One size does not fit all: Lessons from Israel's Covid-19 vaccination drive and hesitancy

Raz, Aviad E.; Keshet, Yael; Popper‐Giveon, Ariela; Karkabi, Maha Sabbah

doi:10.1016/j.vaccine.2021.06.004

Cited by 22 publications

(16 citation statements)

References 7 publications

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“…Reid and Mabhala note that, for many countries, “early studies attribute lower uptake of COVID-19 amongst ethnic minorities to the wider determinants of vaccine uptake, hesitancy or lack of vaccine confidence, including lower levels of trust and greater concerns about vaccine safety” [ 40 ]. As highlighted in recent academic and newspaper articles, some of these same factors are probably also at work in Israel [ 41 , 42 ].…”

Section: Resultsmentioning

confidence: 99%

Addressing vaccine hesitancy and access barriers to achieve persistent progress in Israel’s COVID-19 vaccination program

Rosen

Waitzberg

Israeli

et al. 2021

Isr J Health Policy Res

111

101

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As of March 31, 2021, Israel had administered 116 doses of vaccine for COVID-19 per 100 population (of any age) – far more than any other OECD country. It was also ahead of other OECD countries in terms of the share of the population that had received at least one vaccination (61%) and the share that had been fully vaccinated (55%). Among Israelis aged 16 and over, the comparable figures were 81 and 74%, respectively. In light of this, the objectives of this article are: To describe and analyze the vaccination uptake through the end of March 2021 To identify behavioral and other barriers that likely affected desire or ability to be vaccinated To describe the efforts undertaken to overcome those barriers Israel’s vaccination campaign was launched on December 20, and within 2.5 weeks, 20% of Israelis had received their first dose. Afterwards, the pace slowed. It took an additional 4 weeks to increase from 20 to 40% and yet another 6 weeks to increase from 40 to 60%. Initially, uptake was low among young adults, and two religious/cultural minority groups - ultra-Orthodox Jews and Israeli Arabs, but their uptake increased markedly over time.In the first quarter of 2021, Israel had to enhance access to the vaccine, address a moderate amount of vaccine hesitancy in its general population, and also address more intense pockets of vaccine hesitancy among young adults and religious/cultural minority groups. A continued high rate of infection during the months of February and March, despite broad vaccination coverage at the time, created confusion about vaccine effectiveness, which in turn contributed to vaccine hesitancy. Among Israeli Arabs, some residents of smaller villages encountered difficulties in reaching vaccination sites, and that also slowed the rate of vaccination.The challenges were addressed via a mix of messaging, incentives, extensions to the initial vaccine delivery system, and other measures. Many of the measures addressed the general population, while others were targeted at subgroups with below-average vaccination rates. Once the early adopters had been vaccinated, it took hard, creative work to increase population coverage from 40 to 60% and beyond.Significantly, some of the capacities and strategies that helped Israel address vaccine hesitancy and geographic access barriers are different from those that enabled it to procure, distribute and administer the vaccines. Some of these strategies are likely to be relevant to other countries as they progress from the challenges of securing an adequate vaccine supply and streamlining distribution to the challenge of encouraging vaccine uptake.

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Section: Resultsmentioning

confidence: 99%

Addressing vaccine hesitancy and access barriers to achieve persistent progress in Israel’s COVID-19 vaccination program

Rosen

Waitzberg

Israeli

et al. 2021

Isr J Health Policy Res

111

101

View full text Add to dashboard Cite

show abstract

“…Israel was among the first countries to initiate a large-scale vaccination campaign, on 20 December 2020, and quickly immunized a high proportion of the adult population, achieving early control over the spread of the virus [7]. More than five million Israelis (out of 9.3 million) were fully vaccinated with two doses of the Pfizer-BioNTech vaccine as of 26 May 2021 [8].…”

Section: Introductionmentioning

confidence: 99%

Large-Scale Study of Antibody Titer Decay following BNT162b2 mRNA Vaccine or SARS-CoV-2 Infection

et al. 2021

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Immune protection following either vaccination or infection with SARS-CoV-2 is thought to decrease over time. We designed a retrospective study, conducted at Leumit Health Services in Israel, to determine the kinetics of SARS-CoV-2 IgG antibodies following administration of two doses of BNT162b2 vaccine, or SARS-CoV-2 infection in unvaccinated individuals. Antibody titers were measured between 31 January 2021, and 31 July 2021 in two mutually exclusive groups: (i) vaccinated individuals who received two doses of BNT162b2 vaccine and had no history of previous infection with COVID-19 and (ii) SARS-CoV-2 convalescents who had not received the vaccine. A total of 2653 individuals fully vaccinated by two doses of vaccine during the study period and 4361 convalescent patients were included. Higher SARS-CoV-2 IgG antibody titers were observed in vaccinated individuals (median 1581 AU/mL IQR [533.8–5644.6]) after the second vaccination than in convalescent individuals (median 355.3 AU/mL IQR [141.2–998.7]; p < 0.001). In vaccinated subjects, antibody titers decreased by up to 38% each subsequent month while in convalescents they decreased by less than 5% per month. Six months after BNT162b2 vaccination 16.1% subjects had antibody levels below the seropositivity threshold of <50 AU/mL, while only 10.8% of convalescent patients were below <50 AU/mL threshold after 9 months from SARS-CoV-2 infection. This study demonstrates individuals who received the Pfizer-BioNTech mRNA vaccine have different kinetics of antibody levels compared to patients who had been infected with the SARS-CoV-2 virus, with higher initial levels but a much faster exponential decrease in the first group.

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“…Israel was among the first countries to initiate a large scale vaccination campaign on 20 December 2020. A large proportion of the population were quickly immunised, partly because of the centralised health services and the decision to use only one vaccine, achieving early control over the spread of the virus 101112. Up to 26 July 2021, more than 5.2 million Israelis were fully vaccinated with two doses of the Pfizer-BioNTech vaccine 13.…”

Section: Introductionmentioning

confidence: 99%

Elapsed time since BNT162b2 vaccine and risk of SARS-CoV-2 infection: test negative design study

Israel

Merzon

Schäffer

et al. 2021

BMJ

121

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Objectives To determine whether time elapsed since the second injection of the Pfizer-BioNTech BNT162b2 mRNA vaccine was significantly associated with the risk of covid-19 infection after vaccination in people who received two vaccine injections. Design Test negative design study. Setting Electronic health records of a large state mandated healthcare organisation, Israel. Participants Adults aged ≥18 years who had received a reverse transcription polymerase chain reaction (RT-PCR) test between 15 May 2021 and 17 September 2021, at least three weeks after their second vaccine injection, had not received a third vaccine injection, and had no history of covid-19 infection. Main outcome measures Positive result for the RT-PCR test. Individuals who tested positive for SARS-CoV-2 and controls were matched for week of testing, age category, and demographic group (ultra-orthodox Jews, individuals of Arab ancestry, and the general population). Conditional logistic regression was adjusted for age, sex, socioeconomic status, and comorbid conditions. Results 83 057 adults received an RT-PCR test for SARS-CoV-2 during the study period and 9.6% had a positive result. Time elapsed since the vaccine injection was significantly longer in individuals who tested positive (P<0.001). Adjusted odds ratio for infection at time intervals >90 days since vaccination were significantly increased compared with the reference of <90 days: 2.37 (95% confidence interval 1.67 to 3.36) for 90-119 days, 2.66 (1.94 to 3.66) for 120-149 days, 2.82 (2.07 to 3.84) for 150-179 days, and 2.82 (2.07 to 3.85) for ≥180 days (P<0.001 for each 30 day interval). Conclusions In this large population of adults tested for SARS-CoV-2 by RT-PCR after two doses of mRNA BNT162b2 vaccine, a gradual increase in the risk of infection was seen for individuals who received their second vaccine dose after at least 90 days.

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One size does not fit all: Lessons from Israel's Covid-19 vaccination drive and hesitancy

Cited by 22 publications

References 7 publications

Addressing vaccine hesitancy and access barriers to achieve persistent progress in Israel’s COVID-19 vaccination program

Addressing vaccine hesitancy and access barriers to achieve persistent progress in Israel’s COVID-19 vaccination program

Large-Scale Study of Antibody Titer Decay following BNT162b2 mRNA Vaccine or SARS-CoV-2 Infection

Elapsed time since BNT162b2 vaccine and risk of SARS-CoV-2 infection: test negative design study

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