Teva Israel — SLE and health maintenance organizations (HMOs) Clalit, Leumit, Maccabi, and Meuhedet are the organizations responsible for the distribution and logistics of COVID-19 vaccines in Israel. Teva Israel — SLE is the organization responsible for distributing the vaccines to vaccination endpoints defined by the HMOs, while the HMOs are the organizations responsible for distributing the vaccines to Israelis. Further details, including factors that have contributed to the success and efficiency of COVID-19 vaccine distribution and logistics in the country, are provided below. This report focuses on distribution and logistics only.
- Teva Israel — SLE is the sole distributor of COVID-19 vaccines in Israel, but it has the right to seek the help of partners.
- The country’s four HMOs, Clalit, Leumit, Maccabi, and Meuhedet, are the organizations in charge of getting the vaccines out into communities. They are collectively known as Kupot Cholim.
1. Shipments of Vaccine Manufacturers
- There was news last January 11 that Pfizer had agreed to give the country 10 million doses, with 400,000 to 700,000 doses shipped to the country each week.
- The country was able to convince Pfizer to agree to these shipment terms by promising Pfizer and the World Health Organization (WHO) personally unidentifiable data such as age, gender, medical history, side effects, and efficacy.
- Pfizer also knew that the country has both the infrastructure for distributing and administering the vaccines in the shortest possible time and the potential to serve as a model for other countries.
- Moreover, the vaccines appear to have been procured at a price that was significantly higher than what other countries were able to afford. Reports place the price range at $30 to $47 per person, more than double the price negotiated by Belgium, the United States, and the European Union.
- Apart from Pfizer, Moderna and AstraZeneca have also secured deals with the country. Moderna has agreed to ship 6 million doses of its vaccine to the country.
2. Arrival of Vaccine Shipments in Israel
- Vaccine shipments are received by the logistics centers of SLE and Teva.
- SLE has 30 underground freezers in a location close to the primary international airport of the country. These freezers can hold around 5 million doses of the Pfizer vaccine, which has to be stored at -70°C or lower.
- SLE’s logistics center appears to be located in Shoham. Both this logistics center and Teva’s logistics center in Kfar Saba are capable of meeting the storage requirements of the Pfizer vaccine.
3. Repacking and Distribution to HMO Endpoints
- An article published by Reuters shows that the vaccine doses, arriving in the form of large ultra-frozen pallets, are repacked and divided into bundles of 100 doses, which are then delivered to vaccination sites across the country. The country’s HMOs had converted large spaces such as arenas, theaters, parks, and cultural centers into vaccination sites.
- An article published by Globes indicates, however, that Pfizer vaccines arrive in SLE’s Shoham logistics center in “special packages containing dry ice,” which are then examined, tagged with a Teva GPS chip that replaces that of Pfizer, and repacked into “mini-packages of 970 vaccine shots.”
- Based on this same article, these mini-packages are distributed to endpoints defined by the HMOs. These endpoints include vaccination sites, care homes, and other healthcare facilities.
- To facilitate both distribution in smaller quantities and distribution in remote areas, the country repacks doses into insulated boxes that are about the size of small pizza boxes. This repacking technique was approved by Pfizer.
- Yuli Edelstein, the country’s health minister, claims that Israel is “the first country in the world to perform repacking [and allow] vaccination at endpoints.” According to Edelstein, repackers from the SLE work carefully inside 2°C refrigerators and are supervised by pharmacists.
4. HMO Endpoints or Vaccination Sites
- A press release issued by the Ministry of Health last December 21 shows as of that date, there were 70 immunization stations already opened, and there was a plan to open 196 additional immunization stations the following week. These additional immunization stations were supposed to include 70 sites for Clalit, 38 sites for Maccabi, 32 sites for Meuhedet, 23 sites for Leumit, 23 hospitals, and 10 sites that could accommodate all HMO members in the North and South.
- The locations of the 10 ‘united’ sites were supposed to be Nahariya, Kiryat Gat, Carmiel, Eilat, Dimona, Arad, Safed, Kiryat Shmona, Shefa-Amr, and Sderot.
- By January 6, the number of vaccination sites was around 400 already.
- To reach periphery towns, the health minister shared that vaccination vans and 150 vaccination complexes will be added to the campaign.
- Vaccine doses become the responsibility of the HMOs once they reach the HMO endpoints. HMOs can only keep these vaccine doses at 2°C to 8°C for at most five days.
5. Military Assistance
- The country is inoculating around 150,000 people per day and has plans to increase this rate to 250,000 per day. The vaccination program is now a 24/7 operation.
- The army is helping with the vaccination program even though it is a civilian operation. Seven hundred army medics have been asked to help with the vaccination program.
- Vaccine distribution efforts in the country have so far been a success. The vaccination campaign started last December 19 only, and yet the country was already able to inoculate 27% of its population. Among the world’s countries, Israel has the highest COVID-19 vaccination rate.
- The fact that the country is small and has a universal and mandatory healthcare system, a digitized health data network, and only four HMOs has contributed to this success. Israel is small geography-wise and population-wise. It has a population of around 9 million only and is just about the same size as New Jersey.
- Under the country’s public healthcare system, each adult resident is required to sign up for HMO coverage and entry into the country’s nationwide digital health data network. According to Ran Balicer, chief innovation officer at Clalit, one of the country’s HMOs, Israel has an integrated digital health data infrastructure that has “full coverage of the entire population, cradle to grave.” Targeting the correct population has been easy, thanks to this data infrastructure and the fact that every HMO member has an ID number for easy access to medical records.
- Ronit Calderon-Margalit, an epidemiology professor at the Braun School of Public Health of the Hadassah-Hebrew University, credited the success of distribution efforts to the efficiency of the country’s HMOs. She said, “[the HMOs] all have vaccines from the government to vaccinate the population, and they’re very good with the logistics of distribution of services, of the vaccines.” Because the HMOs have complete information, they were able to generate vaccination candidate lists quickly. Contacting vaccination candidates and providing them with the appointment date, time, and venue have so far been easy for these HMOs.
- No vaccine doses are wasted or discarded because any leftover or soon-to-be-spoiled doses are distributed to interested people outside priority groups. The Pfizer vaccine, after leaving the main storage center, must be used within five days, and a thawed and diluted vial must be tossed out after six hours.
- There is no problem finding people to take the leftover doses because interest in the vaccine is high among Israelis and most Israelis are, in fact, eager to receive the vaccine. Some younger people are even lining up for leftover doses at vaccination sites.
- Israel’s vaccination program is not without controversy or flaws, though. It has been criticized for excluding or deprioritizing Palestinians in the West Bank and Gaza, which are both under the military control of Israel.
- Israel has been criticized as well for its bilateral deal with Pfizer. The country has been accused of hogging Pfizer vaccines by paying more for the vaccines and exchanging data for doses. The WHO recently lamented that 95% of COVID-19 vaccine doses went to just the following ten countries: the United States, China, the United Kingdom, Israel, the United Arab Emirates, Italy, Russia, Germany, Spain, and Canada.
- The country’s decision to repack vaccine doses into smaller boxes was instrumental to the success and efficiency of the country’s vaccine distribution efforts. The distribution and administration of vaccines in the country, however, have been too swift that doses for new or first-dose vaccinations quickly dwindled.
- If only publicly available documents were to be considered, Israel’s vaccine approach would be a ‘yellow.’ Only high-level guidance on Israel’s COVID-19 vaccine distribution and logistics can be located in the public domain.
- The efficiency and success of Israel’s vaccine distribution efforts have been widely recognized, however, so there is a possibility that parties responsible for distribution and logistics have detailed documents that have not been made public.
- The country’s Ministry of Health has web pages dedicated to inform the public about the country’s COVID-19 vaccination campaign. Unfortunately, these web pages do not offer an overview or a detailed explanation of the distribution and logistical aspects of the campaign. A few details about distribution and logistics could be compiled from the ministry’s news releases, however.
- The websites of Clalit, Leumit, Maccabi, and Meuhedet only provide the details that Israelis need to know about the COVID-19 vaccine. They do not offer information about distribution and logistics perhaps because they believe Israelis need not concern themselves with these aspects of the vaccination campaign.
- Maccabi’s website, for example, only shows that “notice will be given as to the layout of the places and the appointment for the vaccination” and that “Maccabi is prepared and ready, both medically and logistically, to provide the vaccines to all Maccabi members, nationwide.”
- Meuhedet’s website only shows that Meuhedet members can schedule an appointment for the first dose through Meuhedet’s website, app, hotline and that the second dose is automatically scheduled 21 days from the exact date and time the first dose was administered.
- SLE’s website does not provide any COVID-19-related information.
- The lack of publicly available documentation on distribution and logistics does not necessarily mean the Ministry of Health, the HMOs, and SLE do not have internal documentation.
- Given the efficiency of the campaign’s distribution efforts, the concerned units or organizations likely have internal documents listing the standard procedures for distribution and logistics but have decided that there is no need to share them with the public.