Israel's bet on early COVID booster shots pays off

People wait in line patiently at a pop-up vaccination center inside a city building in West Jerusalem. "I am here to get my third shot — it's really important so Israel can open up," says Leah Powell, a student visiting from the US. "There is still a mask mandate in some places, but it feels like real life is coming back."

The situation looked less optimistic this summer when the delta variant of the coronavirus was spreading rapidly. Infections started picking up at the start of July and by mid-September, cases were the highest they have ever been. Hospitals received many more severely ill patients — first among the vaccinated, and later among the mostly unvaccinated younger population. 

"The main weapon that we have Israel and in many other places is the vaccine," said Salman Zarka, Israel's "coronavirus czar" and head of the national COVID task force, in an interview with DW. "With the start of delta wave, we realized that people who have had two doses were not protected anymore. We had to take a decision rapidly."

That decision was based on scientific studies suggesting that immunity wanes after six months, putting especially elderly people at risk again. They were among the first to be vaccinated in December 2020, when Israel started its vaccination campaign after striking a deal with BioNTech-Pfizer, and the first group to be approved for a booster this past July.

When the pandemic started, Israel struck a deal making doses available quickly, and along with a swift rollout through its localized health care system and the introduction of a "green pass" in March allowing freedoms to those getting the shots, infection rates declined sharply. In June — when many countries in Europe were just beginning to ramp up their vaccination campaigns — Israel lifted most restrictions, including the indoor mask mandate, and life seemed to have returned to some kind of normal.

However, by mid-June, the delta variant began spreading despite the high vaccination rate, via breakthrough infection. The government began offering a third shot of BioNTech-Pfizer in August, and it has been gradually rolling out a campaign to vaccinate everybody over the age of 12. 

'Third vaccine saved Israel' 

"There is no question that the third vaccine, the booster, saved Israel," said Gabriel Barbash, a professor for epidemiology at the Weizmann Institute of Science and one of Israel's top health experts. "I think life is going back to normal, but to a new normal. We are not going to give up masks. They are going to be required in any place that is a closed space."

While boosters are a "powerful tool" to protect the community, Barbash warned that the effects will diminish at some point. "It's going to wane and we need to be ready, we need to be cautious about it."

Israel's strategy to "live with COVID-19" has worked so far, although it has not been without controversy. Schools and the economy have remained mostly open. Infection rates have sharply fallen, along with it the number of severely ill patients in hospitals.

In combination with the vaccine booster, the government reintroduced the indoor mask mandate and has tightened its green pass system. This consists of an app or document that shows the person's vaccination status or recovery from COVID-19. 

New rules, mixed compliance

With an energetic stride and a smile on his face, Ofer Levi greets swimmers and sunbathers at the outdoor swimming pool he manages on the beach in Tel Aviv. Temperatures are mild on this autumn day and the Olympic-sized seawater pool is busy. "We created a kind of safe zone here when it comes to the pandemic," he said.

To enter the club, people must present their green pass, which includes an ID number and a QR code. "When somebody wants to go either to the pool or the gym, we check the green pass. Everybody has it on the phone these days. Sometimes it's a little bit of an inconvenience, but people understand and cooperate," said Levi.

"During the pandemic, we sat at home for months, and we don't want that time to come back. So, whatever it takes, we do," he said.

In October, Israeli authorities canceled the green passes of those eligible for the third shot but who hadn't received it yet. Those who don't have a green pass can get a 24-hour pass by taking an antigen or "fast" test to enter facilities.

However, compliance by businesses and individuals is not always a given. Some restaurants have customers sit outdoors, with people in close proximity. And on public transport, heated exchanges among passengers about mask-wearing are common.

As of this week, nearly half of Israel's population has received the booster shot. According to the Health Ministry, an estimated 700,000 people have not been vaccinated at all.

Challenges ahead

Israel is currently in the throes of an emotional debate over the vaccination of children aged 5 to 11. On Wednesday night, an expert panel gave its stamp of approval, paving the way for a national campaign. According to Israeli media reports, shipments of specialized child vaccines are expected to arrive next week.

After initially public debates, Israeli media reported that the key discussion that followed was closed to the public "amid a violent discourse." For some time, the head of public health services at the Health Ministry, Sharon Alroy-Preis, was assigned a security detail after receiving threats from those opposed to the vaccinations.

Among the unvaccinated, people who are ideologically against vaccination seem to be a minority in Israel — albeit a vocal one, active on social media and in small demonstrations. In a survey by the Israel Democracy Institute, only 8% are staunchly against vaccination, believing that the vaccines are "a result of political or economic interests." The same survey also found that a majority of Israelis support more restrictions for the unvaccinated.

Also, the recent reopening of Ben Gurion Airport, Israel's main gateway, to foreign visitors after tight travel restrictions since March 2020 has been perceived as a challenge to combating the pandemic. Tourists may now enter the country, albeit under an elaborate set of rules and testing requirements.

"We cannot celebrate the end of the pandemic yet," said task force head Salman Zarka. "Our big concern is not to have a fifth wave and another variant coming into Israel." 

Israel a 'laboratory for the world'

In the neighboring occupied Palestinian territories, vaccination rates are slowly but steadily increasing. While people there lacked access to vaccines during the first months of Israel's vaccination campaign, a mixture of six different vaccines has now been made available by the Palestinian Authority. Some were procured by the Palestinian Authority, others through the World Health Organization's COVAX program and others through "donor" countries such as Russia.

By early November, around 52% of the target population — aged 16 years and above — in the West Bank and Gaza has been administered at least one shot, according to the WHO. The third dose has also been administered to a small number among priority groups thus far.

"In Israel, we are kind of a laboratory for the whole world because of the pace of vaccination. We experience what the world is experiencing, like in the US and in Europe, earlier than other countries," said epidemiologist Barbash. 

Studies are now underway in real time to understand for how long the third vaccine will provide immunity. This could help other wealthy countries to navigate the pandemic in the months to come.