While the U.S. pharmaceutical giant Pfizer confirmed Friday that it will temporarily reduce its deliveries of the Pfizer-BioNTech COVID-19 vaccine to Europe while it upgrades its production capacity to 2 billion doses per year, Tel Aviv has negotiated a deal with the American company on expediting the supply of the shots so that all citizens over 16 can be vaccinated by the end of March in exchange for extensive data on the inoculation program. According to remarks carried by Bloomberg earlier this month, the agreement came after 17 conversations with Pfizer chief executive Albert Bourla. Israeli Prime Minister Benjamin Netanyahu – who is stumping ahead of the country's March elections as Israel's vaccinator-in-chief – said that he reached the deal with Bourla to speed up vaccine deliveries, adding that Israel would serve as a “global model state,” sharing medical data with the company and other countries to “develop strategies” in order to end the coronavirus pandemic that has claimed over 2 million lives worldwide, with nearly 95 million cases recorded.
The deal between Tel Aviv and Pfizer raises major ethical concerns, including possible privacy violations and a deepening of the global divide that enables wealthy countries to stockpile vaccines as poorer populations, including Palestinians in the Israeli-occupied West Bank and Gaza Strip, have to wait longer to be inoculated, critics say.
Israeli Health Minister Yuli Edelstein told The Associated Press (AP) the government will turn over data to "see how it influences, first of all, the level of the disease in Israel, the possibility to open the economy, different aspects of social life and whether there are any effects of the vaccination."
Pfizer's vaccine, developed with German partner BioNTech, has received emergency approval from the U.S. Food and Drug Administration (FDA) and the European Union's regulatory agency and is believed to provide up to 95% protection against COVID-19. But much remains unknown, including its long-term protection and whether it can prevent the transmission of the virus.
Israel, home to some 9.3 million people, is considered an ideal place for studying these questions. Its mandatory universal health care is provided by four publicly funded HMOs with meticulously digitized medical records. This centralized system has helped Israel administer more than 2 million doses of the vaccine in under a month. Israel has also purchased doses of the Moderna and AstraZeneca vaccines.
The inoculation blitz is at the center of Netanyahu’s reelection campaign as he seeks to deflect attention from his ongoing corruption trial, Israel's deep economic crisis and the latest virus surge. The Health Ministry has recorded over 543,00 cases since the beginning of the pandemic and nearly 4,000 deaths. Israeli officials say they aim to have most of the country vaccinated by the end of March, just around election day. But the exact quid pro quo between Israel and Pfizer is unclear, even after a redacted version of the agreement was released by the Israeli Health Ministry Sunday.
Neither Israel nor Pfizer would say how much Israel has paid for the vaccines, though Edelstein called it a "classical win-win" for both sides. Israeli media has reported that Israel paid at least 50% more than other countries. The data is reportedly being shared with the World Health Organization (WHO), but the global body did not respond to repeated requests for comment.
"Arguably the most important secret in the world right now? Pfizer BioNTech's delivery schedule. It's not just when you ordered, but how much you paid. Hence Israel got priority deliveries. Could be the EU's problem be connected with price member states were willing to pay?" Mark Urban, a diplomatic editor and occasional presenter for BBC Two's Newsnight wrote on Twitter Sunday.
Earlier this month, the head of the WHO appealed to drugmakers and wealthier countries to "stop making bilateral deals," saying they hurt a U.N.-backed effort to widen access. Tedros Adhanom Ghebreyesus did not single out any countries or companies.
Last week, Dr. Siddhartha Datta, WHO Europe’s program manager for vaccine-preventable diseases and immunization, said the agency is trying to collect "disaggregated" data – based on age, gender, local area, employment and other factors – and reporting on any safety issues as the vaccines are deployed.
Israel had already announced the acquisition of millions of vaccine doses before the Pfizer deal was announced. It's unclear how the quantity or pace of deliveries has changed, or whether the vaccines have been diverted from other countries.
The arrangement has drawn attention to the unequal distribution of vaccines between rich and poor nations. A recent estimate from the International Rescue Committee (IRC) said that the WHO's global COVAX campaign is likely to vaccinate only 20% of the world’s lower-income countries by the end of 2021.
"This is a shady, under-the-table deal that preferences certain countries over others without any transparency," said Lawrence Gostin, a professor of global health law at Georgetown University in Washington. "In the end, it’s going to be low- and middle-income countries that are going to be left behind."
That disparity is particularly striking in the case of Israel and Palestinians in the occupied West Bank and Gaza Strip, who live under varying degrees of Israeli control and have yet to receive any vaccines. While vaccinating its own Arab citizens and Palestinian residents of Israeli-annexed East Jerusalem, Israel says it is not responsible for inoculating the Palestinians.
Edelstein said Israel will consider helping once it takes care of its own citizens. But the Palestinians and major human rights groups say Israel remains an occupying power and is responsible for providing them vaccines.
Palestinian Prime Minister Mohammad Shtayyeh recently accused Israel of "racism” but has not publicly requested vaccines. With tens of thousands of West Bank Palestinians working in Israel and its West Bank settlements, experts say Israel should share vaccines on ethical and practical grounds.
"I truly think that we need to see how we get the vaccine for the Palestinian Authority,” said Davidovitch, acting chairperson of Israel’s association of public health professionals. "We are talking about it with the minister of health, and I really hope that soon this thing will be solved.”
It’s also uncertain exactly what information is being shared with Pfizer. According to the redacted agreement, "no identifiable health information" shall be shared, and the research is to be published in a recognized medical journal. It said Israel will provide weekly data to Pfizer about various age and demographic groups.
The objective, it said, is to "analyze epidemiological data arising from the product rollout, to determine whether herd immunity is achieved after reaching a certain percentage of vaccination coverage in Israel." The data, it added, is "aimed at helping end the global COVID-19 pandemic for the benefit of all patients inside and outside of Israel."
Privacy Israel, an advocacy group that had petitioned the government to disclose the deal, welcomed its release but said certain questions remained unanswered, mostly about the handling and security of private information. It also blacked out certain details, such as key dates and the names of officials involved. Still, it said there is a "little more certainty" about sharing information with a global corporation.
Tehilla Shwartz Altshuler, an expert in digital privacy at the Israel Democracy Institute, questioned the ethics of a deal that could bring millions in profits to Pfizer. She also said sharing large quantities of information could still potentially put individuals' privacy at risk, even if it's supposedly made anonymous.
"If, God forbid, the data set is going to be hacked, then the risk is going to be yours,” she said, referring to Israeli citizens.
