But as millions of Israelis have “given a shoulder” to make the country safer, it is becoming more apparent that even if the entire Israeli population is immunized, this will not mean life will return to its 2019 reality.
This will be especially true when it comes to opening the skies and resuming international travel in any significant quantity or of any quality.
To do that, “we need to immunize all countries of the world,” explained Lancet editor-in-chief Richard Horton to The Jerusalem Post. “To reach herd immunity, about two-thirds of the world population – four billion to five billion people – need to be vaccinated. Each person has to have two doses – that is 10 billion doses of the vaccine.”
As such, the pandemic will not be solved by spring 2021, health experts said. It will not be over in 2022. And according to the most optimistic predictions, the skies will only really begin to open, and travel and tourism will resume, sometime between 2023 and 2024.
“We live in a global world, with or without realizing it,” said Michael Edelstein, a professor of population health in Bar-Ilan University’s Faculty of Medicine, in an interview with the Post. “A lot of our lives rely on interconnectivity.”
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A report recently published by the Economist Intelligence Unit, the research and analysis division of The Economist Group, explained that whereas the rollout of vaccines against coronavirus has started in developed countries, mass vaccination will take time.
The unit predicts that the bulk of the adult population in advanced economies will have been vaccinated by mid-2022. Middle-income countries will take until late 2022 or early 2023.
“For poorer economies, mass immunization will take until 2024, if it happens at all,” the report said.
In other words, “we will not have synchronistic recovery,” said Agathe Demarais, global forecasting director and trustee for the Economist Charitable Trust, an independent charity that is meant to leverage the journalistic expertise of The Economist newspaper. “In the meantime, while not everyone is vaccinated, we will have the emergence of new variants, and it could mean going back to square one.”
THE CHALLENGES to getting the world vaccinated are many, Demarais explained to the Post.
First, there is an issue of production. Demand for vaccines far outstrips the available supply, and is expected to do so for at least several more months. Moreover, many of the world’s wealthier countries have already prepurchased the available vaccines.
According to the Economist report, of the 12.5 billion doses that the main vaccine producers have so far pledged to make this year, more than six billion have already been preordered.
“When countries made their orders, they did not know which vaccines would work, so they booked every vaccine they could get a hold of,” Demarais explained.
Canada, for example, bought enough for more than five times its population.
Israel paid more than other countries and committed to exchange data with Pfizer to ensure it could vaccinate all citizens who want to be vaccinated – a move that is not an option for poorer countries, “especially given that the coronavirus-induced recession has already depleted fiscal resources and led to ballooning budget deficits,” the report says.
“We don’t have enough vaccines for richer countries, so poorer countries that are next in line will have to wait longer,” Demarais said.
According to the World Health Organization (WHO), coronavirus vaccines are now being administered in 50 countries around the world, but 75% of the doses have been deployed in only 10 countries.
Israel also ordered six million doses of the Moderna vaccine and another 10 million doses of AstraZeneca’s vaccine. It also has a contract with Arcturus, though that vaccine candidate is still in the midst of its phase II clinical trial.
Originally, Israel ordered eight million doses of the Pfizer vaccine, but the company has now pledged to provide the country with a continual supply until Israel has completed its campaign.
Demarais said that while in theory richer countries could ship vaccines to poorer countries, the quantities they will commit to – 1,000 here or there – will likely not make a real difference. And it is also unlikely that countries with excess vaccines would start sharing vaccines until they have completed their own vaccination campaigns.
Another challenge to a global rollout is logistics. Many countries cannot accommodate the Pfizer or Moderna vaccines, which need to be stored between -70°C and -30°C.
Shipping vaccines is also complicated today, Demarais said. Vaccines were usually shipped on passenger planes, but at the moment there are not a lot of passenger planes flying.
In addition, there are not enough healthcare workers in all countries to distribute the vaccines, especially in larger countries like India and China. Paying healthcare workers to carry out the distribution could also pose a hurdle.
“We now face the real danger that even as vaccines bring hope to those in wealthy countries, much of the world could be left behind,” said WHO director-general Tedros Adhanom.
Speaking at a January 27 briefing, he said: “Some countries and companies are making bilateral deals, going around COVAX, driving up prices and attempting to jump to the front of the queue.”
COVAX is a joint program of Gavi, the Coalition for Epidemic Preparedness Innovations and the WHO that is meant to accelerate the development and manufacturing of COVID-19 vaccines, and to guarantee fair and equitable access to them.
“It is understandable that governments want to prioritize vaccinating their own health workers and older people first,” Tedros said. “But it is not right that younger, healthier adults in rich countries are vaccinated before health workers and older people in poorer countries. I hope you will understand this. A me-first approach leaves the world’s poorest and most vulnerable people at risk.”
Edelstein explained that when discussing global herd immunity, it is not that an average of 70% of the world needs to be vaccinated, it is that 70% of every group and subgroup would need to be equally vaccinated. Otherwise, there would continually be outbreaks and transmission in those non-vaccinated areas.
Hence, “vaccine equity is not just a moral imperative,” Tedros stressed. “Ending this pandemic depends upon it.”
A final challenge, according to Demarais, is vaccine hesitancy. In many countries – such as France, Japan and Argentina – around half of the populations have said they do not want to get the jab for various reasons.
Demarais said that these obstacles are compounded by what is becoming known as “vaccine diplomacy,” which she believes will play a key role in determining which poorer countries get access to vaccines, but may also impact the landscape of those countries for years to come.
“Chinese and Russian vaccines are being rolled out both domestically and to emerging countries such as Egypt, via diplomatic bilateral deals,” the Economist report reads. “Russia and China [are] trying to bolster their global status via the delivery of vaccines – this year and beyond. Both countries will also seek to adopt a transactional approach to the delivery of vaccines, using coronavirus shots as a bargaining chip to advance their national interests.”
In contrast to these deals, Israel has signed contracts with companies – not countries – and has been hesitant to agree to purchase the Russian Sputnik V vaccine, even now that it has shown to be nearly 92% effective in an independent study published by The Lancet.
The Palestinian Authority has purchased Russian vaccines; 10,000 were delivered to the PA on Wednesday.
Demarais said the concerns are both that there might be differences between what these countries commit to and what they can actually deliver, and that Russia and China might want something in return down the road.
“This will be a long-term footprint,” she said.
IN THE meantime, Israel’s airports are closed, and global tourism has decreased 74% worldwide in the past year, according to Prof. Chaim Noy of Bar-Ilan’s School of Communication and chairman of the Israel Communication Association.
For perspective, he said tourism decreased by only 4% during the economic downturn between 2008 and 2009.
The world was averaging a billion tourists a year before coronavirus. The crisis has put $100 million to $120 million worth of direct tourist jobs at risk and has resulted in a loss of $1.3 trillion in expected revenues, he said.
“This is unimaginable,” Noy told the Post. “The more the process goes on, the more pessimistic the experts are in terms of when [the industry] will rebound. The more time passes, the more expert consensus is that we are not looking at 2022, but 2023 or 2024 – and even then, no one says things will be back to normal.”
The shift in travel and tourism as a result of the global scale of the pandemic will be both in terms of quantity and quality.
“I think people got burned from opening up tourism too fast, which will make things in the future work slower,” he explained, citing the example of what happened between Dubai and Israel.
Masses of Israelis flocked to Dubai when the normalization agreement was signed. Politics and diplomacy got in the way of monitoring how much infection was traveling between the two countries – and in the meantime, the South African mutation entered Israel.
He said this is an isolated example of a global challenge that has been identified: The spreading of mutations is associated with global tourism, and therefore “nothing can be rushed.”
Noy said that lack of tourism hurts the economy, but rushing to open up tourism will hurt the economy more – and in the most painful spots. It will result in lockdowns and overcrowded hospitals – “the really painful spots.”
Moreover, he said that even when travel resumes, it will look different. People will look for places where they can enjoy “open-air tourism,” outdoor tourism and nature-based tourism. They will also likely first look for domestic options before heading abroad.
He said that before the pandemic, one of the “hottest” sectors of tourism was retirees, who were living longer and in better health and also had more time and money.
“This whole sector is going to be much more worried about traveling even after getting vaccinated,” Noy said.
A report by the WHO released in December noted that travelers will need to ask themselves several questions before getting on an airplane. These include how likely they are to get infected in the country of destination compared to at home; whether the destination country has sufficient response capacity to treat travelers who may need medical care; and whether their own country has capacity to enforce mandatory public health measures on return, if necessary.
Airports will also require a shift for travel to resume, such as putting crowd control and social distancing measures in place. WHO recommends that mask use and hand hygiene measures be put in place to minimize the risk of transmission at points of entry, such as during check-in, passport control, in restrooms, security areas, etc.
“People can hope, but I don’t think anyone can realistically say when travel will come anywhere near where it was before,” Noy said. “We are going to see some radical changes.”
In the first stage, it is more likely that “travel corridors” will be established whereby only certain routes will be available based on the immunology of the disease and bilateral agreements between countries, Edelstein said.
The Post confirmed on Wednesday that Israel and Greece are negotiating an agreement to allow Israelis who have received two doses of the coronavirus vaccine to be able to visit Greece.
Greek officials are expected to visit Israel next week to discuss the possibility.
Some countries will allow in people with proof of vaccination, others might continue to require testing before and after, and still others may require isolation or some combination of all three.
WHO SAID in January that it is opposed, at least “for the time being,” to the introduction of vaccine passports or certificates as a condition for allowing international travelers entry into other countries, something that Israel was hoping to help establish.
It said that “the use of immunity certificates for international travel in the context of COVID-19 is not currently supported by scientific evidence and is therefore not recommended by WHO,” in its December report.
“Beyond the scientific uncertainties around immunity passports, there are ethical, legal and human rights aspects related to privacy of personal data and medical confidentiality; the potential for falsification or engagement in risky behavior based on a false sense of security; stigma; and discrimination,” the report said.
Dr. Dorit Nitzan, WHO’s Israeli-born regional emergency director, told the Post that there are several reasons that these passports could not work at the present time.
“We are not sure that those who are vaccinated do not spread the disease,” she said. In addition, scientists are unsure how long postvaccination immunity really exists.
Another issue is variants.
“We know that for at least the South African variant, the vaccines’ effectiveness is lower than what was planned,” she explained. “You might be vaccinated against one variant, but if you bump into another variant on a flight, you are at risk.”
Israel shut its airports to keep out these mutations while it vaccinates, a move similar to the one taken by the United Kingdom.
“We are closing the skies hermetically, except for really rare exceptions, to prevent the entry of virus mutations, and also to ensure that we progress quickly with our vaccination campaign,” Netanyahu said at the end of last month.
The Health Ministry is pushing the government to keep the skies closed for at least several more weeks, if not months, until a system is in place to maintain testing, isolation and genetic sequencing that could stop the spread of mutations before it starts.
“We cannot indefinitely keep each country isolated on the chance that new strains will emerge,” Edelstein said. “What you need is a mechanism and policy to respond quickly and take critical steps if the situation justifies it.”
The UK variant entered Israel and rapidly infected so many people that it now accounts for between 70% and 80% of all infections in the country.
Nitzan said that a “mega argument” against these certificates comes back to equity.
“How would you feel if, because you got vaccinated, you have the green card, but the same person in another country, because they have only a few vaccines, cannot travel, so they get punished?” Nitzan asked.
She said the goal right now should not be global herd immunity but saving lives.
WHO, like most countries in the world – including Israel – has prioritized the elderly and healthcare workers for vaccination. But while Israel has already opened up vaccination to all people over the age of 16, “probably 98% of countries in the world will not be able to do something like this soon.”
Their goals right now, she said, are simply to shield those most at risk and thereby reduce hospitalization and death.
“I DON’T THINK the virus will ever go away,” Demarais said. “We will learn to live with it, like the flu.”
She said it is expected that, each year, the vaccines will need to be adjusted to work against new strains, as they are for influenza, and coronavirus vaccination campaigns will become routine – at a huge cost.
“We are going to be living with coronavirus for a long, long time,” Demarais said. “It is a grim picture.”
But Ran Balicer, director of Health Policy Planning for Clalit, had a more positive perspective. He told the Post that while the race between vaccination and the risk of mutations will always linger, he believes that in combination with traditional steps of wearing masks and social distancing, the virus could be kept under control and people could return to “a near normal daily routine.”
“I do think we will reach a new status quo that will be more similar to the life we used to know, when we have a very high percentage of the population covered,” Balicer said.
He added that if at some point children can also be inoculated, it will be a game changer – and then, at least in Israel, the country really could have herd immunity.
But this will not guarantee travel abroad.
“Coronavirus, the pandemic and the reactions to it challenge us as tourists [and] as travelers to think and renew,” said Bar-Ilan’s Noy.
“We will have to ask ourselves whether everything was going fine and we really want it back anyway – or this can be our opportunity to take the road less traveled.”