Why Ireland is trying to learn Israel’s COVID vaccine playbook

Israel’s vaccine campaign has been quick and dirty. But effective.

My phone (and email) have been buzzing over the past few days with messages from radio show hosts and producers in Ireland who are eager to hear what living in Israel is like as the country rolls out its vaccination program, which is currently the fastest in the world.

My interview with PJ Coogan on Cork’s 96FM last week:

I shared some thoughts with the Irish Independent here.

Usually, whenever Israel is brought up in Ireland it’s in relation to the conflict with its neighbors in the Arab world.

But the Irish media landscape and Twittersphere has been buzzing to a different tune over the past few weeks (mostly; the issue of how Israel has handled Palestinian vaccinations has also cropped up with predictable regularity).

Everybody, it seems, is interested to know how Israel managed to rollout its vaccine delivery program at record speed.

Why the fascination?

Firstly, in this respect at least, Israel is an excellent case study to follow.

Israel has now vaccinated more than 50% of its population with a first dose* — with more than 4.5 million citizens vaccinated. (These figures are lagging).

By comparison, Ireland is still well short of administering one million vaccinations:

Ireland’s COVID-19 vaccination figures at the time of writing, numbering a little over half a million. Source: Cork Independent via Twitter.

On a per-capita basis, Israel beats out not just Ireland but …. right now, the entire world:

Other reasons for this unusual wave of fascination with Israel:

  • Ireland and Israel both have relatively small populations. Ireland’s population is a tiny bit shy of 5 million. Israel has roughly 9 million citizens. In other words, Israel has roughly double Ireland’s population.
  • Ireland and Israel, geographically, are both relatively small countries

But most significantly, Israel is quite significantly ahead of Ireland in terms of its vaccine rollout. Thus, the Irish are looking to Israel — with its vaunted high-tech prowess and its nimble size — as a possible bellweather for what might be to come there.

In this respect, Israel is at the bleeding edge of the opening up experiment — the perfect status for a startup nation that’s famous for its tendency to do things on the fly. Ireland’s rollout will be slower but it gets to learn the lessons from the Beta test pool.

Epidemiologists are keeping a close eye on developments. But those managing public health drives will also be looking to see how, in particular, how Israel handles its green tag system from a technological perspective.

Ireland has committed to a high state of lockdown that will last until April 5th. That gives the country a month to learn from the international experience — including that of Israel — to prepare for its own easing of restrictions.

When it comes to its vaccine rollout, my guess is that certain factors have given Israel a decisive advantage, particularly vis-a-vis Ireland.

These are simply my beliefs from time living in both countries.

(I grew up in Ireland and moved to Israel six years ago).

Israeli Healthcare Is Both Centralized And Electronic

In Israel, every citizen is required to belong to one of four health maintenance organizations (HMOs; Hebrew: kupot holim).

The HMOs are responsible for providing essentially all front-line medical services including GP services, specialist services, medical imaging and diagnostics, and treatment.

There is private/supplementary health insurance in Israel. But the bulk of medical services are provided through the HMOs. More presciently, everybody — employed or otherwise — needs to be a paid up member of a HMO.

Each HMO operates a national infrastructure of clinics and the various HMOs have tie-ins to different hospitals.

The most striking feature of healthcare in Israel — from an Irish perspective — is the extent to which it is electronic.

The second most striking feature is how quickly everything works: I was recently able to book an appointment with a pulmonologist, for my asthma, in less than a week (although some specialists take longer). The system is used to working quickly.

By logging into my HMO’s website, I can do everything from book a GP’s appointment to view and print out my latest blood tests to see a complete history of every doctor’s appointments including prescriptions issued.

The same system appears to have made it very easy for the HMOs to quickly roll out a triage system for administering the vaccinations. All you had to do was click a button to book your appointment. SMS messages and emails were used to notify members when they were eligible to receive their first dose.

An online menu from the Macabbi HMO for booking vaccine appointments (in Hebrew). Screenshot: author.

Therefore, when it came to rolling out the online infrastructure necessary to support the mass booking of vaccination appointments, relative to Ireland, Israel was at a massive advantage in two respects:

  • Almost every citizen already had access to an online medical system. Each HMO only needed to develop a bolt-on to its platform for booking appointments.
  • Information was centralized in four bodies rather than hundreds — more likely thousands — of GP surgeries. Each HMO rolled out its vaccination program triage slightly differently. But it wasn’t hard to follow updates on when [your HMO] was beginning to offer vaccines. Information — and IT — was already centralized.

Israel’s widespread use of electronic medical records (EMRs) was instrumental in another important respect: it allowed the country to cut a data-for-vaccines quid pro quo agreement with Pfizer. Its system was already equipped for the collection — and anonymizing — of medical data.

Israel was able to leverage its small size, the fact that it was primed to aggregate and analyze anoymized data, and the fact that it served as a perfect test case to its advantage.

Details on Israel’s Pfizer deal: NPR.

My vaccine certificate displayed in my HMO’s website

My digital coronavirus vaccine certificate (private details redacted). As available through my HMO’s website.

Other Factors That May Have Influenced Israel’s Success

What else do I think has made a difference?

Here are my amateur hunches:

  • Logistical excellence: As a country that has had to develop extensive know-how in the fields of logistics and home front operations, Israel was primed to be able to roll out a vaccine effort as expeditiously as possible mobilizing whatever resources were necessary to make things work. The country has done everything in its power to roll out vaccines to its citizens including using its foreign intelligence agency to procure PPE and other supplies when needed. Israel is used to having to fight its own corner.
  • Geopolitics: Unlike Ireland, Israel isn’t a European Union (EU) member state. It has been unencumbered by cross-jurisdictional politics when planning its rollout, although there has been plenty of dissent internally.
  • Tech prowess: Israel is a smartphone-addicted nation and the tech hub of the Middle East. It has been willing to use whatever technical systems it had at its disposal to better its management of the pandemic. This has included — controversially — using its internal intelligence agency to track citizens’ smartphones and, more recently, quickly developing a smartphone application to support its green passport scheme.

As is well known, Ireland and Israel have a tumultuous relationship on the political level.

Despite that, many in Ireland are looking to Israel for cues in how to handle its own response to the pandemic.

In this response, Israel might provide a good role-model.

Daytime: tech-focused MarCom. Night-time: somewhat regular musings here. Or the other way round. Likes: Linux, tech, beer. https://www.danielrosehill.com