The significant increase in COVID-19 cases in Israel, one of the world’s most vaccinated countries, indicates a complicated route ahead.
Israel has one of the highest COVID vaccination rates in the world, having fully vaccinated 78% of people 12 years and over.
Many people are surprised at the country’s resurgence of COVID cases since restrictions were lifted in June.
Israel’s vaccination rate is similar to Australia’s plan to start relaxing restrictions when 70% of over-16s are fully vaccinated.
So, why are cases surging in Israel? And what can Australia learn from it, particularly as Sydney charts its path out of the pandemic?
Herd immunity is much harder with Delta
Around 25% of Israel’s population is younger than 12, so the whole population vaccination rate is only about 60% (including a small proportion of children under 12 with high-risk medical conditions who’ve also been vaccinated).
Even with last year’s virus and the use of the Pfizer vaccine, that wouldn’t be enough for herd immunity.
The Delta variant, which has swept the world since April, is much more contagious. It has an R0 of 6.4, which means one infected person on average infects more than six others in the absence of restrictions and vaccinations. This is compared to the strain circulating in 2020, responsible for Melbourne’s second wave, which had an R0 of 2.5.
In Israel, 60% of hospitalised cases are vaccinated. This is something called the “paradox of vaccination” — in highly vaccinated populations, most cases will be in the vaccinated because no vaccine is 100% protective.
However, the rate of serious cases in Israel is double for unvaccinated under-60s and nine times higher for unvaccinated over-60s, so vaccines remain highly protective against severe outcomes.
NEW: Orange line shows COVID infections among unvaccinated 70+ citizens in Israel. Blue line shows COVID infections among vaccinated 70+ citizens. It couldn't be starker. Among the triple vaccinated, the pandemic comes to a virtual halt. Graph from @GazitDoron. pic.twitter.com/tPt6UKupUH
— Noga Tarnopolsky (@NTarnopolsky) August 20, 2021
Lifting restrictions too quickly
What’s clear in Israel (and the United Kingdom and United States) is lifting all movement restrictions and mask mandates after Delta arrived resulted in surging cases. Current vaccines at about 60% uptake weren’t enough.
In the US, Southern states with lower vaccination rates are seeing the worst surges, with the majority hospitalised being unvaccinated. Alabama, with 36% fully vaccinated (higher than Australia) is overwhelmed. Hospitals and ICUs are full and the health workforce is in crisis due to infected and quarantined health workers.
"I think we may be looking at a collapse of our health care system throughout the state of Alabama." -Dr. David Kimberlin, co-director of the Division of Pediatric Infectious Diseases at the University of Alabama pic.twitter.com/FjCQKcRiNU
— Maddow Blog (@MaddowBlog) August 20, 2021
It provides a glimpse of what Sydney faces if we lift restrictions without the population being adequately vaccinated.
And that includes children. In Texas, paediatric ICUs are full and children cannot get beds. This is another warning that we must urgently vaccinate children, at least those 12 years and over, before lifting restrictions.
In Australia, the 70% vaccination rate at which the federal government proposes to begin easing restrictions corresponds to about 56% of the total population vaccinated.
It was modelled on 30 cases at the start of a new outbreak. With Sydney likely facing daily new cases in the 1000s (with no change in strategy), the outcomes could be much worse than anticipated.