Israel ignores WHO plea to stop booster shots

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The Israeli Health Ministry ignores the World Health Organization’s plea for countries to stop administering third coronavirus shots.

In a response the ministry told Haaretz that the decision to administer a third shot was made after medical factors were taken into consideration and that inoculating Israelis with a third dose saves lives.

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In a series of tweets over the weekend, WHO Director-General Tedros Adhanom argued that for wealthy countries to offer a third vaccine dose while many poor countries have barely started administering first doses is both morally and epidemiologically unacceptable.

“The more people remain unvaccinated against #COVID19 globally, the more opportunity the virus has to spread and evolve into potentially more dangerous variants, which increases the risk for everybody. This is why we need a moratorium on boosters,” he tweeted Sunday.

On Friday, he tweeted that so far, more than 75 percent of all doses have been administered in just 10 countries, while low-income countries have administered just over one percent of all doses.

Israel began administering booster shots two weeks ago. This weekend, it expanded the campaign and began to offer a third shot to people over 50 as well as younger people who are employed in geriatric and health care institutions, or suffer from underlying conditions.

Israel hopes that a third dose will boost antibody levels and thereby stop the spread of the virus, and above all the rise in the number of serious cases.

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However, is it legitimate, during a global pandemic, for Israel to prioritize its own citizens?

“I’ve raised this issue repeatedly in the past, and others have also raised it recently, but the issue never took center stage,” said Dr. Dorit Nitzan, WHO Europe’s coordinator for health emergencies, who participated in the advisory committees’ discussions. Rather, the main issues discussed in Israel revolved around the booster shot’s safety and efficacy.

However, she says that the issue was raised with senior officials in the Health Ministry, “all of them do take this seriously. We need to have a serious, public discussion about it.”

Nitzan stressed that the question isn’t only a moral one, because vaccinating the rest of the world also contributes to Israelis’ safety. As she explained last month, unvaccinated countries “are a hothouse for the development of new strains of the virus,” and therefore, until the global vaccination rate reaches 60 percent, it won’t be possible to protect the whole population long-term.

But it’s also important “to be good and egalitarian and show solidarity, just as you couldn’t vaccinate Tel Aviv and leave Yeruham behind,” she added.

She therefore proposed that for every dose administered in Israel, the country should donate “one dose, half a dose or some other number to the world.”

Prof. Dan Turner, the deputy director of Jerusalem’s Shaare Zedek Medical Center, told the Channel 12 News that he wouldn’t accept a third dose as long as the global vaccination rate remains so low.

“I thought about this complex issue, which represents a clash between scientific, ethical, humanitarian and moral considerations, and decided that I won’t accept a third dose at this stage,” he said. But he added that he’ll monitor the evidence of how much the booster shots reduce incidences of the virus as well as vaccination rates in poor regions, “including among our neighbors.”

There aren’t a lot of supporters of Turner’s approach in Israel’s health care system. However, most members of the advisory committees do think Israel should promote vaccination among Palestinians, mainly for public health issues.

There are several global initiatives to reduce disparities in vaccination rates, including the WHO’s own COVAX program. But so far, all have failed.

“The situation that has been created is a giant red card for global health policy that demands a paradigm shift in developing vaccines and other medicines,” said Prof. Nadav Davidovitch, chairman of the Israeli Association of Public Health Physicians.

“The paradigm in recent decades is that drug companies sign secret agreements with each country and the competition leads to intolerable gaps and excess mortality and the creation of variants. The World Health Organization is very frustrated, and rightly so.”

Davidovitch argued that “there are things that can be done at the regional level. While Israel is administering a third dose, in the PA, only 13 percent have gotten one dose and nine percent have gotten two. That’s both a moral and an epidemiological problem, because we aren’t really an isolated island.”

In contrast, he said, “while it’s true that low vaccination rates in other countries also affect us, through new variants, there’s less we can do there. Israel won’t change the global rules of the game.”

Regulation has so far proved ineffective at resolving the tension between the need to develop lifesaving drugs and the pharmaceutical companies’ profits, Davidovitch continued. “There is global regulatory weakness, which is also reflected in the development, production and supply of vaccines. But Israel needs to make an effort so that at least in our region, things will be different.”

Prof. Eyal Leshem, an expert in infectious diseases who heads the Center for Travel Medicine and Tropical Diseases at Sheba Medical Center in Tel Hashomer, said that Adhanom’s arguments are right “from the perspective of global justice and equality, but because there is no justice and equality in general, and certainly not on health issues, there’s no significant moral difference here.

“Why does Israel have catheterizations while in Africa, children die of diarrhea that could be prevented by vaccines or IVs at negligible costs? Should we halt catheterizations in Israel until Africa has no more children dying of diarrhea?” he asked.

“If vaccine availability is limited, then the WHO should press the drug companies to provide vaccines for old people in the Third World before providing third doses to wealthy countries,” he added. “But that’s also unrealistic.”

The Health Ministry said in response that “the decision to administer a third COVID-19 dose was made out of medical considerations. Israel was the first [country] to inoculate its citizens, and it’s also the first [country] where the effectiveness of the vaccines seems to wane.”

“Thus, naturally, in Israel a need for a booster shot was identified first. Booster shots are common even with other vaccines. Israel finds itself in the midst of a large outbreak of the delta variant as serious cases rise. Thus, administering an extra shot manifests a move required to save lives.”