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As The Virus Changes, So Do We

syringe and other vaccine supplies against a backdrop of Israel's flag.
photo by Jernej Furman, licensed under CC BY

Every war changes the combatants, winner and loser alike. Humanity’s war against the virus that produces COVID-19 is proving to be no exception.

The virus itself is changing, mutating in ways that facilitate its spread so as to outrun the vaccines, therapeutics and social distancing measures that would – in a perfect world – vanquish it to extinction, or at least confine it to nonhuman animal reservoirs. Some of its mutations could make the SARS-CoV-2 virus more lethal, although nature should write off such extra casualties as collateral damage. No parasite benefits from killing its host too quickly.

Humankind will inevitably change too, both to fight this virus (in all its variants) and to better resist future pandemics. We will adapt by using pretty much the same mechanism as the virus: trying multiple approaches, and replicating the methods that work faster and more frequently than the methods that don’t.

Israel has raced far ahead of other nations in its immunization campaign; it realistically plans to have its entire adult population vaccinated by the end of March. This efficiency is not a function of superior wealth. While it has an advanced economy, Israel is not exceptionally rich, ranking somewhere around 20th in national output per capita by various measurements.

Israel has simply leveraged its resources to best advantage. It has a small population – a bit more than 9 million – that is accustomed to pulling together in the face of external threat, even if the country’s internal politics is fractious. It reveres its elderly citizens, many of whom were involved in creating the nation and fighting its battles. It has a unified national health insurance system and a small number of major providers. These four main organizations jointly manage a comprehensive database on all of the country’s residents, for whom coverage is compulsory. Israel was politically willing and able to use the trove of data on its citizens to procure ample vaccine supplies on favorable terms from vendors who were eager to secure access to anonymized, real-world clinical data in return.

Finally, despite national priorities for who should be vaccinated first, there was no pushback when clinics made walk-in service available to all takers, first-come, first-served, after daily scheduled appointments ended. This approach avoided wasted doses of precious and highly perishable vaccine.

Israel’s performance has not escaped criticism. There are the predictable concerns about patient privacy, which is difficult to protect in all cases and especially when gathering data about rare conditions in a small population. And the country has not taken responsibility for ensuring the vaccines are made available to millions of Palestinians living in territory that came under Israeli control in the 1967 war with its Arab neighbors. The exception to this is in East Jerusalem, which Israel formally annexed in 1980, and whose residents are covered by the national health care system.

Still, don’t be surprised if other places incorporate elements of Israel’s success, particularly its national health information database, once the pandemic subsides. We have been talking about digitizing American health records for years, and some progress has been made. Most, though not all, hospitals and physicians’ offices now store information electronically. But in the absence of a single national health insurance system (distinct from a single provider, such as the United Kingdom’s National Health Service), these records live in largely incompatible and proprietary silos.

Despite our own system’s limitations, the United States thus far is a relative success story compared to other western nations apart from Israel. We benefit from having the world’s reserve currency and best national credit. This provides essentially unlimited funds to meet a pandemic emergency. We also are the corporate home of the two major drug companies, Moderna and Pfizer, which generated the first two vaccines using a cutting-edge mRNA mechanism to instruct the human body on how to fight the virus. (Pfizer produced its vaccine in collaboration with Germany’s BioNTech.) Our government was in a position to place large orders with both companies before clinical trials were complete. The White House is now finalizing a deal to further boost supply, such that some 300 million Americans could receive vaccines by summer. Distribution produces far greater challenges here than in Israel. But problems with distribution are less worrisome than shortage of supply.

The U.K. has some of the same advantages as Israel and America. It has a centralized health system and a home-grown supplier in AstraZeneca, which developed its vaccine along with Oxford University. It also is in charge of its own health care policy, thanks to having left the European Union last year via Brexit.

The EU, in contrast, has thus far failed rather spectacularly in rolling out its immunizations. A slogging bureaucracy combined with the politics of trying to satisfy 27 national governments is leading to growing fury inside the trade bloc. Equitable distribution has meant scarcity for everyone. Scarcity is provoking calls for the EU to limit any vaccine exports. That may, in turn, trigger retaliation that would compromise the supply chain for the bloc’s own vaccine production.

As I recently observed, the populations of both America and Europe have a shockingly high level of resistance to taking vaccines, even when doses are available. In Israel, the ultra-Orthodox Jewish community has protested lockdown measures (and has been widely blamed for violating them) but seems to have largely cooperated in the immunization campaign. While a vocal minority continues to resist, Orthodox leaders are doing their best to encourage compliance. No shot is going to work if people won’t take it.

In this respect, too, the war against SARS-CoV-2 is going to lead to adaptive change. People who resist vaccines will get sick more often than those who don’t. Some will die; others will get the message and adjust their thinking. Many individuals will ultimately escape this pandemic unscathed, but no society is going to emerge unchanged.

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