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Israel suffers from COVID-19 despite high immunization rates. What lessons can Australia learn?

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Only a few months ago, Israel was a picture of a successful COVID-19 vaccination.

After an early and rapid deployment, after the majority of the adult population was completely vaccinated, Israel lifted virtually all COVID-19 restrictions and life in Middle Eastern countries returned to near pre-COVID normals. rice field.

Face masks were enthusiastically discarded as businesses reopened, mass gatherings resumed, and people flocked to beaches and restaurants as the daily number of cases approached zero.

However, the celebration and the optimism that herd immunity had arrived did not last long.

By late June, the number of cases began to increase, and they did not stop.

New daily infections Reached a record high of 16,011 on September 1st, Thousands more than the peak seen in January (during the second wave of the country).

Israel recently COVID 7-day moving average highest-19 per million In any country in the world.

So why is the number of cases of COVID-19 still soaring in countries with relatively high vaccination rates?

And what lessons can we learn when Australia is about to reopen?

Israel “opened the door”, just as Delta arrived

Israel took the lead early in the vaccination competition, inoculating almost 80% of citizens over the age of 12 and most of them with Pfizer vaccine by June.

Leaders have conquered COVID-19 and are convinced of the risks that it will spread, so the country has lifted virtually all movement restrictions and mask obligations.

“They were completely alert,” said Kim Malholland, a pediatrician at the University of Melbourne and a member of the WHO’s Strategic Advisory Group on Immunization.

“In June, in the middle of summer, there were lots of big gatherings, religious gatherings, and events of all kinds.”

Two women with shopping bags and masks under their chin are laughing on the streets of Israel.
With the reduction of infectious diseases in Israel, people were encouraged to go out and enjoy themselves.(((

ABC News: Phil Hemingway

).

At the same time, a highly contagious variant of the Delta arrived on the Israeli coast, first appearing in school-age children and soon spreading to parents.

Sharon Lewin, a leader in infectious diseases, said that without means to control delta mutants, it would be difficult to stop the chain of infections, even at moderately high vaccination rates. rice field.

“What we have learned [Israel]And what is consistent with modeling is that even at 80%, some public health measures need to be taken to contain the infection, “said Professor Lewin, director of the Dougherty Institute. I am.

The overall adult vaccination rate is high, but there are pockets of the unvaccinated Israeli population, including some ultra-Orthodox Jewish communities.

What makes things more difficult is the fact that 25 percent of Israel’s population is under the age of 12. Only 68 percent of the total population is fully vaccinated — The threshold is too low to achieve herd immunity.

The number of cases is skyrocketing, but the vaccine is still working

About 60 percent of people hospitalized in Israel in mid-August Severe COVID-19 had been vaccinated twice with the Pfizer vaccine.

The Israeli Ministry of Health has released a report suggesting that the effectiveness of vaccines in the prevention of severe illness has dropped from more than 90% to just 64%.

A small glass vial of Pfizer COVID-19 vaccine and an attached needle.
Almost everyone in Israel was vaccinated with Pfizer COVID-19 vaccine every three weeks.(((

Unsplash: Mika Baumeister

).

But this number can be misleading — and an example of a phenomenon in statistics called Simpson’s paradox.

It’s complicated, but basically it means that the tendency to appear in multiple groups of data can disappear when you combine those groups.

U.S. researchers delve into Israeli data and analyze it according to age group, and the vaccine is More than 90% effective in preventing serious illness in people under 50 and more than 85% effective in people over 50..

“When you interpret the data, you can’t just look at the raw numbers,” said Professor Lewin.

“In Israel, looking at the number of age-adjusted vaccinations, the chances of being hospitalized for people over the age of 60 are 40 minutes with vaccinations compared to those without vaccinations. Decreases to 1. “

She said the fact that fully vaccinated people are still in the hospital Reflection of very high vaccination rate, And the fact that there is no perfect vaccine.

“The advantage of vaccination is that it reduces the chances of hospitalization and death by about 90%, but not 100%,” said Professor Lewin.

“Therefore, even if vaccinated, some people will still be hospitalized and die.”

Fortunately, the relative death toll from COVID-19 in Israel is much lower than it was during the second wave of Israel.

This pattern has been consistently observed worldwide in countries with high vaccination rates.

Costs of early vaccination and weakened immunity

That said, Israeli authorities are concerned that the effectiveness of the COVID-19 vaccine will decline over time.

The majority of people suffering from severe illness are over 60 years old and were vaccinated with the COVID-19 vaccine at least 5 months ago.

“Most of the elderly in Israel were vaccinated with Pfizer every three weeks in January and February,” said Professor Lewin.

“That’s another factor involved here. It seems that not only whether or not you have been vaccinated, but also the time since vaccination is important.”

Preliminary data suggest that protection against symptomatic infections diminishes over time. Israelis vaccinated in April and May appear to be much better vaccinated than Israelis vaccinated in January...

A paramedic wearing glasses and a pink face mask holds the vaccine in front of her face,
Vaccines significantly reduce the risk of infection and illness by taking advantage of the body’s natural defenses.(((

Getty Images: Ahmad Gharabli

).

However, it is difficult to know how much of this is the result of the vaccine itself and how much is affected by delta mutants, relaxation of restrictions, and the health status of early vaccinated people — Many had an underlying medical condition..

Importantly, the same data show that the vaccine continues to provide strong protection against severe illness and hospitalization, Professor Mulholland said.

“Protection against severe disease appears to be associated with cell-mediated immunity, especially T-cell immunity. [protection] For infections, it is more related to neutralizing antibodies, “he said.

Neutralizing antibodies decrease over time, Defensive immunity provided by memory T cells and B cells is expected to last long..

“So you may start to see the decline [protection against infection]Let’s say, for example, 6 months later. However, protection against severe illness can be maintained for even longer and even years. “

Booster shots bring hope — and a moral dilemma

To address the surge in new COVID-19 cases, Israel has reintroduced some restrictions, such as rally caps and masks in certain settings.

Health authorities have also begun management Booster dose..

These were first deployed to people over the age of 60 and are now available to everyone over the age of 12 who received a second COVID-19 jab more than 5 months ago.

Professor Lewin said booster shots seemed to bring clear benefits to people over the age of 60 and those who were immunosuppressed, but it’s not yet clear if it’s needed for everyone.

“The best way is to reduce the total amount of COVID infections worldwide. This only happens if low- and middle-income countries are vaccinated.”

August, World Health Organization Requested a temporary moratorium on booster shots by wealthy nations, To release the dose for countries that most people have never taken.

“If you really need a booster effect, I think you need a more tailored approach,” said Professor Lewin.

“That is, they may be over 60 years old … or they may be taking it because they have measured their antibody response and found it to be low.”

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2/ https://www.abc.net.au/news/health/2021-09-09/covid-19-israel-vaccination-high-case-rates-lessons-australia/100442304

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