Effective Vaccination Protocols
Organized, safe and effective vaccination campaigns are essential to reduce SARS-CoV-2 transmission and achieve economic reactivation in the context of the COVID-19 pandemic.

Focus #1: High-income countries (Israel)

As of March 2021, Israel has been recognized as one of the most efficient infrastructure models for large-scale vaccination against COVID-19. However, before exploring this in more detail, we must emphasize that most of the strengths of the Israeli model are primarily found in high-income countries, so further research is needed to assess the fundamentals of effective vaccination protocols in LMICs.
In less than a month, over 80% of Israel's adult population >60 years received the first dose, outpacing every other country in the world. Through thoughtful planning, efficient use of available resources (including technical, institutional, and human resources), and investment in effective risk communication strategies, Israel went from having the highest per capita COVID-19 infection rate to having herd immunity within its reach. Rosen et al. (2021) described the reasons for Israel’s success, organizing these factors into three main categories: 1) extrinsic to healthcare (e.g., small size of territory, young population, developed infrastructure), 2) healthcare-specific (e.g., systematic organization, cooperation, information technologies, training, and preparedness), and 3) vaccination-specific (e.g., timely decision-making, responsible resource allocation, clear eligibility criteria, effective communication strategies, and technical infrastructure, such as addressing the demanding cold storage requirements of the Pfizer-BioNTech COVID-19 vaccine).
Taking these into consideration, we highlight the following factors as key components of Israel´s exemplary vaccination roll-out:
  1. 1.
    Strategic planning: Israel signed an early contract for Moderna´s mRNA vaccine in June 2020 and later with Pfizer-BioNTech and AstraZeneca in exchange for providing the companies with anonymous immunization data of its population. It must be noted that, according to these agreements, Israel paid significantly more than the European Union (EU) for each vaccine dose (e.g., for the BioNTech-Pfizer vaccine, the per-dose cost to Israel was reportedly about $28 compared with $14 paid by the EU).
  2. 2.
    Universal healthcare system: Israel has a community-based universal healthcare system, with four public health management organizations competing for members’ and government funding. When the national vaccination campaign began, these four entities were assigned the primary responsibility of vaccinating all specific subgroups of the population >60 years old and with preexisting medical conditions. For example: The National Medical Emergency Services Organization, “Magen David Adom,” was responsible for the vaccination of nursing home residents, while hospitals oversaw vaccination of their own front-line health responders. For this reason, everyone in the target groups knew exactly where to obtain vaccination.
  3. 3.
    Centralized national system of government: a centralized government guaranteed a single authority responsible for planning, financing, and implementing the vaccine campaign. When comparing the centralized with a federal government system, Rosen et al. (2021) wrote: “In contrast, several high-income countries have federal systems, with significant implications for how public health efforts are organized. For example, in the US, public health is administered and regulated primarily at the state level... This has led to some ambiguity regarding who is responsible and accountable for the success of the vaccination effort.”
  4. 4.
    Efficiency: Israel has achieved the highest vaccination rate per capita of any country. As of March 15, 2021, 50% of its population had been fully vaccinated, and 60% had at least one dose. The comparable figures for the United States were 12% and 21%, respectively. Digitalization of health management organizations was also critical as it made it possible to generate secure vaccination records, make online appointments, and keep communication channels open for instructions.
  5. 5.
    Sufficient investment: central authorities assigned adequate financial resources for vaccine acquisition and distribution throughout the nation. Policymakers began planning these efforts by as early as mid-2020, just a few months after the WHO declared COVID-19 infection a pandemic.
As mentioned earlier, LMICs – in most cases – lack sufficient resources and infrastructure to organize a national vaccination program such as Israel´s. Further research is required to better understand effective vaccination strategies in resource-limited settings.
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