Israel is a vaccination leader, but it labors to reach Arab citizens

The narrow roads of Daliyat el-Karmel, outside Haifa, were jammed on a recent afternoon.

Hundreds of Jewish Israelis had poured into the hilltop Druze town after hearing there were 900 extra doses of the COVID-19 vaccine available at a vaccination center. The perishable doses had to be used that evening, or be thrown out.

Some Druze who arrived to be vaccinated were ushered to the front of what became a long line snaking down the main street. But they were far outnumbered by their Jewish counterparts, a vivid illustration of a public health challenge facing the country.

Israel has been making international headlines as a vaccine rollout machine as it seeks to become the first country to reach communitywide immunity. But to reach that milestone, a major hurdle has to be cleared: increasing vaccination levels among its Arab minority, 20% of the population.

Indeed, while over 75% of Jewish citizens over the age of 60 have already been vaccinated, the figure among Arabs is just 43%.

Changing those numbers is less a logistical challenge than it is one of persuasion.

Some Israeli Arabs are avoiding vaccination centers because of rumors on social media fueling mistrust of the vaccine’s safety and efficacy. Others are deterred by conspiracy theories about the Israeli authorities, in whom trust is already shaky due to years of systemic discrimination.

Still others deny that COVID-19 is even a problem.

The phenomenon appears somewhat surprising, given that a growing number of Israeli Arabs work in health care, representing nearly a fifth of the country’s doctors, 24% of its nurses, and 48% of all pharmacists, government data show.

Reduced access to health clinics, especially for Bedouin Arabs in southern Israel, many of whom are scattered in tiny shantytowns that lack basic services, also contributes to the lower numbers.

Among the Bedouin, who have to travel to nearby towns and cities to get vaccinated, the vaccination rate for those over 60 is close to 20%.

Drafting Arab doctors

Now, however, three weeks into the vaccination push, the numbers of Israeli Arabs getting vaccinated have begun to rise, as a public awareness campaign tapping religious leaders and other “influencers” from the Arab community – from professional soccer players to lawmakers and doctors – gains momentum.

Their message, in photographs of themselves getting vaccinated, is this: Arab citizens have nothing to fear. Get your vaccine, just as we have.

Bishar Bisharat, a family doctor and public health specialist who chairs the Society for Arab Health within the Israeli Medical Association, says seeing Arab physicians getting vaccinated is especially important.

“Patients know their family doctors in Arab villages and towns. They know where they live, and how they behave,” he says. “They see them as role models.”

Not enough of the doctors, however, are speaking up, says Dr. Bisharat. He and other public health officials note that there is wariness about the vaccine even among the physicians, most of whom are not experts in the field and can fall prey to some of the same rumors circulating among their friends and family.

To help remedy that and increase the ranks of advocates, he’s preparing a nationwide forum to educate and mobilize Arab doctors.

As in other parts of the world, higher rates of poverty and lower levels of education can lead to what public health officials term low “health literacy.”

Among Israel’s Arab minority, that phenomenon combines with a contentious history with the Jewish majority to create a public mindset more receptive to conspiracy theories.

Rumors raging online range from an international favorite – that the vaccine is a ruse by Microsoft founder Bill Gates to implant trackable microchips – to suspicions that the vaccine will make people infertile.

Nadav Davidovitch, director of Ben-Gurion University’s School of Public Health, notes that Israel’s Arab citizens are among the most highly vaccinated groups in the country for other vaccines, so the pushback is not borne of anti-vaccination tendencies.

“It’s more specifically about COVID-19, and rumors around it being developed so fast and the consequences for fertility. So those are the main issues that need to be addressed,” says Dr. Davidovitch, who is on Israel’s national advisory committee for COVID-19.

Vaccinating Palestinians

Even as Israel wrestles with how to persuade its Arab citizens to get vaccinated, it faces calls to ensure that Palestinians in the West Bank and Gaza are covered as well.

Israel maintains that the health of the Palestinian population is the responsibility of the Palestinian Authority. Critics of this policy, including Israeli human rights groups, counter that Israel has a moral obligation to vaccinate Palestinians, arguing that ultimately they still live under its control.

There has been no official Palestinian request to Israel. Officials say they are expecting their first vaccine shipments to arrive by the end of February.

On Thursday Israel announced it would vaccinate Palestinian inmates in Israeli prisons.

Palestinians living in East Jerusalem, meanwhile, have health insurance through Israel’s socialized health system, and have access to its vaccination program. But suspicion of Israeli authorities runs high, and conspiracy theories are rampant.

Dr. Dima Bitar, who runs an East Jerusalem clinic of Clalit, Israel’s largest HMO, says every day brings new “fake news,” as she puts it.

“Are you sure we are taking the same vaccines as the Jews? Is it coming from the same vials?” people ask her. They fear that Jewish Israelis are getting the real vaccine, but that they might be getting one that at best is experimental, or at worst is intentionally lethal.

“And that’s just what I heard today,” she says, sounding frazzled as she sits in her office, interrupted every few moments with queries from patients and staff.

“The fact that we have Jews coming to the clinic for vaccinations has actually helped Arabs get vaccinated too,” she says, saying it boosts confidence in the vaccine among local residents.

One doctor’s campaign 

When Dr. Riad Majadla, head of the coronavirus ward at Sharon Hospital in central Israel, gets home to his town of Baka al-Gharbiya every night at 8, he starts a second shift of sorts. He answers the 250 to 300 messages and texts he’s received over the day from Arab citizens across the country asking about the virus, and more recently about the vaccine.

He reads out loud a couple that have just come through: “I’m 72. I have heart disease and diabetes. Can I vaccinate?” Another asks: “I’m four months pregnant, should I vaccinate?” His answer to both of them, he says, will be “yes.”

Dr. Majadla is one of five physicians in his family – all of whom have been on the front lines of fighting the virus. When he saw that only a trickle of those Arabs eligible for the first round were being vaccinated, he decided to do something.

Following on a public health education campaign he waged at the beginning of the crisis, in which he encouraged preventive behavior, he went back to speaking out on the radio and posting live videos on Facebook explaining why and how the vaccine is safe and works.

Dr. Majadla is now seeing more acceptance of the vaccine on his Facebook page, mixed in with a minority of voices who deride him as a “collaborator” with the Israeli state.

But overall, he boasts, the reaction is positive: “Fingers crossed, we are on the right track.”