“Now is a critical time,” said Israeli Health Minister Nitzan Horowitz when the 56-year-old received a COVID-19 booster shot on August 13, the day his country became the first nation to offer a third dose of vaccine to humans. young as 50 years. “We are in a race against the pandemic.”
His message was intended for his Israelis, but it is a warning to the world. Israel has among the world’s highest vaccination levels for COVID-19, where 78% of those 12 and older are fully vaccinated, the vast majority with the Pfizer vaccine. Yet the country now registers one of the world’s highest infection rates with nearly 650 new cases daily per year. Million people. More than half are in fully vaccinated humans, underscoring the extraordinary transmission of the Delta variant and raising concerns that the benefits of vaccination are waning over time.
The large number of vaccinated Israelis means that some breakthrough infections were inevitable, and the unvaccinated are still far more likely to end up in the hospital or die. But Israel’s experience is forcing the booster issue on the radar of other nations, suggesting that even the best vaccinated countries will face a Delta rise.
“This is a very clear warning sign for the rest of the world,” said Ran Balicer, Head of Innovation at Clalit Health Services (CHS), Israel’s largest health maintenance organization (HMO). “If it can happen here, it can probably happen anywhere.”
Israel is being closely monitored now because it was one of the first countries outside the gate with vaccinations in December 2020 and quickly achieved a degree of population coverage that was the envy of other nations – for a time. The nation of 9.3 million also has a robust public health infrastructure and a population fully enrolled in HMOs that tracks them closely so it can produce high-quality actual data on how well vaccines work.
“I see [Israeli data] very, very close because it’s some of the absolute best data coming out anywhere in the world, ”says David O’Connor, a viral sequencing expert at the University of Wisconsin, Madison. “Israel is the model,” agrees Eric Topol, a medical scientist at Scripps Research. It’s pure mRNA [messenger RNA] vaccines. It’s out there early. It has a very high population [uptake]. It is an experimental laboratory that we can learn from. ”
Israel’s HMOs, led by CHS and Maccabi Healthcare Services (MHS), track demographics, comorbidities and a range of coronavirus metrics on infections, diseases and deaths. “We have rich data at the individual level that allows us to provide real-time evidence in near real-time,” says Balicer. (The UK also collects a wealth of data. However, the vaccination campaign increased later than Israel’s, making its current situation less reflective of what the future may hold, and it has used three different vaccines, making its data more difficult to analyze.)
Now, the effects of declining immunity may be beginning to show in Israelis vaccinated early in the winter; a pre-print published last month by researchers at MHS found that protection against COVID-19 infection decreased during June and July compared to the time since a person was vaccinated. People vaccinated in January had a 2.26 times higher risk of a breakthrough infection than those vaccinated in April. (Potential confusers include that the very oldest Israelis with the weakest immune system were first vaccinated.)
At the same time, cases in the country that barely registered in early summer have each time doubled to 10 days ago, with the Delta variant being responsible for most of them. They have now risen to their highest level since mid-February, with hospital admissions and admissions to intensive care units beginning to follow. How much of the current increase is due to declining immunity in relation to the Delta variant’s power to spread like wildfire is uncertain.
Clearly, “breakthrough” cases are not the rare events the term implies. On August 15, 514 Israelis were hospitalized with severe or critical COVID-19, an increase of 31% from just 4 days earlier. Of the 514, 59% were fully vaccinated. Of those vaccinated, 87% were 60 years or older. “There are so many groundbreaking infections that they dominate, and most of the inpatients are actually vaccinated,” said Uri Shalit, a bioinformatics specialist at the Israel Institute of Technology (Technion) who has consulted on COVID-19 for the government. “One of the great stories from Israel [is]: ‘Vaccines work, but not well enough.’ ”
“The most frightening thing for the government and the Ministry of Health is the burden on the hospitals,” says Dror Mevorach, who takes care of COVID-19 patients at Hadassah Hospital Ein Kerem and advises the government. At his hospital, he queues anesthesiologists and surgeons to spell his medical staff if they are overwhelmed by a wave like January, when COVID-19 patients filled 200 beds. “Staff are exhausted,” he says, and he has restarted a weekly support group for them “to avoid some form of PTSD. [post-traumatic stress disorder] effect.”
To try to tame the wave, Israel has turned to booster shots, starting July 30 with people 60 and older and on Friday expanding to people 50 and older. By Monday, nearly 1 million Israelis had received a third dose, according to the health ministry. Global health leaders, including Tedros Adhanom Ghebreyesus, director general of the World Health Organization, have called on developed countries not to administer boosters, as most of the world’s population has not even received a single dose. The affluent nations are already considering or administering booster vaccines so far mostly reserving them for special populations such as the immune system and health professionals.
Still, studies suggest that boosters may have a broader value. Researchers have shown that boosting induces a rapid increase in antibodies, which are needed in the nose and throat as a crucial first line of defense against infection. The Israeli government’s decision to start boosting those 50 and older was driven by preliminary data from the Ministry of Health, which indicated that people over the age of 60 who received a third dose were half as likely as their twice-vaccinated peers to be hospitalized. at the hospital in recent days, Mevorach says. CHS also reported that out of a sample of more than 4,500 patients who received boosters, 88% said any side effects from the third shot were no worse and sometimes milder than from the second.
Still, boosters are unlikely to tame a Delta wave alone, says Dvir Aran, a biomedical data researcher at Technion. In Israel, the current rise is so steep that “even if you get two-thirds of the 60-plus [boosted], it will just give us another week, maybe 2 weeks, until our hospitals are flooded. “He says it is also crucial to vaccinate those who still have not received their first or second dose and return to the masking and social distancing that Israel thought it had left behind – but has begun to reintroduce.
Aran’s message to the United States and other wealthy nations considering boosters is strong: “Do not think boosters are the solution.”