Israel is leading the world in its vaccinations, but the program is not without controversy

Israel is by far leading the world when it comes to vaccinating its population against COVID-19. Even as the country faces high rates of infection and is on lockdown, last week Prime Minister Benjamin Netanyahu boasted: “We will be the first country in the world to emerge from the coronavirus.”

More than 20% of its population of 9.29 million have so far received the Pfizer-BioNTech vaccine, which to date far outstrips the rates of vaccination in every other country in the world.

Since approving the vaccine the country has moved quickly, marshalling its emergency resources to great effect, yet the vaccination program -- spearheaded by Netanyahu himself -- is not without controversy, as the 5 million Palestinians living in Gaza and the West Bank have been excluded from the rollout.

Emergency footing

Israel possesses both a strong standardized public health system and a relatively small population. The U.S., meanwhile, has 64 health jurisdictions – each with their own rules and regulations -- and the best per capita vaccination rates have been seen in areas with smaller populations.

Even so, the rate of vaccination in Israel is astounding. Netanyahu announced on January 10 the objective to increase the pace of vaccinations to 170,000 daily, and said that 72% of people over the age of 60 have received their first dose. By March, he said, the government would “bring shipment after shipment and complete the vaccination of the over-16 population in Israel.” Then, the authorities will look to begin vaccinating under 16s if the research shows it to be safe. As of Friday morning, 170,000 Israelis have received their second booster shot -- part of the two-shot regimen the Pfizer vaccine requires.

"At the moment we are in a mighty race between two events: The spread of the disease and the distribution of the vaccines,” Netanyahu said. “We are ahead of the whole world in vaccines with the millions of vaccines that we have brought.”

Israel’s frontline healthcare workers have moved swiftly to vaccinate such large numbers in a short period of time.

While the majority of vaccinations are taking place outside hospitals at specialist centers staff continue to work flat out to both vaccinate the population and treat the steady influx of coronavirus patients.

At Ichilov Hospital in Tel Aviv, which has been administering the vaccines for some time now, the staff is very much on emergency footing to vaccinate as many as possible.

“It’s like a mission, I’m doing injections for my friends and for my colleagues,” Vicky Greenberg, the head nurse at the hospital’s surgical intensive care unit, told ABC News.

“I really hope that in a few months we’ll be able to celebrate Pesach (Passover) with our families, not in Zoom like we did last year. I have to get married so I have to do it in May. It must work until May. Patient after patient for eight, nine hours a day.”

Prof. Joseph Klausner, Ichilov Hospital’s head of surgery, described the early success of Israel’s early vaccination program as a “combined effort.”

“On one hand, it is a relatively small community relative to the [United] States, for instance, so it's much easier to get there, to get to the population and get treatment in there. But definitely there was some effort directed towards to achieve this.”

Dr. Dalit Salzer, another doctor at the hospital, told ABC News she was “proud and excited” to be a part of the early vaccination efforts at the beginning of a 26-hour shift.

The hospital’s current CEO is also Israel’s former COVID commissioner, Prof. Ronni Ganzu, who has seen the challenges of leading a coronavirus response from a national and local levels. Both a strong public healthcare system and manifold experiences of political and military crises have helped mobilize the resources required to vaccinate so many, so quickly.

“We understand that in disaster, in emergency situation, we have a very short time to act,” Ganzu told ABC News. "And this is what we are really used to do. We are trained to do so, the energy they want to do to win the war, [we are] really looking forward to give the vaccine to as many as possible Israelis.”

Deals and data

The accelerated vaccination program is taking place at a time when the country is experiencing the highest rates of COVID-19 infection and mortality since the beginning of the pandemic . The country is in lockdown until January 21, even while rolling out its mass vaccinations, with 3,892 coronavirus deaths and 533,026 confirmed cases as of Friday, according to the Health Ministry.

The controversial Israeli prime minister has placed himself at front and center of the vaccination program’s success. He was the first Israeli to receive a jab, and over the weekend, with media present, he received his second. Netanyahu has boasted of a close relationship with Pfizer’s Chairman and CEO, Albert Courla, whom he describes as a “friend.”

The pair have had 17 conversations as of January 17, Netanyahu claimed last Sunday. Israel will share with Pfizer and with the entire world the statistical data that will help develop strategies for defeating the coronavirus,” as part of the agreement, Netanyahu said earlier this month.

“Pfizer and the Israeli Ministry of Health (MoH) have entered into a collaboration agreement to study the real-world impact of the Pfizer-BioNTech COVID-19 Vaccine,” a Pfizer spokesperson told ABC News.

“This project will gather critical real-world epidemiological information that will enable real time monitoring of the evolution of the epidemic in Israel and evaluate the potential of a vaccination program using the Pfizer-BioNTech COVID-19 vaccine to trigger indirect protection and interrupt viral transmission.

“While this project is conducted in Israel, the insights gained will be applicable around the world and we anticipate will allow Governments to maximize the public health impact of their vaccination campaigns, determine potential immunization rates needed to interrupt transmission and ultimately help bring an end to the global COVID-19 pandemic.”

A report in Politico claimed that an off the record briefing from officials on January 5 had suggested Israel were paying Pfizer $30 per person, more than what is paid by some other countries. One report by an Israeli broadcaster claimed that the country had spent $47 per person , or $23.50 per dose, according to the Times of Israel.

That is more than what the U.S. government paid for their initial 100 million doses, $1.9 billion, which amounts to $19 per dose and $38 per person. The EU agreed to pay Pfizer/BioNTech $18.50 per dose, or $37 per person, according to Reuters.

“In order to conduct this project, the Israeli MoH will receive vaccine doses at a previously agreed price (which remains confidential),” the Pfizer spokesperson said.

Politics and Palestine

Israel’s vaccination policy has drawn the condemnation of human rights groups and the Palestinian National Authority, as the rollout does not include the more than 5 million Palestinians living in the West Bank and Gaza, many of whom travel into Israel for work.

The country is vaccinating Israeli residents in settlements in the West Bank, but not Palestinians who live there or in Gaza. Human rights groups, including Amnesty International, have said the exclusion means Israel is “ignoring its obligations” as an occupying force under international law and “exposes Israel’s institutionalised discrimination.”

There have been high rates of infections and death in the West Bank and Gaza, which is currently under a short term lockdown, and Amnesty called on Israel to “ensure that vaccines are equally provided to the Palestinians living under their control.”

“We condemn the racism of the occupation state, which boasts about the speed of vaccinating its citizens and neglecting the legal responsibility to provide vaccines to the people under occupation,” the Palestinian Prime Minister, Mohammad Shtayyeh, said this month.

But that, in the current climate, is unlikely to happen. Yuli Edelstein, the Israeli Health Minister, has said the priority is to vaccinate as many Israelis first before considering any shortage on the Palestinian side.

The Palestinian Authority is in negotiations with several other companies to procure their own vaccines. The Russian Direct Investment Fund announced that the Russian Sputnik V coronavirus vaccine has been registered by the Palestinian Ministry of Health. The delivery of the vaccine will begin in February, according to Mai Kailleh, the Health Minister.

“I think there are definitely moral and legal obligations,” Yossi Mekelberg, a professor of international relations and senior fellow at the think tank Chatham House, told ABC News. “Many of them work inside Israel or in the Jewish settlements in the occupied West Bank. They move from one place to another. But it doesn't play to Netanyahu's base, and probably won't happen."

In the meantime, doctors in Gaza, hit badly by the first wave and now fearing the surge of a second, say the need for a vaccine is as acute as ever.

“We can say we are working in a comfortable situation, we are not under pressure anymore and I hope this will continue because there is always a fear of a second wave and usually it is an aggressive one,” Dr. Mohammed El Sheek Ali, the head of the Covid department at the European Gaza Hospital, told ABC News. “We need the vaccine and as soon as possible because we are facing a difficult situation in Gaza, we have a lack of resources.”

ABC News' Bruno Nota, Nasser Atta and Sohel Uddin contributed to this report.