Israel’s COVID vaccination success

• Israel’s healthcare system backbone is digital, and its HMO system has for decades emphasized the use of data, analytics, and digital front doors to engage its customers 
• Digital’s rapid response: By having data on customers and a direct interface with them, HMOs were able to rapidly link people with vaccines – supporting higher vaccination rates and reducing waste
• Israel is leading the way, not only by having one of the world’s highest vaccination rates per capita¹, but also has been feeding data to help inform research on vaccine efficacy and adverse events

Israel has been heralded as leading the world in vaccinating its population against COVID-19.² Many in the global healthcare community have been wondering how we’ve achieved this. I’d like to share my personal vaccination experience that illustrates many of the factors driving this success story.

A couple of weeks ago, when the government announced that those below 50 were able to get vaccinated, I opened the app of my healthcare insurer/provider, Clalit, and booked an appointment at a nearby clinic, which already knew I was eligible to receive the vaccine – it was just a matter of me deciding when would work best to get it. Once I selected my slot, I received an instant text message confirming a time and place, and other reminders leading up to the appointment.

On the chosen day, I took a short walk to the clinic, where my health card was scanned at the door. I received the vaccination and was on my way after waiting 20 minutes to make sure I had no adverse reactions. No waiting in line. No questions asked. No papers to fill out. My follow-up jab appointment was booked while I was at the clinic, after which I was given a vaccination ID, at any point in the process I could update the appointment through the app. Once I was fully vaccinated, the vaccination ID was digitally loaded into a special app that we use in order to get a “green pass”. The green pass is now being used as proof of vaccination for getting into public places such as cinemas or cultural events. I can show it at any time using my phone so there is no need to go with a paper certificate or a card, and I can be confident knowing I’m safe and so are those around me. I had always been happy with the care I’ve received – I’m not alone as over 90 percent of Israelis report high satisfaction with their HMO³ – but this seamless and easy vaccine experience made me truly proud.

With four HMOs covering the entire population, Israel has a highly centralized system. Each of these players has full digital records for every citizen, instantly accessible to any HMO and healthcare provider, who can view these records via unique member IDs.

Even before COVID, the HMOs were using digital to connect to their customers – people can book appointments, request prescriptions, ask questions about conditions, and more through their HMO apps. This level of patient record sharing also means citizens can switch providers easily, which encourages HMOs to offer good member experiences.

These HMOs have also undertaken community-based COVID-19 care and outreach efforts. As Ran Balicer, Chief Innovation Officer of Clalit Health Services and Professor at Ben-Gurion University of the Negev explains, “The four Israeli HMOs are one of our secret weapons in the fight against COVID-19. We know everything about peoples’ health, including any underlying conditions and allergies and use high- and low-tech vaccination scheduling approaches. We can easily find and contact our target groups, at any time, so no-one slips through the net. Appointments can be booked online and via our app. And, for less tech-savvy people, we’re using call centers to make appointments.”

The experiences of Israelis are in stark contrast to many other geographies, where it’s been much harder to identify and reach citizens, with long lines at vaccination centers, questions to answer and time-consuming forms to fill out.

Israel’s fast vaccination roll-out was also helped by a simplified indication strategy. Citizens were selected purely on age (initially everyone aged 60 and over), along with certain professions, such as healthcare workers, teachers and members of the military. The country’s approach to supply chain management has also supported the roll out, for those involved it is very clear as to who does what and when.

And, as Professor Balicer notes, a further benefit of the country’s connected healthcare and operational agility has been incredibly low wastage of vaccines. “Once they’ve come out of the freezer, vaccines have a short shelf life, so the stock must be used quickly – a case of ‘use it or lose it’. As soon as any clinic finds it has excess doses, we instantly reach out to HMO members – regardless of their age – who we know live close to the clinic, most of whom are happy to come in at short notice. At Clalit, our vaccine wastage rate is only 0.1 percent.”

The high degree of trust in HMOs has contributed to the success of the vaccination program. However, like in many places, Israel has also had to deal with hesitancy over the efficacy and safety of the vaccines, with rumors circulating, often via social media. The HMOs, and the government, have made great efforts to address this barrier by being transparent and leading by example.

Professor Balicer feels the key is to be very open about issues like success rates and side effects, and present rational, science-based evidence. “These vaccines are new, so we didn’t try to gloss over any unknowns. Senior politicians, and healthcare figures – including myself – very publicly received our jabs, to reassure citizens of their safety. Most importantly, we took time to meet with community leaders to discuss concerns, in order to build trust.” This included culturally adapted outreach efforts to influential religious leaders, answering tough questions and addressing fears and adapting messages to fit different groups. This tactic paid dividends, with key religious leaders endorsing vaccines and stepping forward to have jabs live on TV. 

As of February 2021, more than 5 million Israelis have received at least one vaccination, out of a population of 9 million, with 6 million doses administered overall. And 70 percent of over-60s have had both doses.⁴

The success of the program has also highlighted the benefits of interacting digitally with the health system. With telehealth already progressing rapidly due to COVID-19, citizens are recognizing the efficiencies of engaging with their healthcare providers digitally. In fact, whether by coincidence or not – HMOs are launching apps that help promote healthy lifestyles by incentivizing good choices with reward points – it was the nudge I needed to help me keep active and well while in lockdown, and will continue in promoting better health even after COVID.

My country is relatively small (by population and geography) and has a younger population, which has undoubtedly helped the vaccination roll-out. But what’s made a significant difference is our digital backbone, which has given us a huge advantage. Domestically, I think we sometimes forget about how lucky we are to have this digital infrastructure in place. Speaking of digital infrastructure, in the past few years we at KPMG in Israel have had the honor to support Israeli leading health care players in their digital journey including the Ministry of Health, hospitals and HMOs.

In a country with a thriving technology sector, it’s heartening to see such innovation being used to improve the health of citizens and hasten our post-pandemic economic recovery. A vaccine works only when people receive it – and I truly credit our digitally-enabled system for making that happen.

• Building a digital healthcare system helps in the good times and the bad: Having digital infrastructure has enabled Israel’s successful patient-centric model of care, and helped in the rapid response during the pandemic
• Digital can be the front-door to interface/engage your customers, but also can help providers maintain information about their customers – including whether they need to be engaged directly via telephone, and in the supply chain by understanding where and how to distribute vaccines, and even in re-opening society through health status certification tools like the ‘green pass’
• Digitally based systems are rooted in trust: Having a transparent, communicative, and customer-focused system helps build confidence, uptake, and action by customers