JERUSALEM—The massive surge of COVID-19 infections in Israel, one of the most vaccinated countries on earth, is pointing to a complicated path ahead for America.
In June, there were several days with zero new COVID infections in Israel. The country launched its national vaccination campaign in December last year and has one of the highest vaccination rates in the world, with 80 percent of citizens above the age of 12 fully inoculated. COVID, most Israelis thought, had been defeated. All restrictions were lifted and Israelis went back to crowded partying and praying in mask-free venues.
Fast forward two months later: Israel reported 9,831 new diagnosed cases on Tuesday, a hairbreadth away from the worst daily figure ever recorded in the country—10,000—at the peak of the third wave. More than 350 people have died of the disease in the first three weeks of August. In a Sunday press conference, the directors of seven public hospitals announced that they could no longer admit any coronavirus patients. With 670 COVID-19 patients requiring critical care, their wards are overflowing and staff are at breaking point.
“I don’t want to frighten you,” coronavirus czar Dr. Salman Zarka told the Israeli parliament this week. “But this is the data. Unfortunately, the numbers don’t lie.”
The complex and sobering truth is that no single policy or event brought Israel to this crisis, Hagai Levine, a Hebrew University of Jerusalem professor of epidemiology, told The Daily Beast. A deadly set of circumstances came together to put Israel on the precipice, most of which can be summed up as: “We are still in the midst of a pandemic, and there is no silver bullet.”
“All the vectors have influenced the rise in morbidity,” he said.
But the principal causes of Israel’s current predicament are the dominance of the extremely infectious Delta variant, which was carried into the country by Israelis returning from foreign vacations during the weeks in which Israel dropped all restrictive measures—along with the worrisome decrease in vaccine efficacy after about six months.
Israel vaccinated its population almost exclusively with the Pfizer/BioNTech vaccine, which received full FDA approval on Monday and remains the gold standard for the prevention of severe illness due to the coronavirus.
But in early July, with citizens over the age of 60 almost completely vaccinated, Israeli scientists began observing a worrisome rise in infections—if not in severe illness and death—among the double-vaccinated.
Fully vaccinated people with weakened immune systems appeared particularly vulnerable to the aggressive Delta variant.
By mid-July, Sheba Hospital Professor Galia Rahav began to experiment with booster shots for oncology patients, transplant patients, and the hospital’s own staff. A group of 70 elderly vaccinated Israelis with transplanted kidneys were the first to receive a third dose.
The success of Rahav’s trials in boosting immunity at about the sixth-month mark contributed to the Centers for Disease Control decision, announced last week, to begin offering booster shots to Americans in September.
In order to keep severe illness and the number of COVID deaths down, and avoiding a fourth national lockdown, Israel has embarked on an aggressive effort to provide all adults with boosters in a matter of weeks.
As of this week, all Israelis over 30 will be eligible to receive booster shots. By the end of the month, they are expected to be universally available to anyone over the age of 12 who received their second vaccine five months or more ago.
Israel will then reconfigure its Green Passports, granting them only to the triple-vaccinated, and limiting their validity to six months. In anticipation of this change, the number of unvaccinated Israelis getting their first shots has tripled since the beginning of August.
The World Health Organization has asked wealthy countries to halt all third vaccines for a period of two months, hoping that a moratorium will allow poorer countries, where few citizens have received even a first inoculation, to catch up. The United States rejected the call and Israel has ignored it.
Watch: Ultra-vaccinated Israel's spike in COVID-19 cases serves as warning to U.S.
Asked what has brought Israel to peak transmission even as the country has already provided third doses of vaccines to 1.5 million citizens, Rahav, who has become one of the best known faces of Israel’s public health messaging, sighed, saying, “I think we’re dealing with a very nasty virus. This is the main problem—and we’re learning it the hard way.”
“It is a combination of waning immunity, so that inoculated people get reinfected, and at the same time the very transmissible Delta variant,” Rahav said, adding that Israelis lacked the discipline to revert to mask usage as the numbers began rising. “But it is not an Israeli problem,” she added. “It is everywhere.”
Her conclusion should give pause to American authorities, who face school reopenings as, at best, only 50 percent of eligible adults have been fully vaccinated.
Unlike New Zealand, which aims for zero community transmission of the coronavirus, and imposes lockdowns when even a single positive case is identified, Israeli authorities have opted for a model they are calling “living with corona.”
“Israel really is a pioneer,” Levine, the former chairman of the nation’s Association of Public Health Physicians, said, referring to the groundbreaking vaccination campaign and the country’s efforts, currently underway, to fully reopen schools on Sept. 1 while keeping in place measures aimed at preventing school-driven outbreaks, such as the one that closed the nation down last summer.
“We’ve achieved a plan that is not hermetic,” Zarka, the coronavirus czar, told a local radio station. “Clearly there will be cases of illness at schools… [but] shutting oneself up at home and closing the school system isn’t exactly the solution.”
He has asked the government to impose stricter limitations on the size of cultural and sports events until the incidence of the coronavirus declines.
“Each country has to assess its own epidemiology,” Levine said, “its culture, its public health, the public’s confidence in its health authorities.” Referring to New Zealand, he added that “we can all learn from other countries, but you can’t copy paste other countries’ methods.”
Israel was forced to make quick decisions and in a time of great uncertainty. Levine was among the public health officials who expressed doubts about the wisdom of Israel’s untested move towards nationwide booster vaccination, but he told The Daily Beast that the latest statistics, showing that only 0.2 of the first 1.1 million recipients of the third jab were infected with the coronavirus, proved it had been a “brave decision.”
The last week has shown a significant reduction in morbidity among triple-vaccinated Israelis over the age of 70—the first group to receive the booster.
Like the other experts, Rahav supports schools reopening, but noted that thanks to upcoming Jewish holidays, which will close schools in about 80 percent of the country, Israel will once again be uniquely positioned to serve as a huge laboratory.