Confounded by coronavirus? The 'legacy' of D-G Bar Siman Tov
Senior medical officials and others are beginning to grade Moshe Bar Siman Tov's management of the crisis.
By MAAYAN JAFFE-HOFFMANOUTGOING HEALTH Ministry director-general Moshe Bar Siman Tov appears at a press briefing at the Prime Ministers office last month(photo credit: FLASH90)
For the last three months, Israelis fought a war against an invisible enemy, the novel coronavirus. Prime Minister Benjamin Netanyahu served as the general, and at his side was “Lieutenant” Moshe Bar Siman Tov, 43, affectionately known as “Barsi.”In his gray and tan shirts, open jackets and dark-rimmed glasses, the Health Ministry director-general would appear alongside the prime minister in prime time, instilling fear in the Israeli people.“Anywhere you go, there could be a person with coronavirus,” Bar Siman Tov warned the public during a March briefing. “You could be infected and put others at risk... Our ability to beat coronavirus is largely dependent on you. Safeguard yourself.”He predicted that 5,000 Israelis would die and as much as 5% of the population – about 430,000 people – would fall sick. But in the end, the number of infected Israelis – less than 17,000 – is on the decline, and the death toll hovers around 265: Both numbers being only about 5% of his frightening estimates.Many credit Bar Siman Tov for his decisive, swift and confident early decisions, such as completely closing Israel’s borders to foreigners – a reaction that helped stop the spread and ensure the virus did not overtax the country’s health system. But some of those same people also say that his later decisions to tackle the crisis lacked focus, strategy and leadership.As the country pulls out of the crisis, and after the director-general announced his resignation this week from a post he had held since 2015, senior medical officials and others are beginning to grade his management of the crisis. The mark is not high.“WHEN WE are in a war, everyone should do their maximum to help us get out of it,” the head of one of Israel’s largest health funds told The Jerusalem Post. “Today, more and more people are asking why, why and why.”The answer to “why?” comes down to the decisions made largely by one man: Bar Siman Tov.“There was only one way, and that was Barsi’s way,” the health fund head said. “Bar Siman Tov ran the show. He had the ear of the health and prime ministers, and everyone knows that.”A top medical director at one of the country’s largest hospitals expressed similar sentiments. He told the Post that Bar Siman Tov’s “poor management was clear: There was no transparency, the number of tests was too low, the warehouses were empty of needed protective equipment. He was the director-general, and it became clear he did not prepare at all.”“When people ask me how this event was handled, I say very poorly,” said former National Security Council head Giora Eiland in a Zoom lecture on the subject.Bar Siman Tov quickly centralized the country’s coronavirus response under the Health Ministry, although it lacked funds and had never been on the front lines of any battlefield. The director-general, said Hadassah CEO Zev Rotstein, “was used to making all the decisions by himself.”He said that Bar Siman Tov has a history of employing only those who say “yes,” and opposing anyone who thinks differently – and the coronavirus crisis proved no different.Rotstein said that in the early stages of COVID-19, Bar Siman Tov was operating on a simplistic model for the spread of the pandemic, which was based on international data, and led him to believe the country would see crazy numbers of sick and dead. He said the first models did not take into account the median age of Israeli citizens (around 30) or the warm climate, two factors that could have heavily influenced the spread of corona.“This frightened and paralyzed everyone and caused panic,” Rotstein said, and when Bar Siman Tov was presented with alternatives by medical professionals, scientists and mathematicians, he was too stubborn to budge.Countless examples of Bar Siman Tov’s inability to relinquish control can in hindsight be seen in his handling of the pandemic. First, according to Eiland, was procurement of much needed testing kits and ventilators, which was delayed by the ministry’s procurement department for lack of experience and connections, putting Israel at a disadvantage.The Health Ministry was aware as early as January 20 that COVID-19 was likely to penetrate Israel, but by mid-March when it finally recruited the Mossad and Defense Ministry for support, competition for essential items was fierce. The Mossad had to run clandestine missions to get what was needed, for which Israel received negative media.Testing, too, was run under the tight control of the ministry. Rotstein said that one person was authorized to sign off on coronavirus examinations: Prof. Sigal Sadetsky, head of Public Health Services. She felt that the way to fight the epidemic was not to test widely but, rather, to test people who came from abroad and had symptoms. She explained that whereas screening is important for data gathering, isolation is what will control the spread of the coronavirus.“For more than a month and a half, we had no information because we did not examine the right people,” Rotstein said. “If a person was already isolated, he was not contagious.”Rotstein said the people who needed to be found were the “super spreaders,” people who were asymptomatic and were traveling freely and infecting others. He said this was especially acute when it came to senior living facilities, which for the first half of the crisis were neglected.“The elderly people were most susceptible to death from coronavirus, and we knew that from Europe’s experience,” Rotstein said. “It took too long to start examining the people who work with this elderly population.”Rotstein said that he and others pressed the ministry to change its methodology, and he even did some testing on his own, for which he was accused of being a traitor – although ultimately the ministry issued orders to operate exactly as he had originally recommended.For more than a month, the ministry likewise insisted on operating a single coronavirus testing lab – the Central Laboratory for Detecting Coronavirus at the Sheba Medical Center, Tel Hashomer – which required that all tests be taken by Magen David Adom emergency medical technicians at private homes. The tests would then be transferred to the central lab, and the results to the Health Ministry, and would reach the patient sometimes only after seven or eight days.It was only after three people who worked in the central lab became infected and it had to be shut down that the ministry agreed to open more labs.The same thing happened with plasma donations, which were allowed to be collected only by MDA.Moreover, the crisis was plagued with communications challenges, said Manfred Green, head of the School of Public Health at the University of Haifa. He said that both the public and top medical professionals had many questions about the regulations that remain unanswered. Why 100 meters or 500 meters? Why is wearing a mask necessary in open spaces?“Someone needed to explain the rationale,” Green said, “but there was little transparency.”“Bar Siman Tov is not a person that knows how to get people around him to work with him,” said the head of the health fund. “When dealing with a complicated situation, you want to find people who want to work with you and collaborate with you. Bar Siman Tov is not that type of person. In a way, he was lonely in his position.”The result: The health epidemic became an economic epidemic that unnecessarily shut down the country, Rotstein said. “Bar Siman Tov left Israel under blockade for too long because he felt threatened – and the damage to the country is enormous.”In late March, dozens of medical managers expressed similar sentiments when they signed a letter to the prime minister calling for new leadership and demanding that the crisis be put in the hands of medical professionals. They said that the head of the healthcare system should be a “doctor with clinical knowledge and close familiarity with the field of medical care.”BUT THIS story started long before corona. In 2015, Bar Siman Tov became the first non-doctor to ever hold the post of director-general of the ministry, in what was a contested appointment.Health Minister Ya’acov Litzman selected Bar Siman Tov at the end of Roni Gamzu’s tenure. They had become close in 2011, when Bar Siman Tov led the negotiating team with the Israel Medical Association, for which he was accused of doing irreparable harm to Israel’s health system.Sources close to Litzman said that the haredi (ultra-Orthodox) minister, who was already in his current role, was impressed by the “genius economist.”The Israel Medical Association appealed to the High Court of Justice against the appointment, because of Bar Siman Tov’s lack of medical experience, but the court ruled on the side of the government: An economist is not less suited to manage the health system than a physician.Bar Siman Tov assumed his role with a feeling of confidence and superiority, having previously been in charge of the Budgets Department, which oversees the state budget, a job he rose to in near-record time.His career started when he was in his early 20s and still a student at the Hebrew University, when he was recruited to the Finance Ministry’s labor and welfare team. In 2006, he was promoted to oversee the welfare planning team in the National Insurance Institute, then to run its health budget team. In 2010, Bar Siman Tov returned to the Finance Ministry as deputy head of the Budgets Department, in charge of the health, education and welfare budgets.Senior officials said that the medical establishment believed that having come from the Finance Ministry, Bar Siman Tov would be able to help infuse much needed funds back into the starving healthcare system.“The system had been dried out by the Finance Ministry, and we thought if we took in one of them, he would be able to serve as a negotiator between the Finance and Health ministries and bring the resources we needed,” a former director-general told the Post.But Green said that this never happened, and instead Bar Simon Tov fought with his former colleagues in the Finance Ministry and rubbed elbows with the country’s top medical minds; he appeared totally mismatched to his role.“You don’t appoint a chief of staff who has a business administration degree and never served as a soldier,” Green said.Green noted that his comments were not aimed personally at the director-general who he described as "clearly a talented professional in his field. Given his professional background, he appeared to have learned rapidly on the job. But I believe that that his professional training is not what is required for the leader of the country’s medical system."He added that "to instill confidence and provide a vision for the health system, I believe that the D-G must have an excellent understanding of what clinical medicine and public health is all about."DAN BEN-DAVID, head of the Shoresh Institution for Socioeconomic Research, said that the system was already broken before Bar Siman Tov started.“The health system continued its multi-decade deterioration during the past several years,” Ben-David said. “The number of hospital beds per capita continued its steady plunge since the 1970s, with hospital occupancy rates reaching the highest levels in the OECD and the number of nurses per capita among the lowest in the developed world, while the number of nursing graduates remains near the bottom of the OECD. In the past two decades, the number of persons dying from infectious diseases per capita in Israel doubled, placing Israel 73% higher than the No. 2 country in the OECD, with 12 to 15 times more deaths than persons killed annually in traffic accidents.“No one fixed these issues,” he continued, noting that this was on Bar Siman Tov – but not only on him. “First and foremost are the people who go on our TV sets almost nightly to ensure that we understand who’s in charge.”But the coronavirus was not the first crisis for which Bar Siman Tov was harshly criticized. In 2018, the ministry came under attack for his overly delayed and disorganized handling of the measles outbreak.The media reported that Bar Siman Tov had been informed that the health funds had gotten many calls about measles even six months prior, and he did nothing with the information until the media started reporting about it.“This is a scandal,” a senior official at one of Israel’s main health funds told Haaretz back then. “We’re lucky it’s only measles and not some other disease.”“There’s a key problem of leadership here,” another person involved said. “I don’t think the person heading the ministry today can run the response to such an event. This is both a professional and communication crisis.”Earlier this year, a report by State Comptroller Matanyahu Englman warned that despite the Health Ministry formulating a program in 2005 to prepare the healthcare system for a potential influenza pandemic, there are still sufficient drugs for only 16% of the population today, rather than the necessary 25%. The report also highlighted decreasing rates of vaccination and a lack of readiness.Many have contrasted Bar Siman Tov’s handling of both the measles and the coronavirus pandemic to Gamzu’s management of the polio outbreak in 2013-2014. Gamzu reportedly understood the need to communicate clearly with all sectors, including the ultra-Orthodox and Arab sectors, and he met personally with opinion leaders in these communities.“The polio crisis was defined as an emergency... and the crisis was handled through mobilization of, and cooperation among, many players – doctors and experts, HMOs, local governments and others,” a senior official told Israeli media then.Ultimately, some 980,000 children were vaccinated against polio between August 2013 and January 2014, and the disease caused no injuries or deaths.So, what is Bar Siman Tov’s legacy?“Regretfully, I don’t think the healthcare system looks different from [what it was] before he came,” another former director-general told the Post. “If you see the system today and five years ago – [it’s] the same; nothing new.”The department head of a major hospital added: “If we don’t move forward, we move backward... He has no legacy.”Bar Siman Tov and his advisers declined to respond.
