key: cord-0716460-w2orzh5w authors: Muhsen, Khitam; Cohen, Dani title: COVID-19 vaccination in Israel date: 2021-08-09 journal: Clin Microbiol Infect DOI: 10.1016/j.cmi.2021.07.041 sha: 50503c2fd511a7043ee0566d86140bd3fadd9125 doc_id: 716460 cord_uid: w2orzh5w nan Centralized management of the COVID-19 epidemic in Israel was led by the MoH, and operationalized by sick funds and hospitals. Operational assistance was provided by the military, civilian organizations, and local municipalities. Before COVID-19 vaccines became available, non-pharmaceutical preventive measures were implemented in Israel to control the epidemic, including limitations on international travel, school closures, social and physical distancing, obligatory face masks in public spaces (enforced by law), cancelation of mass gatherings, and several prolonged near-complete lockdowns (4) . In addition, a large-scale program of contact tracing and isolation was implemented, through epidemiological investigations and J o u r n a l P r e -p r o o f digital tracking, with widespread RT-PCR testing among contacts of confirmed COVID-19 patients (4). These measures were associated with a reduced risk of SARS-CoV-2 transmission (5). Nonetheless, maintaining strict public compliance with nonpharmaceutical preventive measures was challenging, and disease surges that occurred after lifting lockdowns suggested that such measures may only be effective for shortterm reduction of viral transmission and disease burden. On December 19, 2020, Israel introduced mass vaccination with the BNT162b2 mRNA vaccine (Pfizer-BioNTech) (6) . Herein we describe the Israeli experience and perspective on COVID-19 immunization. The BNT162b2 COVID-19 vaccine was introduced in Israel during a third nationwide wave of COVID-19 infections, and while under lockdown (Fig. 1) . Vaccine introduction was accompanied by an extensive campaign which was entitled "Back to Life" to encourage uptake. Positive incentives, termed "the green passport" were provided to immunized individuals that allowed them to attend events with larger gatherings such as theatres, restaurants and hotels. Initially, health care workers, individuals aged 60 years or older and those with underlying conditions were prioritized for COVID-19 immunization, after which the vaccine was offered to residents aged 16 years or older in a staggered, in an-age Vaccine uptake was rapid (Fig. 2a) , within two months about half of the total population had received a vaccine dose. As of June 1, 2021, 81% of the population aged 16 years and over had received the second vaccine dose. Vaccine uptake was high, exceeding 75% among those aged 20, years and increasing with age, surpassing 90% in individuals aged 60 years and above (Fig. 2b) . hospitalizations, severe disease and death, during a period in which the variant of concern Alpha (B.1.1.7) was predominant in Israel (8) . Further studies are needed to assess the vaccine effectiveness against additional emerging variants of concern i.e. Based on the results of a phase III trial (6), the BNT162b2 vaccine did not induce protection until day 12 following immunization with the first dose, therefore this period can be used as a reference when comparing the incidence of infection after day seven following immunization with the second dose (7) . Using this method, Chodick et al. showed vaccine effectiveness of 94% against COVID-19, which was consistent across age, sex and population groups, although effectiveness was lower among immunosuppressed patients (7) . Another study from Israel showed that immunization J o u r n a l P r e -p r o o f of pregnant women with the BNT162b2 vaccine was safe and effective against SARS-CoV-2 infection (14) . The quick and high uptake of the second vaccine dose coupled with the high effectiveness against SARS-CoV-2 infection and COVID-19 led to substantial and consistent reduction in COVID-19 incidence and mortality (4, 8) . These encouraging decreases were followed by gradual re-opening and lifting of COVID-19 restrictions. This corresponds to sustained declines in COVID-19 incidence in all age groups, including unvaccinated age groups, thus suggesting indirect protection (herd immunity) (15) . Israel's MoH recommends immunization with a single dose of BNT162b2 to individuals who recovered from COVID-19 at least three months after recovery. It is estimated that 20-25% of those who recovered from COVID-19 received BNT162b2 vaccine, this likely also enhanced the development of herd immunity. Towards the end of June and at the beginning of July 2021 a consistent increase in the incidence of SARS-CoV-2 infection has been seen (Fig. 1) , including among vaccinated persons, with most infections caused by the Delta variant of concern. An analysis of reports of events that occurred within 30 days following immunization Following the FDA authorization of the BNT162b2 vaccine among children aged 12-15 years, Israel's MoH recommended immunization of this age group. About two months after the MoH's recommendation, vaccine uptake among children aged [12] [13] [14] [15] years remains low at around 30%. 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