Israel used healthcare workers as influencers to vaccinate public

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Israel’s Health Ministry Wednesday revealed its strategy for vaccinating its population during the COVID-19 pandemic.

In late 2020 Israel’s Ministry of Health signed a contract with Pfizer to be “the world’s lab” for COVID-19 vaccines. Based on Israel’s data, international agencies, including the US FDA, approved the vaccines for their own populations.

But Israel knew that in order to successfully roll out the injections, it would have to overcome a major hurdle: Most rational people, when asked to inject themselves with an unknown serum, refuse — and the group most known for vaccine hesitancy is healthcare workers.

A 2010 study in Beijing found that less than 18% of healthcare workers took the flu vaccine. A 2007 US study revealed that even after an intensive vaccination campaign, less than 35% of healthcare workers received their flu injections. An Italian study showed that in 2005, a flu vaccination campaign was able to raise vaccination rates among healthcare workers from 10.4% to 36.6%, which dropped to 23.3% a year later.

Even when the World Health Organization (WHO) declared the swine flu an epidemic in 2009, seasonal flu shots among healthcare workers in Spain rose to 50%, but still less than 17% took the H1N1 vaccine.

A 2013 study found that less than half (42%) of Israeli nurses received whooping cough vaccines over the previous five years, and only 44% had received their flu shots the previous year. Even though the Health Ministry had ordered nurses working with infants to take the whooping cough shots, only 2% did so.

They felt "that the risk associated with contracting diseases and the severity are not worth the risk of getting vaccinated with a vaccine that has not been used long enough to know what its side effects are. It was a direct statement regarding the swine flu vaccine and the pertussis vaccine, and they felt that the authorities were using them as guinea pigs,” the researchers wrote.

The nurses held a deep distrust in the medical system. "What, we are in Soviet Russia? I am not taking the vaccine this year," said one. "If I want, I'll get vaccinated. I'm an adult, I'm responsible, and if I want, I'll get the vaccine,” said another.

Similarly, Israel’s Health Ministry reported in 2019 that Israeli healthcare workers are even more hesitant to be vaccinated than those in other countries around the world. In 2018-2019, 46% of nurses received their flu shots while only 35% of doctors were vaccinated.

When Pfizer’s COVID-19 vaccines arrived in Israel in late 2020, a government survey found that only a third of the public was willing to get vaccinated. Officials toyed with the idea of using social media influencers to sway the public, but a Health Ministry propaganda chief, Information Department Deputy Director General Einav Shimron, devised a better plan.

"I knew the vaccines were going to arrive but only a third wanted to be vaccinated," Shimron said in an interview. "I was thinking about how to properly explain it. In Britain they vaccinated adults first and I thought it was right to vaccinate medical staff first. I managed to convince [officials] that it was necessary to start with the medical team.” 

Without a vaccinated healthcare force, Shimron understood, the majority of the public would not take the shots. So she turned healthcare workers into unwitting influencers.

“It should be remembered that when they saw that members of the medical staff were standing in line to receive a vaccine, it influenced the majority of the public to get vaccinated,” she said, and created a campaign to get the healthcare workers on board. 

“We invited the Medical Association, the Nurses Association, the Association of Family Physicians, the Association of Pediatricians, we held webinars for doctors. The idea was to start with internal information for doctors. This is a lesson we learned from managing the swine flu crisis from 2009, when we launched a new vaccination campaign to the public without first explaining to the doctors. . . . If doctors are convinced, it will be easier to convince the public, it would be a game changer. An idea came up to use influencers, but I insisted on contacting the professionals first. The doctors are the biggest skeptics and as soon as they were convinced, everyone followed them."

But still, holdouts among healthcare workers and the public remained; so the government settled on forced vaccinations as a strategy, and imposed harsh mandates throughout the country. Vaccine passports were quickly rolled out, accompanied by militant rhetoric from Israeli officials.

Then-Prime Minister Naftali Bennett, who accused the unvaccinated of "walking around with a machine gun firing Delta variants at people,” at one point proposed mandating bracelets which would publicly identify those who had not received the injections. He also proposed forcing the unvaccinated to pay for their own healthcare. 

When Pfizer developed its first COVID-19 booster, most countries were hesitant to offer up their populations without any prior data. But, as it had done with the first Pfizer vaccines, Israel volunteered. The government again looked to kick off its booster campaign with healthcare workers — and Sheba Medical Center eagerly stepped forward.

Then-Prime Minister Naftali Bennett gave a batch of the newly developed boosters to Sheba Medical Center Infectious Disease Unit Head Professor Galia Rahav to experiment on 2,000 members of the hospital’s medical staff. The experiment was apparently not conducted under the official auspices of Israel’s Health Ministry.

“She tried it first, on their doctors, on the hospital staff, 2,000 people,” said Bennett. “She sampled the decrease in antibodies and mortality.

“So [Galia] was the first in the world. So every day I would call and ask, ‘What's going on, Galia?’ and she would update me.”

After the third dose, the mandate was dropped and vaccination rates among healthcare workers fell along with it. Data reported by Zman Magazine show that a vast majority of medical staff at Assaf Harofeh Hospital, Baruch Padeh Medical Center, Shmuel Harofeh Hospital and Ichilov Hospital — Israel’s second-largest — did not receive the fourth or fifth COVID-19 doses.