Israelis over the age of 60 were among the first in the world to get vaccinated
By early January 2021, 65% of older adults in Israel were already given the first dose of the Covid-19 vaccine, which led to a 60% drop in hospitalizations for that age group after 3 weeks. How did we do it?
The facts
One of the biggest challenges in distributing Covid-19 vaccines is maintaining cold storage throughout the supply chain. The vaccines have to be kept in sub zero temperatures and be used quickly once they are thawed (which is required to administer the vaccine). Pfizer’s vaccine, which is currently being distributed in Israel, has to be kept in -70 degrees celsius. It comes in 5-dose vials with no preservatives, which can only be kept at room temperature for 6 hours before they expire.
Only a fraction Israel’s older population lives in long term care facilities. Most older adults live in the community, so in order to vaccinate them quickly there needed to be swift action from community-based healthcare providers.
The facts
One of the biggest challenges in distributing Covid-19 vaccines is maintaining cold storage throughout the supply chain. The vaccines have to be kept in sub zero temperatures and be used quickly once they are thawed (which is required to administer the vaccine). Pfizer’s vaccine, which is currently being distributed in Israel, has to be kept in -70 degrees celsius. It comes in 5-dose vials with no preservatives, which can only be kept at room temperature for 6 hours before they expire.
Only a fraction Israel’s older population lives in long term care facilities. Most older adults live in the community, so in order to vaccinate them quickly there needed to be swift action from community-based healthcare providers.
Covid-19 vaccine distribution successfully prioritized older adults
Older adults who live in long-term care facilities are considered a high-risk population, so they were first in line to get vaccinated, and by January 7 every staff member and resident received their first dose.
In the community, vaccines are being distributed to the general public by community-based healthcare providers called “Kupot Holim”. All of them have a nationwide chain of healthcare centers that have clinics, pharmacies, laboratories, etc’. They cover a very wide range of healthcare services, including vaccines, and they are publicly funded according to the Bismarck Model. Some of them even own and operate hospitals and senior living communities. Every citizen or permanent resident has to be registered (and is therefore entitled to receive healthcare services) in 1 out of 4 of these “Kupot Holim”.
This means that every citizen and permanent resident in Israel has a healthcare provider, which has access to their medical record and contact information. As soon as vaccines arrived in December of 2020, they started reaching out to people over the age of 60, and scheduled them appointments to get the vaccine. In other countries, older adults who don’t have a computer or an internet connection, need assistance to get a Covid-19 vaccine appointment.
Population density has its advantages
With a population of ~9 million people spread across 22,145 sq.km (8,630 sq. miles) – Israel is one of the most densely populated countries in the developed world. This also means that if a vaccination center has open vials at the end of the day and they don’t want them to go to waste, they can call people who live nearby and invite them to get vaccinated. Since they have everyone’s medical record, they can choose to call people over the age of 60 or people with certain chronic conditions who are at a greater risk of severe illness and mortality from Covid-19.
What about people who are homebound?
Population density and existing health infrastructure made that easier as well. Early on in the pandemic, Israel utilized Magen David Adom – Israel’s National Emergency Pre-Hospital Medical and Blood Services Organization, to collect covid-19 tests to from people in their homes. This organization, with its fleet of ambulances and thousands of paramedics, is the one that’s been tasked with administering the covid-19 vaccine to people who are homebound, making sure no one is left behind.
Tech as an enabler for the vaccine rollout
While health-personnel are at the front of this complex operation, it’s actually IT people – the ones who maintain the digital infrastructure of all healthcare providers, that work behind the scenes to make sure health providers could handle the influx of calls and web traffic from everyone wanting to get vaccinated.
They quickly set up secure call centers that were able to receive all the calls from people asking to get vaccinated, despite the fact that many of the call-center employees are still working from home. They added features to existing websites and apps allowing people to schedule a vaccine appointment in a few clicks, and also provided a tracking app to every nurses’ station at the distribution center, which enabled anyone coming to their appointment to receive the vaccine in 15 minutes or less (thus reducing crowds which is important in a pandemic).
Technology also helped with the supply chain and handling inventory – making sure that every vaccine distribution center had the right amount of vaccines, so there would be little to no waste. At Ichilov, one of the largest hospitals in Israel, the tech team developed a process that allows medical teams to scan the barcode of each vial, thus tracking it from the minute it arrives until the patient receives the second dose. They also set a call center and an online appointment scheduling software for hospital workers, which includes notifications to make sure no one misses their appointment.
Current status (early February 2021)
83% of older adults were given at least one dose of the covid-19 vaccine.
More than 4.5 million doses were distributed overall to ~34% of the population.
More than 1.8 million Israelis were already given the second dose – this means that ~20% of the population is fully vaccinated (1 week after being given the shot).
What can be learned?
Prioritizing older adults, people with high-risk medical conditions, and healthcare personnel, seems to be in consensus around the world. However, actually following through on prioritization guidelines is not always easy.
Having the right infrastructure and technology in place, prior to the arrival of the vaccines, and the density of the population, were the key to Israel’s success in distributing them according to these guidelines, with little to no doses going to the biohazard basket.
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