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Comment by scrollaway | Hacker News Reader

Israel feels like the only nation taking the importance and urgency of vaccination seriously.

Here in Europe, articles are coming out complaining that the slow vaccination could be harming the economy which, well, fucking duh. (https://www.brusselstimes.com/news/belgium-all-news/154626/c...)

Fast rollout. Involve pharmacies. Involve the army. Distribute widely and efficiently. Prepare for months before the vaccine is here. Follow-up campaign to convince vax holdouts. A real War Effort.

There's barely any calls for volunteering here in Belgium. Hospitals and vaccination centers will complain to the government that they are understaffed but you seldom hear them urgently asking for new volunteers to assign to COVID teams and vaccination centers. We spent a ton of time debating whether the social bubble should be 2 or 3 large, whether kids should be 12 or 14 before they count for it, etc etc and those spending that time were the same people who didn't prepare for the eventuality of a vaccine, and started doing so in late December.

Sorry this has veered off topic. The number of articles that can be summed up to "Vaccines work, are good, and israel is doing it right" frustrate little european me. :(

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To give some balance. Just as I got my second jab and waiting the 10min needed for surveillance. (Tel Aviv, Israel)

> Israel feels like the only nation taking the importance and urgency of vaccination seriously.

It's a mixed situation here.

* Israel supposedly paid 3 times more than others per shot (but if it works, it's cheaper than the economy losses).

* Israel has free public health care.

* All public health care databases are connected.

* Pfizer gets very detailed annoymized dataset.

* centralization means the health care also hospitalization covered by health care and connected to database.

* Israel is a small country. I can easily cover it by 7hrs drive bottom top.

All those helped get enough jabs.

Yet, There's enough population that don't social distance / comply to basics such as wearing a mask (even indoor!). Some population even did huge events during lockdowns with zero enforcement.

Hope this gives some proportion.

Belgium is a small, densely populated country. One of the highest average salaries in Europe. Not to mention great universities and flourishing biotech sector. Bottom line: this country can afford to pay for, and should be able to produce a lot of vaccines. Yet it doesn’t, I guess it’s some kind of EU bureaucracy thing. The UK seems to be doing much better since they’re not tied by the EU supply strategy.

There are not enough vaccines at the moment anyway since EU failed miserably at getting them. You can't really make a massive effort of maybe even asking military to help etc if there are not enough jabs. Then it's smarter to use the ones you have in q strategic manner.

Sure but the EU still failed in securing supply from the available manufacturing capabilities.

Instead they were de prioritized in the list.

> Israel supposedly paid 3 times more than others per shot

More than that even, closer to a factor of 10.

https://www.jpost.com/israel-news/the-cost-of-vaccinating-is...

$47 / head!

VS closer to $5 in other countries.

If it saves lives and gets their economy back to normal, that was the right call. Meanwhile we’re discussing sending multi-thousand dollar checks in the US because of Covid.

The US has administered 5x the vaccines as Israel.

It's not that likely that a comparable investment from the US would have accelerated vaccine availability to the same extent as happened with Israel, which was able to get substantial shipment in part because the US invested a lot in the mRNA vaccines, and in part because the EU waffled about making orders.

> The US has administered 5x the vaccines as Israel.

To put that into context: the US has a population ~36x the population of Israel.

The mRNA vaccines cost more everywhere.

Given the better efficacy, I think the comparison doesn't boil down to a single number very well.

It's still cheap in the grand scheme of things.

The mRNA vaccines are about $20 per shot[1], making it $40 / head, "MSRP".

1: https://observer.com/2020/11/covid19-vaccine-price-pfizer-mo...

Thanks for the added context!

thanks!

The US also has almost no sense or urgency (maybe more than the EU, but pretty bad).

Examples:

- modernas main bottleneck is filling. They applied weeks ago to fill the same bottles with 15 doses instead of 10. The FDA has still not approved it.

- the us prioritizes second doses over first doses. This creates a ton of cascading issues, including the fact that many places are storing half the doses for 28 days. Many people have reported getting the same lot number for the second shot.

- the FDA takes 3 weeks to schedule approval meetings (after having reviewed the data enough to believe an EUA is warranted).

-the FDA hasn't approved Astrazeneca, one of the last countries to do so.

-our prioritization system is a mess. It's really hard to figure out who is eligible. "Healthcare workers" (which was supposed to be the first group) is vague, so of course what happened is what you would expect. I know about 100 people personally who have gotten the vaccine as healthcare workers. Only 1 works with COVID patients. Most of the others have less contact with people than grocery store workers. They should have just done covid ward workers first (<1M people) then go by age only. Super easy to know who is eligible. Our local hospital sat on doses from late Dec to late Jan because they didn't know who to give them to. After sitting on them for almost 30 days, they realized if all the doses went bad it would be a scandal so they just gave it to everyone on the property first come first serve.

The us has 330 million people. Israel has roughly 10.

Their is a real supply shortage. Israel Can and did secure enough vaccines for all its people. The us cannot, there’s not enough supply.

Because of the lack of supply the us has been focusing its efforts on using the supply it has to go to the groups most likely to face complications from covid, and the folks supporting said group.

The US is leading the world when it comes to total vaccines given.

As for the second shot prioritization. The feds screwed up distribution with there being no strategic reserve. What you have already is what you’ll have. Anything else is not gaurenteed.

I think you’re making a lot of assumptions that FDA approval/disapprovals are slow due to a sense of urgency. I’d like to see evidence for that, I’d personally assume it’s quite the opposite— they’re trying to get it as right as they can before doing something at scale that can’t be easily undone.

If 15 doses lead to issues compared to 10, then you jeopardize all those vaccines which are slow and difficult to make. You also give people false sense of hope and possibly either get lower effectiveness or build public distrust. These are tough balancing acts.

It's really hard to grok why 15-vs-10 doses in a bottle should be a problem. Sure you've got the out-of-fridge time, but that hardly seems like an issue when the population is itching to get vaccinated.

My understanding is that they wanted to validate that the additional needle insertions through the vial doesn't damage the seal enough to cause contamination.

Is the seal important if the vial is going to be fully used up ~now? Presumably the needle has to be clean regardless of whether the seal exists at all (e.g., it could be dirty inside the bore and the seal state would be irrelevant), so the seal's purpose is to prevent contamination from the environment when there is no needle present. That kind of contamination takes time to happen and more time to incubate, and if the open lifespan of the vial is only a few hours is that important? Seems like that minor uncertainty is a good trade for swifter execution.

I don’t know much about this issue, but from your comments it sounds like you don’t either. I’m not trying to be mean, but considering it wasn’t an automatic approval from the FDA that would suggest there’s legitimate concern to at least investigate. Be wary of Dunning-Kruger effect, especially when we’re talking about the healthcare of every person on Earth (the ideal scope of these vaccines).

This is a hollow appeal to authority (the FDA is infallible) mixed with an appeal to emotion (fear of death) with no attempt to provide concrete information or to present thinking towards a conclusion.

According to a study, the AstraZeneca one has about 22% efficacy or something. I cannot find the study right now. What did you read about it? 22 is a very low number, IMO.

I think it's almost entirely a supply issue?

Israel, UK and USA procured large amount of doses ahead of time, and now EU is having trouble getting enough doses for their population.

That was my understanding.

It’s weird because the NYT ran an article about how little we procured ahead of time, compared to the EU. And now they’re the ones fumbling it

It still seems far too slow in the US. 'Warp Speed' got us to the finish line, but all out of breath and without the need to still plan and execute taking advantage of the race's completion. Reminds me that historically 'we' got to the moon, and then like 50 years later are only reaching the point of maybe going back again, hopefully regularly this time.

According to this:

https://ourworldindata.org/covid-vaccinations

US has fourth fastest vaccination rate per capita, behind Israel, UAE, and UK.

And is number 1 for total amount of covid vaccines given.

That’s huge when you realize manufacturing capabilities don’t come online overnight. The us secured the large majority of supply.

In Denmark it's 100% a supply issue.

There's vaccination centers set up all around the country which are being utilized at 1-5% capacity, just waiting for vaccines to arrive.

They are upgrading the infrastructure even more despite that, anticipating being able to vaccinate 10% of the population per day.

The UK has (first-dose) vaccinated close to a quarter of the population now. Given the vast population difference between it and Israel it seems to be doing pretty well too.

Yes I agree, the UK is also doing very well considering. It just baffles me that no other country is even in the same category as israel in terms of readiness, despite nine months to prepare.

There’s just not that many countries as rich as Israel who could be, though? UK and UAE are doing pretty well. All EU countries are subservient to the EU on this, America and Canada are geographically huge and of course America has Covid and medicine as an outsized political issue, Oz and NZ don’t need to rush it ... I guess maybe the Asian tigers are lagging a bit here?

i don’t think “rich” has much to do with it. look how much economic loss and fiscal stimulus many countries have endured, on a per capita basis. in the grand scheme of thing, relative to that, does it matter whether they pay 20$, 40$, 100$ etc per dose?

Let's say you're buying two-three treatments per person to try and make sure you end up with one that works, at 2021 Q1 delivery prices of around $40 per treatment ... $100 per capita. And let's say you're Malaysia, so that's $3.2bn in total which is 10% GDP.

If you wait until Q3, you can get a proven vaccine for $3 per person, so $90m instead, so going early is going to cost you ... $3.1bn? So that's still 10% of GDP ish. Not sure that's an easy sell.

that’s 1%’of their gdp not 10%

The Asian countries also don't appear to really need to rush it

most countries of the EU vaccinate at perhaps 20% capacity due just because there isn't enough supply.

Yes, currently the UK is vaccinating at rates of up to 600,000 per day. That's about 3x the top daily rate of, say, France.

I had my first jab yesterday in London, I am (just) under 30 so I was surprised to be offered it, but I went along anyway and it was very well organised. In an out in 5 mins, the vaccines were being given by army and navy medics (all in uniform, which was cool but also a bit apocalypse-y). They said they were giving over 100 an hour in there alone, and there can't have been more than 15 bays for vaccines.

I was very impressed. I am looking forward to seeing how it continues. If there is a way to improve supply I have no doubt they could go even faster.

As a side note; The side effects to the Oxford jab was less than ideal. Bad chills (on an already very cold day) and a cracking headache. Feel much better now but I wasn't expecting it to be so bad! I had had COVID before, although it was mild, and I've heard this can make the reaction a bit worse than normal. So maybe that was why.

Out of curiosity how did you qualify for the vaccine? I work for the NHS but as I'm not frontline don't qualify for it. Not that I disagree with the decision but the internal talk I've heard is that the government has been extremely strict about only vaccinating those in the priority groups.

I am in the same situation as the parent comment. Youngish but offered it at the weekend. I would be group 6 but I think there is more at play.

There are vaccine centres in London (certainly the one I attended) having to close early because a lot of people in group 1-4 are refusing to take up their appointments. I believe that so they can make use of their supply they've had to transition to lower groups a lot sooner than planned.

The US was over 1 million/day during the last days of the Trump administration. I imagine now we are well beyond that level.

That’s the deep state at work! [0]

0: by which of course I mean strong institutions like the NHS, apolitical and well-organised army, regional councils, and the civil service

If EU countries had the same supply as the UK, they would also have vaccinated roughly the same percentage of people.

EU approved the vaccines over a month later IIRC, and Germany and France won't use the easy to distribute vaccine (astraveneca) in over 65s, the major target group.

So I'm not sure it's only a supply issue.

The AZ story is a very interessting one. This whole debate started after the Handelsblatt, a German newspaper, pblished an article saying that the AZ vaccine is only 8% effective for people over 65. Totally wrng of course, as 8% was the number of trial patients above thaage. Yet, the source was apparently someone in the German Ministry of Health. Obviously, that story went viral, it got all the uplift it needed when Bild and Spiegel jumped on the bandwagon. The latter has a, IMHO, obvious pro-Biontech agenda. With countries like France having already a problem with low vaccine willingness, and some smaller screw ups in AZs trial data, EMA restricted the AZ use for patients over 65 due to "insufficeint data", even if EMA thinks AZ will be effective. That detal, obviously, is way too small for online news.

My pet theory is, that someone looked for a scapegoat why German vaccinations are so low. AZ was a welcome one, especially after the question of whether AZ had to use its UK factories for EU orders. After that stunt, I have the impression AZ is somewhat pissed.

The handelsblatt report is (probably) based on a draft from the STIKO, which included a 6% effectiveness rate (most likely a different draft), but with a huge confidence interval (https://www.bmj.com/content/372/bmj.n414), so it's probably correct but irresponsibly misleading.

The EMA allowed the use of AZ for patients over 65 (because they guess that it'll probably be effective), but the STIKO and other government institutions of the various EU countries restricted it.

I don't think it'll make a huge difference, since more than a third of german vaccine doses were used based on occupation, where AZ can be used. The obvious scapegoat for slow vaccinations is that AZ cut deliveries by a large amount, which might not be AZs fault, so the different scapegoat wasn't needed.

The issue with the EMA approval date is a red herring, in my opinion. Unfortunately it gets given a lot of attention (especially in the UK press) even by organisations that should know better.

The most important thing to remember is that both the UK and EU pre-paid for AZ to manufacture their vaccine pre-approval. The date of regulatory approval and the manufacturing schedule are supposed to be completely decoupled.

It's true that the UK got their vaccine order in first and nobody is denying that. That's why the UK was getting shipments from AZ back in December. When the EU finally signed their contract they were told that their deliveries could start in February.

While I doubt the EMA is going to comment publicly on the timing of their decisions, I don't think it's a coincidence that their approval of AZ was done in late January. They already knew that the meaningful supplies were starting in February so they simply collected as much data as they could before making the "go/no-go" decision.

So while the "feckless EU bureaucrats screwed it up" storyline is forever popular (both in the UK and EU press) they seem pretty blameless on the issue of AZ approval. They just had to get it approved before the manufacturer was ready to start deliveries and they managed that.

What kicked this into a crisis is that AZ announced that their February deliveries to the EU would be less than half of the expected amount. The EU's position is that the UK and EU should be treated equivalently at this point: they both pre-paid for certain quantities to be delivered in February, so any production shortfall should be shared. Needless to say, the UK sees it differently and doesn't want any UK-based manufacturing to go to the EU. Hence we got this ugly diplomatic standoff.

The EU thinks it should be treated equivalently, but what do the contracts actually say? If the contract is weaker than the UK one, then that could be called an EU screwup.

Some countries probably, but institutional strength in the EU varies dramatically country by country

Most developed countries seem to be able to deploy close to 100% of the vaccines provided so far, modulo whatever strategy they have chosen regarding keeping some amount of second doses in storage. So that doesn't seem to be bottleneck.

Israel simply paid more and bought a larger amount of vaccines delivered earlier. Which is smart but it's not a strategy that all countries can replicate, not because we cannot afford it but simply because there is a bottleneck in production. There is not enough vaccines for all no matter how much we pay, so we would end up competing in price for no real speed up.

The US, which is what I have seen data for, is nowhere close to 100%. It's at ~75% per https://www.bloomberg.com/graphics/covid-vaccine-tracker-glo...

Now some states _are_ close to 100%. Some are close to 60%. Investigating the differences in approach that lead to those differences in numbers mostly comes down to whether states prioritize vaccinating people or creating complicated rules and sticking to them.

When combined with things like this from https://www.theguardian.com/global-development/2021/feb/14/w... : "Instead we have a patchwork of approvals and I have 70m doses that I can’t ship because they have been purchased but not approved. They have a shelf life of six months; these expire in April.", it sure seems like a large part of the apparent supply bottleneck is self-inflicted. Some basic "if it's approved in another G-8 country (or whatever criterion you want to pick) we should auto-approve it here" logic would probably significantly help with this sort of thing....

We ended up paying more (not much more at $20/shot "MSRP" apparently) but I think a greater part of that was contributing anonymized medical data. Statistical data on: groups vaccinated, positive test results, treatments in case of infection, etc. is worth a lot. That would also explain the swift deliveries, despite making that stats deal fairly late in the process. (early 2021)

I have yet to be convinced that paying the vaccine suppliers more is zero sum. More money potentially means more production / faster scaling up.

Vaccine production started way before the Phase 3 results were out. You cannot know ahead of time for which vaccines you should make a strong bet. Now we can prop-up production of the successful vaccines and they are doing so.

Anyway, getting the first vaccines is always going to be zero-sum for the same reason getting first-row in a concert is zero sum.

"You cannot know ahead of time for which vaccines you should make a strong bet."

Actually you can. When dealing with a pandemic causing the level of disruption we've seen, you throw money at propping up production of every serious vaccine candidate, hoping that at least one of them works out.

Yeah, overpaying and betting on 20 candidates in parallel is the reasonable thing to do, even if you're cynical enough to not care about the loss of life or health.

Every additional day of lockdown probably costs as much as the entire production lifecycle of a vaccine, including distribution.

I think the EU economy contracted at least 5% in 2020. The EU GDP was $18.3 tn, so 5% is about $915bn. That's $2.5bn per day (!). And that's just the direct impact, the whole psychological, PTSD, etc. longer term impact probably makes that higher, I'd be shocked if the total cost isn't something like $3bn per day.

6.8%. https://www.brusselstimes.com/economics/154783/euro-zone-gdp...

That makes things even worse. We're talking about a drop about the size of the entire Spanish economy.

They should have been throwing money at every reputable vaccine producer, including burning all red tape to make sure that excessive production capacity will be ready before the final approval is even given.

We have already done so, the first production was potentially at a loss if the Phase 3 results were not good. And we have done so for each vaccination effort out there. So there is already a lot of oversupply we may be throwing.

To be clear, I agree that the return on investment of a quick and successful vaccination campaign is so big that it makes sense to aggressively bet on it. But I also think the evidence shows we have bet quite aggressively on it, at least to unprecedented levels.

What I cannot comment on is how much better we could have done, the supply chain and logistics of producing 1 x (world population) for each candidate vaccine in the hopes at least one of them works and we can roll-it out quickly are so ridiculously complicated I don't know how it could have been made to work. I fear I would just be misdirecting my frustration with the current situation and an incomplete understanding of the problem from the comfort of my armchair.

I don't have confidence that (in the case of the EU) the same politicians that just claimed that they couldn't foresee any problems with mass production, did everything they could've done to ramp up production last summer. On the contrary the EU ordered quite late and less than they got offered from the vendors. In addition, the EU doubled the ordered doses only this January from 300M (100M of those were optional) to 600M from Biontech, after some EU member states also made additional orders. Imagine these orders would've been made in July. That might have provided the financial incentive for the vendor to e.g. ramp up an additional production line or factory in summer. I can't say whether this would have helped or not, but I certainly don't have the feeling the EU did everything they could have done to make the vaccine available as soon as possible.

My 81-year old grandparents will get their first dose of vaccine on February 28, while other countries are already vaccinating much younger people.

Imaginig that we ordered these doses in July, we would still have had close to 4 doses per person in the EU by July. Ordering more now didn't do anything ggod so far. Especially since these suppliers convientently left out when these additional doses they offered the EU would have been and will be available.

Aside from that: The US, UK and Israel have all proven that it is possible to do better than the EU here. They didn't know as well and ordered way sooner and more. AFAIR the UK even recently claimed that they vaccinated more people than the EU even in absolute numbers.

I think you'd be seeing some improvements as we are seeing some upward adjustments in production capacity projections on a 3-6 month timeframe now that everyone is spending so much to get additional doses because of political pressure, but it wouldn't be nearly enough to change the situation drastically as some have been claiming.

The thing I don't get is why not try to mass manufacture the candidates before we know they are effective? It seems the work of what drug to make was done really quickly, and most of the time is spent in the trials, and then mass production.

Maybe I missed it, but you'd think with something so devastating we'd just make a bunch of candidates, get them out to the clinics for storage, and as soon as we thought a given candidate was effective start injecting everyone?

And if a given drug doesn't work, what's a few billion?

That is exactly what happened -- governments around the world paid for pre-approval manufacturing and the pharma industry has spent the last 6-8 months ramping up production. That's the reason we have any supplies at the moment.

The truth is just that mass-manufacturing of a brand new vaccine is a hard problem. The fact that we're only a couple months from the very start of vaccinations and the world is already nearing 200 million doses delivered is, frankly, amazing. The only problem is that due to the severity of the crisis we wish we had a magic wand that gave us 10x the supply right this instant.

The good news is that manufacturing continues to ramp up dramatically. It just feels like it's slow because we're all so eager for it to improve. If you look at the month-on-month growth, though, it's clearly ramping up fast: https://covidvax.live/

10 times that!

The site you linked is really nice! Not sure where they get the numbers from, but regardless a great resource.

One of the more interessting metrics in there is "daily doses per mil", as it shows the difference between the vaccination campaigns. Would be even better if the also shwed when each campaign started.

Yeah it's an interesting visualisation of the data.

I can't personally vouch for its exact accuracy -- every government reports their metrics on a different schedule and I guess they're building realtime estimates based on that. Certainly seems reasonable enough to look at for the broad trendline.

Do you have any data/links for "ramping up production"? What exactly was done, how many doses vaccines were available at the moment of approval etc?

While there was some pre-production, I disagree that vaccine supply is the only binding constraint we have going on. And the lack of sane regulatory approvals and sane distribution setups has been heartrending.

If you look at https://www.bloomberg.com/graphics/covid-vaccine-tracker-glo... and scroll down to "U.S. Vaccination Campaign" you will see that in the US 74.5% of the vaccine doses that have been delivered have actually been used.

This could happen for a combination of two reasons, as far as I can see: either delivery is ramping up so fast that most of the delivered doses were delivered very recently, or because people are doing a terrible job of using doses that get delivered.

My impression is that the latter is a larger factor than the former, so far, based on the wide variation by state in the "Supply used" column. West Virginia has used ~96% of their supply. D.C. and Rhode Island have used only 60% (and it's not like their populations are larger or more spread out than West Virginia's!). And I should note that I can imagine various poverty-and-social-whatever issues D.C. might be facing, but they don't obviously apply to Rhode Island in the same way.

Things like http://www.arnoldkling.com/blog/virus-update-3/ item 3 are pretty common: crazy vaccine-distribution setups meaning people who want vaccines can't get signed up to get them, while vaccines are getting thrown out due to spoilage.

Things like https://www.nytimes.com/2021/02/10/us/houston-doctor-fired-c... are, I hope, not common, but you can bet that case will have a chilling effect on efforts by doctors to avoid wasting vaccines.

https://www.theguardian.com/global-development/2021/feb/14/w... includes this incredible from a major vaccine manufacturer: "Instead we have a patchwork of approvals and I have 70m doses that I can’t ship because they have been purchased but not approved. They have a shelf life of six months; these expire in April."

Does that sound like a manufacturing supply constraint to you?

Similar is https://marginalrevolution.com/marginalrevolution/2021/01/ap... where we have a vaccine, and a factory that can produce it, and the vaccine is approved in the UK, but it's not approved in the US. This is also not a supply constraint.

> And I should note that I can imagine various poverty-and-social-whatever issues D.C. might be facing, but they don't obviously apply to Rhode Island in the same way.

I don’t think this is true. Rhode Island has tremendous wealth disparity.

https://www.providencejournal.com/news/20180210/studies-inco...

I am very aware that Rhode Island has significant numbers of people in poverty, especially around Providence. I don't think it's anywhere close to DC's situation, though I could be wrong, of course.

And just to be clear, right behind DC and Rhode Island we have Alabama (OK, maybe poverty). Then just a few % above them New Hampshire, Kansas, Alaska, Pennsylvania.

These are all quite different from each other on various socio-economic and geographical axes.

And of course the states with the most successful vaccination campaigns in the US (with ~98% of vaccine supply used) are West Virginia, North Dakota, and New Mexico. Which are also quite different from each other in various socio-economic ways.

So it's hard to blame the socio-economic angle for the state-by-state disparities here, though I would be quite willing to look at data showing otherwise.

What bothers me the most, is the delay in signing the vacine contracts with Pfizer and AstraZeneca.

The US for all the criticism it can take, closed this negotiation in weeks. We spent a whopping 3 months arguing with pharma companies about price and liability before closing these contracts.

There are people dying avoidable deaths while we allowed for this inertia. There are no serious media outlets pushing the European Comission for answers on this failing. There will be no hearing to find a cause for this failing. As a very pro-european citizen this made me very bitter, there could have been a strong EU wide vaccination programme and EU transnational solidarity but instead we see this blunder that will set us back for months probably +1 year of these lockdowns and economic damage.

I imagine the US has a ton of leverage in such negotiations. Something along the lines of "give us a good price on this to make us look good or else maybe we'll actually do something about the ridiculous price gouging for medicine in this country."

No pharma exec wants to be the one that killed the golden goose.

Both the Netherlands, France and Germany, were already ready to close contracts, when the EC stepped in to do an EU wide contract. It absolutely makes sense to do an EU wide contract rather than depend on the solidarity of larger countries that order surplus.

The issue is the EC went on a panel wide long discussion to then get to more or less a carbon copy of the initial german contract. Those were 3 months wasted that could have made a difference in ramping up vaccine manufacturing.

It seems to me that, if negotiation leverage is the crucial factor here, then wouldn't the US and EU be in a similar spot?

The EU's economy is roughly the same size as the US's[0], but the EU has roughly a little over 445 million citizens compare to the US's ~330 million.

I would imagine that EU countries paying for the healthcare of 445 million citizens would be considered as quite a large "customer" for pharmaceutical companies and could strike a good deal.

How does the US get an edge in negotiations over the EU? It feels that military power wouldn't factor here, but I'm having trouble coming up with other ideas. What else could it be?

[0]: https://ec.europa.eu/eurostat/documents/2995521/10868691/2-1...

There's a limited supply. Sure, Europe could have negotiated better, or could have chosen to pay more and get more vaccine doses faster. But that just means other countries get less doses. As long as production isn't ramped up enormously, we're dealing with a zero sum game. I think we can look at countries that manage to get a sufficient supply with admiration. Envy, yes.

I agree that in Belgium things are not as well organized as they should, as usual. They should for months they were preparing and plans would be ready and working by the beginning of January. But it turned out nothing was ready, debates about who to give the vaccine first were only starting instead of being started many months before. But at this point none of that really matters: it's simply not the bottleneck. Vaccination centers are ready for thousands of people per day, but only get 100 doses.

By the way I've read and heard about calls for volunteers for hospitals and vaccination centers. Vaccination centers don't really need many people now though because of the low supply.

If Europe were willing to pay higher prices it's possible that suppliers would have built more factories. In fact given the size of the EU and it's negotiating power that could have been a requirement of the deal, especially if the deal was made at the beginning of the pandemic, so I disagree that it has to be zero sum.

Israel had a very good starting point - the 4 mandatory healthcare providers (Clalit, Maccabi, Leumit, Meukhedet), who due to a voucher system could only compete on service. They had every interest to digitize and improve efficiency over the past decade or so.

That's why they did digitize - every resident has a digital medical file, and healthcare providers can easily track and report back to Pfizer and the ministry of health on side effects and efficacy (i.e. it's easy to look up who got the vaccine and when, when they get admitted to a hospital with COVID).

healthcare providers in Israel have centralized systems/databases for at least 20 if not 30 years the only "digitization" over past decade, it's shiny websites.

You're right, the digitization effort was around 2000 or so.

But you're presenting that as somehow being bad, while it's actually better than what a lot of other countries have.

I don't present it as something bad. I adjust a timeline by a decade or so :)

And as somebody who currently resides in USA, I am well aware that it's better compared to local state of affairs

On the local level things seem to work, they're just not getting nearly enough vaccine. The machinery is there, it's just sitting idle in the parking lot.

This is a huge, enormous screw-up which can be almost entirely pinned on promoting people that have achieved nothing but failures into EU offices, the latest and most egregious case of which is Ursula von der Leyen. Guess what, when you're promoting an incompetent moron who failed at every job so far into an office with actual power and responsibility, they're going to fuck things up. Previously they'd only promote idiots to Commissioner level or so, which was already pretty bad if you ask me, but not this bad. Not "billions worth of economic and innumerable social damage"-bad.

Up to now, no one dared to task the EU with something as important, because it was always clear from the start that the EU isn't capable of handling tasks that are complex, time-critical and important. But since the production chains of most vaccines are spread all over the EU, smaller members were afraid to be left out, larger members wanted a slice of the cake for their pharmaceutical industries (i.e. France) and the current EU leader von der Leyen was promoted there by Germany's chancellor Merkel, everyone was in a position where they just had to involve the EU.

Israel has one of the best biowarfare offense and defense in the world. For them, Iran releasing a bioengineered pathogen is a legit threat. The El-Al flight that crashed in Amsterdam in 1992 was carrying materials to produce large quantities of Sarin for the purpose of testing gas masks.

Israel is specifically suited to treat COVID as a test-run for a biowarfare attack. A real War Effort, because it is one.

Actually it's the HMO system here, much more than the military. Every Israeli, by law, has healthcare insurance. It works much like income tax - deducted automatically from your pay, varies according to income level, and is transferred directly to the HMO you pick among several options which compete (quite vigorously) with each other.

Na. Lots of places have socialized medicine like Israel. Not many of them, if any of them, are having the successful rollout Israel is enjoying. The entire Israeli society is prepared for this sort of event more so than any other in the world. Civil society, healthcare (as you pointed out), military and, dare I say, even religious all work together to pull this off.

I agree with Nir, HMOs are carrying a huge amount of the load here (after the government supplying all those vaccines). You have 4 HMOs total -- one of them (Clalit) being huge -- so there's not much fragmentation; a very fast crew of health workers which allows us to reach that level of vaccinations/day; and an existing well-tested infrastructure for flu vaccines, which are in high demand each year.

I don't think the military was involved yet, and religion was in fact working against vaccination efforts as a few anti-vax rabbis drove sectors of the Haredi population off.

EDIT: Saw another comment about a person in uniform doing the immunization so I might've been wrong about the army's involvement. But either way most comments referring to military involvement mean i.e. wartime levels of involvement, military handing out gas masks door-to-door etc. We're not at the level that the army is a sizable force, from what I can tell. (Except immunizing their own soldiers of course)

It's because at every level of government Israel plans for, practices and anticipates any type of scenario from nuclear war, to chemical attack to biological warfare.

Rapidly distributing materials to the population is absolutely within the ability of the IDF and their civil counterparts. Vaccines fall into these categories. It also doesn't hurt that most of the over 18 population have been in the military and know how to follow orders. For those of you who would attribute the successful roll out to the latter, don't. It all starts with anticipating black swan events and being prepared for them.

My take on it. No one believed Trump would do it, not wanted to give him a win. So there was little upfront planning. Then the vaccine was announced and people scrambled. Here in WA, a month after they got the first vaccines they decided to open songs vaccine centers. As if it was a new idea. Why weren't these ready to go day 1? Then there is the whole mess of who gets it. Should have been strictly by age. Instead there is a huge list of who can get it. And it was supposed to be done without discrimination. But because of the long list of exceptions, it makes it easy to discriminate. Then there was the whole save the second dose... No give everything out. While there are people who want to wait, that really isn't the problem. A freezer broke here, in the middle of the night and the put it a message in social media and delivered all the vaccines within hours. The stupid thing is, if they have the vaccine just to the elderly, we could practically go back to normal in like a month...

Except for Palestinians of course where they refuse their legal duties as an occupying power to render medical aid.

https://www.cnbc.com/2021/02/03/israel-giving-5000-vaccine-d...

1) At worst, flatly false. At best, debatable. https://www.nytimes.com/2021/02/04/world/middleeast/israel-p... .

2) Generally, the Palestinian Authority can do a better job allocating its resources, uh, you know, to prepare for these sorts of events https://en.wikipedia.org/wiki/Palestinian_Authority_Martyrs_... . Of course, it goes without saying that the terrorist run enclave of Hamas-land in Gaza is another story completely, yet for the purposes of this discussion fall under agreements with the PLO, see point 1.

Under Oslo accords Palestinian Autonomy has it's own medical system. I believe they are signed up to Covax effort

Yes, this is in the article in question, after the interview of a bunch of Palestinian Middle-East Experts - unclear to me what that title stands for exactly - they also interview a Palestinian Health Ministry official at the very end of the article:

> The Palestinian Authority has not commented on the news. But up until the latest announcement, no vaccines had reached Palestinians except those living in East Jerusalem or working in the Palestinian hospitals there.

> Palestinians expect first large vaccine shipments in March

> The Palestinian Authority expects to receive its first shipments of independently-procured vaccines in March.

> Yasser Bouzia, a Palestinian Health Ministry official, told CNBC that the PA is currently finalizing a bilateral agreement with AstraZeneca for 2 million doses of its U.K.-developed vaccine. It expects to receive another 2 million vaccine doses through COVAX, a global scheme that was established to ensure equitable vaccine access globally.

> “That will cover almost the majority of the population. And after that we will look for other sources to have another almost 1 million people to be vaccinated, because we are aiming to vaccinate almost 5.2 million people,” Bouzia said.

> Until then, infections are still spreading, despite government-imposed restrictions.

they should not be denied vaccines but it seems the palestinian authority are anyway happier to shoot themselves in the foot in order to make israel look bad https://www.ynetnews.com/article/S1EnkZNjU and https://www.nytimes.com/2020/09/11/world/middleeast/annexati... and as far as not providing medical aid; https://cufi.org/issue/pa-stops-referring-palestinian-patien... [EDIT]: feel free to explain why i'm wrong to hold israel to the same standards as the PA.

The Palestinians in the west bank and Gaza have their own healthcare systems. This was part of the Oslo accords. Plus, any Israeli medic who goes to Gaza is likely to be slaughtered. They wouldn’t trust vaccines coming from Israel anyway. Decades of war and demonization have done their part.

Israel is vaccinating the Palestinian residents of east Jerusalem since they are part of the Israeli medical system.

Needless to say that the Arab citizens of Israel (20% of Israel’s population, many of whom identify as Palestinian) have full access to vaccines.

Would Palestinians accept a vaccine from Israelis? I would certainly hesitate to be injected with anything by an occupying power.

Since when has 'law' applied to Israeli behavior in Palestine?

As a Jew, it makes me feel sick to see my people treat others as subhuman. My expectation is that of generosity, open democracy, freedom of religion, respect for international law, and demilitarization, but apparently US/Israeli geostrategy is having none of that.

As an Israeli I always wonder why people who live in the US or Europe think they have some special insight into Israel/Palestine by merit of being Jewish or Muslim.

Israel is vaccinating Palestinians who are Israeli citizens. It actually runs special promotion campaigns (including the PM visiting Nazareth) because some in Arab population are reluctant to take it.

It does not vaccinate Palestinians in the Palestinian controlled areas as it has no authority to do so. Furthermore, Abbas and the PA leadership make a point of not allowing their citizens access to Israeli healthcare (though they did make sure to get vaccinated themselves).

Some time ago my wife was involved in an effort to provide life saving medical care to a Palestinian child in an Israeli hospital. The hospital waved all costs and the treating surgeon was in daily touch with her. The PA refused to allow the child entrance into Israel to receive that care. This wasn't an isolated case, it's PA policy.

I think it's an unreasonably high standard to expect Israel to vaccinate Palestanians in the occupied territories before Israelis. Going from that stance to saying (all?) Israelis treat Palestinians as subhuman is also a bit of a stretch. Are Americans treating Canadians as subhumans by not allowing Pfizer to ship vaccines from its US factory to Canada? In Judaism "the poor of your city" come first. What other country in the world is giving their bought vaccine allotment first to someone else or promoting anything that looks like worldwide equal distribution where every human on this planet has equal access?

And sure, as a fellow Jew I'd like to believe we're better than everyone else, but hey, we're not. I guess maybe better than some.

The complexity of the Palestinian/Israeli conflict can't be reduced to these simplistic terms. Anyone can take some specific incident or piece of data out of context and make their case around it, and all sides take every opportunity to do so while at the same time refusing to accept any responsibility to how they got to where things stand today.

I do hope that once Israel has finished vaccinating its population it will extend the additional vaccines to the PA and to Gaza, I think it's in their own interest and it's the right thing to do.

I think giving first priority to Israeli citizens when Palestine is under occupation is the definition of second class. There should be some kind of even distribution based on proportion of population. If they don't want the responsibility, they should withdraw barricades and forces from Palestine.

See how well that turned out in Gaza. Regardless of final status outcomes, defended borders will remain. If only the PA did not pay for slay[0] and had enough money to secure vaccines on the open market.

[0]https://en.wikipedia.org/wiki/Palestinian_Authority_Martyrs_...

>they should withdraw barricades and forces from Palestine. The oslo accords, gaza withdrawl. They were attempts to give palestinians autonomy. They were disasters. Israel need to continue occupation purely to ensure their own survival.

Isn't the vaccination distribution a zero sum game between nation states? Supply is limited. Some countries will get it sooner than others. Europe lost the bit against several other powers. Not to my surprise, I must say.

Is it zero sum? People keep saying that but if you give the suppliers more money, that allows them to scale up more and faster. It's not a given that they're just at 100 percent of their production capacity.

Actually, they do seem to be at their limit. There have been articles about this (which I merely glanced over). Scaling up manufacturing for vaccines, especially new RNA based ones, isn't something that scales infinitely with money. Not in the short or medium term, at least. In some cases, scaling up required downscaling of current production.

Searched for the well written article I've seen, to link it here, but I'm only getting SEO bullshit.

Just about any part of production that could be scaled up by throwing money at the problem has had billions of dollars flowing in its direction.

> Isn't the vaccination distribution a zero sum game between nation states?

It's complicated. Right now there are vaccines that have been purchased and produced but not delivered due to regulatory approval issues (70 million from just one manufacturer, according to https://www.theguardian.com/global-development/2021/feb/14/w... ), vaccines being delivered but not used (see https://www.bloomberg.com/graphics/covid-vaccine-tracker-glo... "Supply used" statistics), and so forth.

Blaming supply constraints is a great cover for these organizational and regulatory failings, though. "We don't have enough vaccine" sure sounds better than "we've only bothered to use 60% of the vaccine we got our hands on" (hello, Rhode Island and D.C.).

The bottleneck is vaccine production. It doesn't matter how fast you vaccinate.

Sure, Israel did a great job negotiating for vaccines, but it's a zero-sum game so only a few countries could have pulled this off.

> The bottleneck is vaccine production

Given claims like "I have 70m doses that I can’t ship because they have been purchased but not approved. They have a shelf life of six months; these expire in April." from https://www.theguardian.com/global-development/2021/feb/14/w... it seems like claiming that the bottleneck is production needs some serious caveats....

Huh, I hadn't seen this. Thanks for enlightening me.

I'm curious where these 70M doses are bought but not approved. As far as I can tell, AstraZeneca is approved all over Europe.

Unfortunately, the article doesn't make clear which exact vaccines it's discussing.

So it's entirely possible that the specific vaccines approved in Europe are supply-constrained, while other vaccines are in the situation described in the article. All that means is that saying that "the problem problem is production" is very specific-vaccine and specific-regulatory-unit dependent and needs to be evaluated carefully.

It's only a zero-sum game if more money wouldn't ramp the production up faster. This might be case but I whish people who say it's zero-sum would say why they think so.

Because nobody credible in the vaccine industry is saying "we could speed up XYZ if we had a bit more money." If they did, they'd find themselves buried under an avalanche of cash before they finished the sentence.

The story right now is one of the entire industry ramping up production as fast as they possibly can with money being no object.

I think we all in Europe are in a similar situation (based in comments of friends of different countries), so it seems to me that is not because the internal organization of delivering / injecting the vaccine but the production of it.

The production is going very slow, and therefore the rollout it's super slow...

Europe has definitely dropped the ball in terms of supply, but looking at the numbers, I can't help but feel like at least Belgium couldn't actually distribute more if it had more to distribute. Just recently the country was boasting about being ahead of its own schedule and all I can think is "if you're ahead of schedule despite all of europe being dry on supplies, your schedule sucks, doesn't it?".

It's very likely that europe failing to supply us is saving the jobs of other politicians who failed to organize us better.

Belgium is as disorganized as you can get. Most of the time over the last 20 years they didn't manage to form a government, just an endless chain of interim solutions that quickly broke apart. It shows...

There are a lot of analyses already about what has gone wrong with the European vaccine effort. It seems to be partly a mixture of being a bit stingy with procurement, being skeptical of new RNA vaccines, putting too much stock in sanofi and j&j, and requiring everything ratified by every country to proceed. In fact it was going so slowly that four countries decided to organise their own precurement, and that became the EU effort. So it seems mostly a problem of procurement/supply. A smaller country like Israel has a simpler logistical issue.

Thanks for your comment. Production and delivery of vaccines is the bottleneck. Israel is a very small country, compared to the EU.

You could be very well organised in terms of rollout and distribution. But every European country is having the same problem - shortage of production and provider's incapacity to distribute it without fail. Israel case is unique, because they payed more per vaccine, thus guaranteeing the supply needed to be able to mass vaccinate the population.

> they payed more per vaccine, thus guaranteeing the supply needed to be able to mass vaccinate

Who could have guessed that paying the right price would guarantee the supply of a rare commodity everyone would want? :)

Quite right. And on the flip side, who would have guessed that haggling down the price of a super cheap at-cost AZ dose and playing hardball on liability when everyone else was bending over backwards would result in delays and supply problems for the EU...

Who would have thought ordering twice as many doses as needed wouldn't be enough for some? And who would have thought that ordering more, and above manufacturing capacity, would reduce availability?

Overestimating doses required allows you some room for manoeuvre. Plans can change, like when the Sanofi/Merck/Pasteur vaccine tuned out to be a dud and was abandoned within the EU.

Manufacturing capacity at the continental AZ facilities have been hit by teething issues. There were also teething issues at AZ's UK facilities, but the impact was less because the order was placed three months earlier in the UK.

And yet, we're ahead of schedule here: https://www.brusselstimes.com/news/belgium-all-news/154717/a...

Like I said in another reply: if you're ahead of schedule when your supplier is dry, your schedule is awful. Isn't it? It makes no sense otherwise.

If we had 1 million vaccines to distribute right now, we couldn't. We have 150 "vaccination centers", all of which are converted testing centers but which makes only 10 percent or so of them full time; most of them are open a couple days a week. If you crunch down the numbers you end up very optimistically at the ability to distribute 250-350k vaccines per month... In a country roughly the same population as israel.

Edit: i don't even sort of understand why I'm getting downvoted for sharing plain numbers.

Israel is in a continuous state of war. It is both prepared and aware that a pandemic can disrupt your defences enough to make you an easy target. I think this played a big role in their response.

Israel has competition between several private healthcare providers. That fact makes them agile and efficient than most places in the world (e.g. Britain's NHS ). The army has nothing to do with the vaccine rollout.

That's quite irrelevant to the point. And in fact the UK are also doing very well with vaccine rollout (and the army is involved).

In Israel, where everyone has received a military training and is ready to organise, the IDF is of course very involved in the vaccine rollout though the Home Front Command. The supply of the vaccine is also controlled by the government, not private healthcare providers.

But my point was not even this. It was about how to consider the pandemic and its potential consequences as part of the internal government's discussions on how to respond and then the capacity to act quickly. I have no doubt that Israel has deemed Covid a very serious threat to national security and has thus mobilised accordingly using their experience of the de facto continuous state of war or at least high alert to organise and act quickly and effectively.

IDF isn't involved in the vaccine rollout. And if your point was right, the lockdowns in Israel would have been much more effective and on time. The reality is the the first lockdown was removed too early, and the other lockdowns started too late with lame enforcement. Everyone who watches news in Israel can tell you that.

the involvement of the health plans in periodic drills of responses to military bioterror exercises [32] have apparently honed their capacity to work with the IDF and other organizations in emergency situations.

In addition to nurses employed by the health plans, supplemental staff were recruited from the Home Front Command of the Israel Defense Forces (IDF), private companies, and others.

In the current vaccination campaign, the Home Front Command of the Israel Defense Forces (IDF) is playing several vital roles. It is responsible for ultra-cold storage of the vaccines in a central location, transporting those vaccines to a large number of vaccination sites, and also organizing vaccination sites in small localities [1]

IDF facilities have also provided 50% of all covid tests.

[1] https://ijhpr.biomedcentral.com/articles/10.1186/s13584-021-...

The fact that healthcare providers could use external staff such as IDF medics only strengthen my point. Even though is just a drop in the ocean of the vaccine task force. I haven't seen any other resource says IDF transporting the vaccines. Teva is the responsible of that and it's not an issue. Neither about anyone who is not soldier and got vaccine at IDF. The Covid tests in Israel are nothing to be proud of.

There is no such thing as "external IDF medics". If you're putting some medic in uniform you have to pull him from some healthcare provider or hospital.

Why? Some people who are recruited as medics into IDF wouldn't have thought about being medics before that. They also have to serve their Army service either way.

Those who are on active duty are... on active duty. So you have to pull someone from the reserve. So instead of doing what they are doing at normal jobs they would be doing what IDF tells them to do. And no one would be doing their normal jobs.

Right, except a IDF medic in reserve may not work in healthcare day-to-day. Similar to combat soldiers, intelligence officers and listeners -- all working a different job since they finished military service.

My mother got injected by combat medic in uniforms. You can count it as involvement in rollout

India. It is an enigma that why is India's response to Covid-19 gets ignored. India to date has vaccinated more people than Israel and has one of the least CFR per capita.

Now I will get downvotes from India, but let's try:

It is percent of population that matters not absolute number of vaccinated people. Israel is near 70%, while India is only 0.5% [1].

CFR per capita, while looks good (113.97 deaths per million) is not actually good compared to Mongolia (0.62 deaths per million)[2]. You know, who else is doing well - Belarus (195.31 deaths per million). I don't believe Belarus numbers as all countries around are burning (500+ deaths per million). Could it be that India is faking it as well? Based on corruption index [3] it is even worse than Belarus.

sources:

[1] https://ig.ft.com/coronavirus-vaccine-tracker/?areas=gbr&are...

[2] https://www.statista.com/statistics/1104709/coronavirus-deat...

[3] https://en.wikipedia.org/wiki/Corruption_Perceptions_Index

India has its own challenges since https://www.dailymail.co.uk/news/article-2325502/Map-shows-w...

> It is percent of population that matters not absolute number of vaccinated people. Israel is near 70%, while India is only 0.5% [1].

Which is more commendable considering the vastness of the land itself. Israel == Delhi and surrounding reasons.

Given the economic parameters of the country, it has better CFR than US, Italy, Germany and UK. Thats pretty amazing considering the health expenditure and wealth of US, Italy, Germany, UK is enormously high than India.

As when number fudging that is not happening.You can look at data from independent foreign houses stationed in India.

There is another elephant in the room:

* Average age in India 26.8

* Average age in countries you are comparing with is 38+

And about independent foreign houses: sources please :)

Very proud of the great success of India here. Was very worried they would have a calamity but they have managed it better than anyone else in my opinion

You're right I haven't been looking at india's numbers. I'll keep a closer eye on it from now on.

You perfectly expressed my feelings. Greetings from Germany!

From Germany here as well, I am extremely sad how the vaccine situation was handled, 3.3 percent of population over two months is an extremely bad metric, especially when the lockdown situation is being lengthened for another month.

By this rate, people won't be vaccinated by 2021.

The dashboard for Germany: https://impfdashboard.de/

It's important to not get too discouraged with "By this rate..." The rate is increasing and should continue to do so. More production capacity is coming online week by week.

Why is this getting down voted? Anti-Israel users I guess? Mad that Israel has its shit together?

I didn't vote but I wouldn't upvote a comment saying israel is doing good when they are a occupying power with first and second rate citizens. If they did good they would help the Palestinians first or equally, not let them die off.

>when they are a occupying power with first and second rate citizens. If they did good they would help the Palestinians first or equally, not let them die off.

This is objectively untrue though

There's a reason why my Israeli company won't do business with any Y Combinator company. This sentiment is common on Hacker News and across the parent organization. It comes from deep-seated hatred, and will hurt them in the end.

??? I'm pretty sure there are several YC startups with Israeli founders.

You have the European Union to blame for this, I’m afraid.

I clearly am blaming them. But I do think they're taking the hit where, had they done their job properly, several countries would be on the hot coals for not being ready to distribute appropriately.

That's a populist cheap shot thing to say I'm sorry. At least back it up with some hard numbers and facts that without EU things would have been much better. Or that the involvement of the EU lead to a worse outcome.

While I agree with the sentiment, don‘t forget the elephant in the room is vaccine supply. It‘s just not arbitrarily scaleable and most vaccination centers in my EU country are sitting around idle.

What some describe as smart moves by Israel is also rather selfish. It’s made possible by the fact that they are a rather small country that has a large support by major powers for historical reasons, but they made a pact with the devil here: They simply outbid everyone so the vaccine goes to them INSTEAD somewhere else (including Palestine). They sold all kinds of patient data on top in order to get where they are now.

Vaccinating the 100x larger EU is simply a different beast. If the EU had been as "smart" as Israel here and bid as much, don‘t forget we‘d all be stuck at 5% vaccination speaking in absolute numbers of vaccine availability.

They got the deal by quickly offering Pfizer and Moderna (not the devil) whatever they asked: More money (but ~$40 instead of ~$20 per dose is trivial, to both sides), indemnification, and data.

It's $47 per head, not per shot[1]. It seems like we didn't overpay that much.

1: https://www.jpost.com/israel-news/the-cost-of-vaccinating-is...

Israel vaccination speed is not only due to price. Israel was the first to order vaccines even before any published results. Israel is geographically small and has medium-low sized population which helps in logistics and effectiveness.

I think there was a lot of skepticism in Europe initially regarding the vaccine while in Israel the demand was very high from the get-go.

That is really smart risk management. Even if they overplayed and even if the vaccines turned out to be garbage, the price is small compared to costs of lockdowns

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