Israeli Vaccination Data

Early general population results from Israel's mass vaccination program

Israel is leading the world in vaccinations with over half its population now fully vaccinated. And they are primarily using the Pfizer mRNA vaccine with a reported 95% vaccine efficacy based on the Phase III trials.

Here's a key statistic from the Israeli Ministry of Health report:

"...out of a group of 715,425 Israelis fully vaccinated, only 317 — 0.04% — got infected with the virus at least one week after their second shot, and 16 were hospitalized with serious symptoms."

Why is the data important?

This data is significant for two reasons:

1. This is the first large-scale tracking of post-vaccination Covid diagnoses in a general population

2. This is a large enough fraction of the total population that full-population comparisons can start to be made.

What we’ve seen so far are highly-controlled drug trials with carefully selected populations. Generally, when a therapeutic is rolled out to the general population, it will underperform the results seen in such highly-controlled studies.

With vaccines, what’s seen during a controlled trial is called “vaccine efficacy” versus “vaccine effectiveness”, which is what’s seen when that same vaccine is deployed across the general population. And “effectiveness” will always be less than the “efficacy” seen in the trials.

Secondly, Israel is the first country to go significantly beyond just vaccinating the elderly and high-risk populations. So their early data is valuable to get a sense of what a full vaccine deployment might look like in terms of actual vaccine effectiveness.

So what does the data say?

The tracking data looked very narrowly at a one week period following the 2nd vaccine injection. This was a cohort study, which means that one week of data for each individual participant is scattered over the roughly two months of the study.

But it’s still a single week of surveillance.

So if we annualize the case count, that's 317 cases x 52 weeks or ~16,500 cases expected over a one-year period. This is in a population of 715,425 or about a 2.3% rate of being diagnosed with Covid in a one-year period.

So to compare this with the US, let's assume we get 100% of the US population vaccinated and we scale the Israeli results up to the full US population of 330M.

That would imply about 7.6M diagnosed cases in a year with a fully vaccinated population. The US actually saw 26M diagnosed cases over the past year. This implies a "vaccine effectiveness" of only about ~70%.

So why the 95% vs 70% discrepancy?

"95% Vaccine efficacy" is what was reported out of highly controlled trials involving specially chosen test populations having the vaccine administered under highly idealized conditions.

"Vaccine effectiveness" is what happens when that same vaccine is administered to the general population. It is not surprising to a 30% drop-off, especially for vaccine trials involving upper-respiratory pathogens.

It’s also important to understand these are “population statistics” and can in NO way be applied to individuals. 70% might mean that everyone has an equal level of protection…or it might mean that 70% of those vaccinated have perfect protection and 30% have zero protection. Or anything in between…there’s simply no way to apply such population statistics to predict the risks any single person might face.

So the Israeli results cannot be called great or amazing (as many of the press reports have done)...but are certainly fully in alignment with expectations.

What about hospitalizations?

So the Israeli surveillance data also included hospitalizations and that data looks far less promising.

16 out of the 317 diagnosed cases resulted in hospitalization. That is a ~5% hospitalization rate.

By comparison, right now in the US, we are running between a 3% to 5% hospitalization rate for diagnosed Covid depending on region.

These numbers (just 16 cases) are fairly small and the time period of the data is quite short, but it looks like the vaccine is not offering any benefit if a vaccinated person actually goes on to develop Covid.

It’s important to remember that none of the vaccine trials looked at either hospitalization or deaths. The Clinical Study Protocols explicitly stated that the trials were too short and with too small a population to make any determination of whether the vaccines might reduce either hospitalization or death.

It’s not clear what this means, but one possible explanation is some fraction of those vaccinated ended up with very little protection and when infected look essentially like those in the unvaccinated population. But too early to draw any real conclusions.

Conclusions

This data is still quite preliminary and suffers from both a relatively small population (175,000 subjects) and short duration of follow up (1 week) but indicates that the Pfizer vaccine should be expected to:

1. Reduce the risk of diagnosed Covid by ~70%

2. But show no reduction in the risk of severe disease requiring hospitalization if the vaccinated person goes on to develop Covid.

If this 70% “vaccine effectiveness” number holds, and I think it likely will, then this will be the high-water mark of therapeutic protection for the foreseeable future.

This should be coupled with the experimental evidence that none of the vaccines confer effective sterilizing immunity. Meaning the vaccines will not effectively prevent infection and re-transmission, though such infection will be somewhat reduced and likely be asymptomatic or quite mild.

This means basic mitigation, wearing a mask, distancing, and avoiding high-risk venues will likely remain MORE effective than the best vaccines!

Btw…this mirrors the former CDC Director Dr. Redfield’s Congressional testimony back in late August after he’d seen the early Moderna and Pfizer data and the animal studies.

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I want to state clearly, this is NOT a case against getting vaccinated!

I'm trying to take a hard look at the early available data and paint a realistic picture to counter some of the uninformed vaccine boosterism being promulgated in the press right now in a misguided attempt to counter the anti-vaxxer nonsense.

People aren't stupid and we'll all see this play out over the coming months as we witness friends and family who are vaccinated go on to catch Covid. Vaccines against upper-respiratory viruses will never be 100% effective.

We see this played out annually with the seasonal influenza vaccines…and we all know multiple people who went on to get the flu after having gotten vaccinated. This will not be substantially different.

But naive boosterism (even for the best of intentions) is a dangerous game that will come to backfire in the same way as the "don't go buy a mask" line did back in February and March.

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Getting the vaccine remains absolutely vital…in addition to ongoing mitigation. The analogy I use is that if you're going into a gunfight, you have three choices:

1. show up in a snarky t-shirt

2. wear a bullet-proof vest

3. or duck behind cover.

Only an idiot would choose the snarky t-shirt. Smart people would take the bullet-proof vest (the vaccine) and still duck behind cover (the mask and mitigation).

Don't be foolish...do BOTH!

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About the author:

I am a scientist with 20+ years in the biotech industry. I currently work as a consultant with companies involved in developing molecular diagnostics platforms, including some of the key testing platforms used to detect the SarsCoV2 virus.

So I bring an insider’s perspective that is scientifically oriented but directed to a general audience trying to make sense of the conflicting stories surrounding the Covid pandemic.

To learn more: https://www.linkedin.com/in/dalewharrison/

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