hospitals and not on the total number of patients, which as mentioned also included a young population, some of whom had no symptoms at all.

The initial response to the first wave – March – April 2020 – Israel responded quickly, and thus was among the first countries in the world, to response to the spread of the Corona disease. With the appearance of the disease in Israel, a policy of banning the entry and exit of non-citizens to Israel was announced, and later on the transfer of the educational systems to distance learning as well as work from home where this was possible. They also gave instructions to maintain social distancing and finally, within about a month, a total lockdown was announced in which the movement of citizens from their homes was restricted. Along with this, a policy of breaking the chains of infection was announced by questioning infected people about those they came in contact with, as well as a strict policy of isolation for infected people or those they came in contact with.

This policy indeed led to a dramatic decrease in morbidity rates and an exit from the lockdowns at the beginning of May 2020, but this was not done in a controlled manner and the result was renewed outbreaks of waves of infection (a second wave in May-July 2020, which culminated in a general closure of the entire country, and the third wave in December-January 2020).

It should be noted that Israel’s efforts to develop a vaccine for the virus on its own through the biological institute subordinate to the Israeli Defense Ministry did not go well as this required knowledge and ability that were beyond Israel’s ability. But an important Israeli contribution was an analysis of the available information found in the health systems in Israel about the trends and characteristics of the behavior of the virus that allowed Israeli scientists to make an important contribution in this field to scientific research in the world.

Vaccination of the population – With the development of vaccines for Corona by a series of pharmaceutical companies and receiving emergency approval for its distribution at the end of 2020, Israel quickly prepared to vaccinate the entire population starting in December 2020.

Quick action by the Israeli government while taking advantage of the country’s advantages and strengths – the fact that it is a relatively small population that has access to health services, made it possible to present a quick and reliable picture of the results of the vaccination. This fact made it possible to turn Israel into an attractive experimental laboratory for the companies developing the vaccines, and because of this Pfizer, for example, was willing to give Israel priority in the supply of vaccines, which made it possible to vaccinate the population with a full vaccine (two vaccines as required according to Pfizer’s medical specifications).

The rapid vaccination operation, within the framework of which about 60% of the country’s population were vaccinated within six months (and with the exception of their young people, no vaccination has yet been offered, this was even a much higher rate), made it possible to formulate a policy that allows the recovered and the vaccinated to fully return to their daily routine – on the basis of presenting a certificate of recovery from the disease or vaccination. And so, Israel also became a pioneer in returning to normality in the shadow of the disease for this population of those who are recovering and vaccinated. The data provided by Israel unequivocally proved the effectiveness of the vaccines, their contribution to improving the body’s ability to defend itself in case of illness, but also the decrease over time in the effectiveness of the vaccine.

As mentioned, the corona was proven to be a deceptive disease because it soon became clear that the vaccine weakened after a few months and apart from that, new alpha, delta and Omicron variants were discovered that the vaccines turned out to be less effective against and that thus even infected or vaccinated people were infected once again.

Indeed, in June 2021, although about half of the country’s population was already vaccinated, there was a renewed increase in cases of infection, most of which originated from Israelis who returned from other countries and were infected with the delta strain of the virus that became dominant in the world and in Israel. And so, the fourth wave of the corona pandemic began in Israel, yet it was a virus whose impact on patients was easier. In July 2021 Israel was the first country in the world to vaccinate its citizens with a third vaccine (booster vaccine).

“Living alongside the pandemic” – but this time the government decided on a policy change under the title of “living alongside the pandemic”. The leading principle of the strategy states that contagion must be suppressed with minimal damage to the economy. Thus, the examination of the severity of the pandemic will not be done according to the number of patients but according to the burden on the health systems and the number of seriously ill patients and even those on ventilators.

And yet, at the beginning of September 2021, Israel was the country with the highest number of verified people in the world in relation to the size of the population. But on the other hand, life continued as usual and economic life began to recover.

A fifth wave began at the end of 2021 – in the months of November – December with the appearance of the Omicron strain. Although the government imposed a ban on entry and exit to Israel and encouraged work from home in the private sector, it avoided imposing a lockdown. In addition, it decided in January 2022 to give a fourth vaccine to the entire population. The sixth wave – in June 2022, morbidity began to increase again, mainly due to the spread of the 5.BA variant, but this did not receive any attention, as it turned out that, as a rule, its damage is mild in those who are vaccinated. In September 2022, Israel began to vaccinate the population with a vaccine against the Omicron.

In all of the above regarding the vaccination of the population of Israel against Corona, as of October 2022, 6,718,301 received at least one dose, of which 1,643,280 received two doses, 3,661,649 received 3 vaccine doses, and 849,358 received 4 vaccine doses (out of a total population of 9.2 m.)

It is worth noting that many avoided receiving the vaccines both because the delta and omicron strains turned out to be easier and because Israel’s population is mostly young anyway and the vaccines for children under 16 were developed and put into use after the pandemic had already passed its peak and therefore the rate of vaccination among the young population was relatively low.

It should also be noted that the response of the population knew ups and downs, in the beginning mobilization was evident, but as time passed, fatigue was evident and also the feeling that the pandemic is not so terrible since it affects adults. This had the effect of decreasing vaccination rates. It should also be noted that the effect of the vaccine opponents was marginal.

Israel’s economy and the corona virus

The pandemic also had economic consequences, since in order to slow down the rate of its spread, a policy of social distancing and closures was decided which resulted in the paralysis of economic life. The government in Israel  initiated a wide range of aid programs for those affected by the economic damage of the corona virus.

At the peak of the corona virus, the level of unemployment that was on the eve of the outbreak of the crisis increased from 3-4% to about 10%, but in practice about a quarter of employees were forced to go on temporary leave or were affected by the scope of the job and salary. But the recovery was quick. The extent of unemployment decreased starting at the beginning of 2022 to about 3%, even less than its pre-covid rate of 2.2%, the GDP per capita decreased by 3.9%, recorded a rapid recovery compared to all the developed countries of the world and recorded an increase of 8% in 2021 and a rate of approximately 7% in 2022.

In conclusion, during the waves of the Corona pandemic, 11,710 Israelis died and about four and a half million were infected. It goes without saying that research into the long-term damage of the disease, post-Corona, is still in its infancy and it is therefore premature to assess the long-term consequences of this number of patients on society and the country.

However, this is a relatively low number of casualties compared to countries like the USA where over a million people died (out of a population of about 330 million) Italy where over 177 thousand people died out of a population of about sixty million or Germany where about 150 thousand people died out of a population of 83 million.

In general, it can be stated that society and the government systems in Israel were able to successfully deal with the pandemic and its consequences, to respond as quickly and effectively as possible, in view of the limits of knowledge about the disease, and to reduce as much as possible its effects.

The robustness of the state’s systems, their points of strength and their experience helped the Israeli leadership make effective decisions. The rapid economic recovery from the pandemic and the return to normality are proof of this

Israel – as a society and as a country – was therefore able to successfully meet the challenge of the corona virus.