JERUSALEM – In its most comprehensive field trial to date, Israel has shown that a robust coronavirus vaccination program can have a rapid and powerful impact and show the world a plausible way out of the pandemic.
Cases of Covid-19 and hospital admissions have fallen dramatically among people vaccinated within weeks, according to new studies in Israel, where a rapid rollout of vaccines has made it something of a testing lab for the world. And early data suggests that the vaccines work almost as well in practice as they do in clinical trials.
“We say gently, the magic has begun,” tweeted Eran Segal, a quantitative biologist at the Weizmann Institute of Science and co-author of a new study on the impact of the vaccine in Israel.
The hopeful news about vaccines is hardly a free ride into a post-pandemic future.
As the world rushes to curb the virus before more dangerous mutations spread, severe vaccine shortages could keep other countries from repeating Israel’s success or preventing new variants from emerging.
Even Israel, which has outdone every other nation in vaccinating its people, is far from out of the woods. The country extended its third nationwide lockdown on Thursday.
Still, researchers found hope in the vaccine’s ability to quickly combat cases among Israelis who received the shots.
“I find this quite compelling that we are seeing actual effects of vaccination at the population level,” said William Hanage, an epidemiologist at Harvard’s TH Chan School of Public Health who was not involved in the Israeli study.
The real news from Israel adds to other signs of hope after months of gloom. A growing number of vaccines show strong efficacy against Covid-19 and are particularly protective against serious diseases. Some research suggests that vaccines can even slow the transmission of the virus.
The new Israeli study looked at national health statistics for people aged 60 and older, who were the first to receive the Pfizer-BioNTech vaccine because of their high risk. When analyzing data from six weeks after the vaccination campaign, when the majority of people of that age had been vaccinated, they found that the number of new Covid-19 cases fell 41 percent compared to three weeks earlier.
That group also experienced a 31 percent drop in hospital admissions for the coronavirus, and a 24 percent drop in those who became seriously ill.
The study is important in part because the authors were able to isolate other factors, including lockdowns, that also reduce the number of infections. The researchers found that the vaccines, even taking those factors into account, had a significant impact.
How big an impact is has yet to be determined.
But new data released Thursday by one of Israel’s largest health networks suggests that the vaccine’s protection could be nearly as good in practice as it was during the clinical trial.
The vaccine had 95 percent efficacy in clinical trials. Researchers warned in November that those numbers may not add up in the real world.
For example, people who volunteer for trials do not represent the entire population. Also, the Pfizer BioNTech vaccine is challenging to administer nationally, as it must be kept frozen until shortly before administration.
But Maccabi Healthcare Services reported Thursday that of the 416,900 people who vaccinated it, only 254 received Covid-19 a week after their second dose. In addition, all cases were mild. By comparing these numbers to unvaccinated people, the researchers estimate that the vaccine has an effectiveness of 91 percent.
“The data remains very encouraging and the high efficacy of the vaccine is maintained and stable,” said Dr. Anat Ekka-Zohar, the director of the Data and Digital Health Department at Maccabi.
The results are all the more striking, experts said, as Israel faces a worrying new variant of the coronavirus. The variant B.1.1.7 now accounts for 80 percent of the samples tested in Israel.
The variant was first identified in Britain in December, has spread to 72 other countries, and may be up to 50 percent more transmissible than other variants.
Israel is leading the world in vaccinating its citizens. To date, more than a third of the population of more than nine million people has received a first dose of the Pfizer-BioNTech vaccine and nearly two million people have received a second dose.
The first target was civilians over the age of 60, an age group responsible for 95 percent of the more than 5,000 Covid-19 deaths in Israel. According to the Ministry of Health, 84 percent of that age group has been vaccinated.
As a relatively small country with a highly digitized universal health system, Israel became an attractive testing ground for Pfizer. As a result, Israel struck a deal with the company, offering data in exchange for a steady supply of vaccines.
Despite its successes, Israel remains vulnerable. After a dip in new cases at the end of January, the average rate is climbing again. The infectivity of the B.1.1.7 variant may be partly caused, as can the lower adherence to the current lockdown compared to previous ones. And on a handful of Palestinians in the occupied territories, all Palestinians are still waiting for vaccines, leaving them and Israelis less protected in the event of new spikes.
It is also impossible to say what would happen if a more troubling variety spread in Israel. A variant first identified in South Africa is not only more contagious, but can also make vaccines less effective.
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Answers to your vaccine questions
Currently, more than 150 million people – nearly half of the population – are eligible for vaccination. But each state makes the final decision on who goes first. The 21 million health workers and the three million residents of long-term care facilities were the first to qualify. In mid-January, federal officials urged all states to qualify anyone 65 and older and adults of any age with medical conditions that put them at high risk of becoming seriously ill or dying from Covid-19. Adults in the general population are at the back of the queue. If federal and state health officials can resolve bottlenecks in vaccine distribution, anyone 16 and older will be eligible as early as this spring or early summer. The vaccine is not approved in children, although studies are ongoing. It can take months for a vaccine to be available to someone under the age of 16. Visit your state’s health website for current information on vaccination policies in your area
You don’t have to pay anything out of pocket to get the vaccine, although you will be asked for insurance information. If you don’t have insurance, you should still get the vaccine for free. Congress passed legislation this spring that prohibits insurers from applying any cost-sharing, such as a co-payment or deductible. It was layered on extra protection that prevented pharmacies, doctors and hospitals from considering patients, including those who are uninsured. Still, health experts are concerned that patients will fall into loopholes that leave them vulnerable to surprise bills. This could happen to those who have to pay a doctor visit fee in addition to their vaccine, or Americans who have certain types of health coverage that aren’t covered by the new rules. If you get your vaccine from a doctor’s office or an emergency room, talk to them about possible hidden costs. To make sure you don’t get a surprise bill, it’s best to get your vaccine from a health department vaccination site or local pharmacy once the injections are more widely available.
That has yet to be determined. It’s possible that Covid-19 vaccinations will become an annual event, just like the flu shot. Or it could be that the benefits of the vaccine last for more than a year. We have to wait and see how durable the protection against the vaccines is. To determine this, researchers will follow vaccinated people looking for “breakthrough cases” – those people who fall ill with Covid-19 despite vaccination. This is a sign of a weakening of protection and gives researchers clues as to how long the vaccine will last. They will also monitor the levels of antibodies and T cells in the blood of vaccinated people to determine if and when a booster shot may be needed. It is conceivable that people need boosters every few months, once a year, or just every few years. It’s just a matter of waiting for the data.
At the same time, Israel’s acclaimed vaccination program seems to have run into a problem as the number of vaccinated fell dramatically last week, suggesting that the country’s initial enthusiasm may be waning. Due to the delay, some vaccination centers have been abandoned this week.
The vaccination program has met with resistance from some groups, notably ultra-Orthodox Jews and Arab citizens, two communities hard hit by the virus.
The government and health networks are launching new efforts to get more people vaccinated. Israel’s health networks have made vaccines available to anyone 16 or older this week. Experts advising the government recommended allowing only those vaccinated teachers back into the classroom.
As an added incentive, once lockdown restrictions are relaxed, they recommend limiting participation in cultural or religious gatherings to people who have been fully vaccinated, recovered from Covid-19, or can show a recent, negative test.
Experts have also pointed to gaps in the Weizman Institute’s study that have yet to be filled.
Hagai Levine, an epidemiologist at Hadassah’s Hebrew University in Jerusalem, warned the researchers were only observing broad trends in the country, rather than tracking individual vaccinated people.
As a result, the study raises a number of questions that cannot be answered. For example, it is not clear why the researchers did not see a drop in the number of cases, serious illness and hospitalization until three weeks after the start of the campaign. In the clinical trial of the Pfizer-BioNTech vaccine, researchers saw the first signs of protection about 10 days after the first dose.
It is possible that the impact was slower in Israel because the vaccination campaign was mainly aimed at older people, whose immune systems took longer to defend themselves.
“The message to the world is that even if you are vaccinating at an insane pace like Israel, you have to be patient,” said Hagai Rossman, a co-author of the Weizmann study. “There is no magic wand.”
Other countries may not fully experience the benefit Israel has gained from its vaccine. Keeping the vaccine cold – it must be stored at temperatures below -76 degrees Fahrenheit to remain effective – it can be difficult in some places during transportation.
Still, Dr. Hanage that other countries should be encouraged by Israel’s results and see them as an incentive to vaccinate as many people as possible as soon as possible.
“I actually think the recent results should be very reassuring,” he said. “Overall, I think it’s good news.”
Isabel Kershner reported from Jerusalem and Carl Zimmer from New Haven, Connecticut.