His message was meant for his fellow Israelis, but it is a warning to the world. Israel has among the world’s highest levels of vaccination for COVID-19, with 78% of those 12 and older fully vaccinated, the vast majority with the Pfizer vaccine. Yet the country is now logging one of the world’s highest infection rates, with nearly 650 new cases daily per million people. More than half are in fully vaccinated people, underscoring the extraordinary transmissibility of the Delta variant and stoking concerns that the benefits of vaccination ebb over time.
The sheer number of vaccinated Israelis means some breakthrough infections were inevitable, and the unvaccinated are still far more likely to end up in the hospital or die. But Israel’s experience is forcing the booster issue onto the radar for other nations, suggesting as it does that even the best vaccinated countries will face a Delta surge.
“This is a very clear warning sign for the rest of world,” says Ran Balicer, chief innovation officer at Clalit Health Services (CHS), Israel’s largest health maintenance organization (HMO). “If it can happen here, it can probably happen everywhere.”
Israel is being closely watched now because it was one of the first countries out of the gate with vaccinations in December 2020 and quickly achieved a degree of population coverage that was the envy of other nations— for a time. The nation of 9.3 million also has a robust public health infrastructure and a population wholly enrolled in HMOs that track them closely, allowing it to produce high-quality, real-world data on how well vaccines are working.
“I watch [Israeli data] very, very closely because it is some of the absolutely best data coming out anywhere in the world,” says David O’Connor, a viral sequencing expert at the University of Wisconsin, Madison. “Israel is the model,” agrees Eric Topol, a physician-scientist at Scripps Research. “It’s pure mRNA [messenger RNA] vaccines. It’s out there early. It’s got a very high level population [uptake]. It’s a working experimental lab for us to learn from.”
Israel’s HMOs, led by CHS and Maccabi Healthcare Services (MHS), track demographics, comorbidities, and a trove of coronavirus metrics on infections, illnesses, and deaths. “We have rich individual-level data that allows us to provide real-world evidence in near–real time,” Balicer says. (The United Kingdom also compiles a wealth of data. But its vaccination campaign ramped up later than Israel’s, making its current situation less reflective of what the future may portend; and it has used three different vaccines, making its data harder to parse.)
Now, the effects of waning immunity may be beginning to show in Israelis vaccinated in early winter; a preprint published last month by physician Tal Patalon and colleagues at KSM, the research arm of MHS, found that protection from COVID-19 infection during June and July dropped in proportion to the length of time since an individual was vaccinated. People vaccinated in January had a 2.26 times greater risk for a breakthrough infection than those vaccinated in April. (Potential confounders include the fact that the very oldest Israelis, with the weakest immune systems, were vaccinated first.)
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A grim warning from Israel: Vaccination blunts, but does not defeat Delta | Science | AAAS
