Bennett must learn that Israel can't be a Start Up-Nation for COVID-19

Israelis above 60 years old receive their third dose of the COVID-19 vaccine at a Clalit health care maintenance organization, on August 08, 2021 in Jerusalem.
(photo credit: OLIVIER FITOUSSI/FLASH90)

A number of public health decisions were made rapidly and sometimes without the full consent of public health professionals over the last 18 months of the COVID crisis - analysis.

Prime Minister Naftali Bennett became a millionaire through his hi-tech ventures, but he might need to be more humble when it comes to managing the country’s health.

Last weekend, the prime minister wrote a column about why Israel decided to administer a third booster shot to all citizens over the age of 12, in which he accused public health experts of being “conservative” and “risk-averse.”

Public health professionals, however, say they are not “risk-averse” but “cautious” – and that is exactly what citizens deserve.

“The hi-tech industry prides itself on taking risks, not being put down by failures, but this is not the case in health,” said former Ben-Gurion University of the Negev president Prof. Rivka Carmi. “When we launch a campaign to introduce a new drug, or in this case a vaccination, we have to be extremely careful.”

In public health there is a concept called the precautionary principle, which means that “when there are threats of serious damage, scientific uncertainty must be resolved in favor of prevention,” according to an article published in the American Journal of Public Health.

Another concept is “do no harm.”

“Even before you know you are helping a situation, you have to be fairly confident that you will not harm the patient,” Carmi explained.

These principles exist because sometimes taking actions without enough evidence can cause irreparable damage.

In clinical medicine, for example, if a pharmaceutical is given or a procedure is done without waiting for all the test results to come in and it turns out that the physician gave the wrong treatment, “sometimes you can backtrack and sometimes you cannot,” said Prof. Yehuda Neumark, director of the Hebrew University of Jerusalem-Hadassah Braun School of Public Health.

He said the need for caution is even greater when dealing with the health of whole communities or populations.

“If it turned out that getting a booster was not a good idea, what would we do now?” Neumark asked.

Children wearing face masks attend a class as students return to school after the summer break, less than a month into a coronavirus disease (COVID-19) vaccine booster drive, at Arazim Elementary School in Tel Aviv, Israel September 1, 2021 (credit: REUTERS/AMIR COHEN)

He highlighted a number of public health decisions that were made rapidly and sometimes without full consent of public health professionals over the last 18 months of the COVID crisis, such as three lockdowns and keeping schools closed for around 200 days.

“Our children suffered for quite a long time because of that. I think it will take these kids a long time to catch up with what was lost,” he said. “When we are talking about the health of the entire population, it behooves us to move forward carefully.”

Bennett’s article was specifically about why he rushed to open up boosters to everyone. He said in the case of COVID-19, “not making risky decisions can be more damaging than taking a calculated risk.”

Carmi said she does not completely agree.

“We are doing a nationwide experiment here – a medical, clinical experiment – and the only thing is that we are not following the rules of a clinical trial.”

She said she does not believe, and the advisers of the US Food and Drug Administration said, that there is enough evidence yet to give third shots to younger people.

At the FDA meeting, “It was repeatedly argued that there is not enough data on this topic – neither from the clinical study nor from the data from Israel,” Carmi stressed.

SHE SAID even if it turns out that Israel made the right decision, and even if with additional data the US decides to administer booster shots to everyone, “This does not change the fact that in Israel, for more than a month and a half, a treatment has been given that is not approved by the world’s largest regulatory bodies, even for emergency use, and is not based on efficacy and safety data.”

She said people under 65 who are asked to get a booster shot should be given full information to be able to make their decision and asked to sign a consent to participate in this national experiment.

“Our booster campaign is actually a campaign of enforcement,” she said. “It is about the Green Pass, which on October 1 is going to require three vaccines for anyone not vaccinated within the last six months. If you don’t get the third shot, you will lose the Green Pass. This is a kind of coercion.”

Carmi did not question the efficacy or safety of the vaccine itself, which has been fully approved by the FDA. She also said that she stands behind the decision to give the third dose to people over the age of 65 who are at greater risk for severe disease, as well as to administer it to other high-risk populations. But she does not believe it should be given to the young until more evidence is available.

“This is not some hi-tech start-up where the more risk you are able to take the more you can really go forward, the more opportunity you have to be successful,” she said. “This is a matter of health and sometimes life and death. So, we have to be extremely cautious.”

The way to be cautious is to base decisions on evidence.

“The general approach of public health professionals is to collect data, use tools to analyze and interpret that data and then to come with recommendations that are evidence-based,” explained Prof. Daniel Cohen, the former head of the School of Public Health at Tel Aviv University.

When complete evidence does not exist, this does not always mean that public health professionals have to sit and wait for it. Sometimes, said Neumark, “We have to act in situations of uncertainty, and we do that all the time. But it is a kind of balancing act between how long it will take to accrue the relevant evidence versus how quickly we have to act to protect the people.”

The first vaccines were meant to prevent serious disease and death and they have done that. They were first offered under emergency use authorization and now they are fully approved.

The chance of a child or teen, especially one who has already been vaccinated with two shots, dying of COVID-19 is extremely small, Carmi said, noting that the government should keep this in mind over the number of positive daily cases.

Most of Israel’s serious cases are among the unvaccinated. Some 80% of those hospitalized in serious condition in the last month were over the age of 50.  However, around 40% of new daily cases are children under 11.

“I do not see being conservative as criticism of the public health sector,” Neumark said. “I think that we are the guards of public health and therefore it is our responsibility to proceed cautiously.”

He said that sometimes politicians move faster than public health officials think is correct or diligent. Other times there is a feeling that the politicians are not acting quickly enough to enact needed policies.

“Politicians would do well sometimes taking a moment to listen to the experts,” Neumark continued. “That has not always been the situation in this pandemic.”

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