Israel could become the first country to stamp out the coronavirus, but only if it lives up to its reputations for innovation and science.
As I detailed last week in the Wall Street Journal, the United States didn’t order enough of the Pfizer and Moderna vaccine doses, but nevertheless can move rapidly towards herd immunity by giving everyone a single dose of vaccine as soon as possible.
Standard procedure would be to follow the protocol of the clinical trial and give 2 doses per person to half the country and make the other half wait much longer for their first dose. But the Pfizer vaccine is so effective that one dose has efficacy of at least 75%, maybe as much as 90%. The science is detailed at the end of this article. But the essence is that if we give the entire population one dose, the epidemic will end because this will get the country past the 70% protection needed for herd immunity. When more vaccine is available, protection can be topped up to 95% so it is safe to travel and welcome tourists.
To best understand the policy choice, imagine you are holding the next vial of vaccine. Do you use it to raise protection from 90% to 95% in someone who already got a first dose? Or do you use it to raise someone else from 0% to 90%?
The answer seems obvious, but two things are needed to take this approach: understanding the science, and flexibility to act.
There is no shortage of understanding of science in Israel. And for flexibility, Israel is renowned for innovation in science, technology, and the military.
In the entire world, Israel may be best positioned to end the epidemic fast by giving everyone a first dose of vaccine and deferring most booster shots until everyone has gotten a first shot (except for medical personnel, who should get 95% protection as soon as possible).
Maybe Israel will fail to innovate because of governmental paralysis. But what better way is there to show fitness in leadership than by marshalling the innovation and science needed to end this epidemic soon?
Addendum: the science:
The Pfizer vaccine showed no efficacy until about 10 days after the first shot, but then the protection kicked in and there was no appreciable increase in efficacy from the booster, given at 21 days. Efficacy for the first 21 days, counting both periods, was 52%, consisting of 0% efficacy for the first 10 days and then x% for the next 11 days. Solving for x, we get 100% efficacy after 10 days, surely an overestimate because efficacy after 2 doses is only 95%. Because of the small numbers of patients in that period in the Pfizer study, I chose a very conservative value of 75% efficacy after one dose for my WSJ article. Harvard epidemiologist Michael Mina independently chose 80%. I wouldn’t be surprised if the true value is 90%, based on data from other vaccines. The Moderna vaccine is expected to be equally good.