COVID-19 is here to stay, but Israel shows that boosters, masks and vaccine passports can tame the virus

It was the first country to vaccinate, the first to reopen, then the first to widely implement a booster shot. 

Now Israel is returning to life close to normal only six weeks after the peak of its worst COVID-19 wave yet.

In mid-September, new infections of the Delta variant had surpassed 10,000 per day and hospitals were groaning under the pressure.

But today, its restaurants are bustling, cinemas and theatres are packed, university lecture halls are full and the major airport is heaving.

Deaths and new infections have plummeted to the single and triple digits, and the country will be welcoming overseas tourists from November 1.

As Australia prepares to begin delivery of a third dose of the vaccine from next week, Israel's turnaround offers a glimpse into a possible future of the pandemic.

So how did the country go from a cautionary tale to a success story in less than two months? The answer lies only partially in vaccines.

Taking a gamble on COVID boosters

In August, as the Delta variant spread rapidly across Israel, driving up hospitalisations and leading to more than a thousand deaths, the government took a different path to many countries facing the same problem, including Australia.

Eschewing harsh lockdowns, it instead rolled out a mandatory booster shot to everyone over the age of 12. While masks were compulsory in certain settings, its economy remained defiantly open.

"We were faced with a crucial decision," said Professor Cyrille Cohen of Bar Ilan University, who is also a member of the Israeli government advisory panel on COVID-19 vaccines.

"Should we go back into lockdown? Should we start to think about again closing our businesses and schools? Or should we abide by another solution?"

Although Israel had become an early adopter of the Pfizer vaccine at the beginning of 2021 — thanks in large part to a deal struck between then-prime minister Benjamin Netanyahu and Pfizer CEO Albert Bourla — the data was becoming hard to ignore.

By July, a study suggested that two doses of even the most efficacious COVID vaccines were not enough to prevent infection, and their potency was fading over time.

The shot was still found to be more than 90 per cent effective in preventing disease.

But for the many Israelis who had been double-vaccinated in January, immunity had in some cases waned to just one-fifth of what it was when they were first jabbed.

Without any real-world data on the efficacy of booster shots in the wider community, the Israeli government took a fateful gamble.

In late August, the government approved a third shot as a booster for young adults and teens, and then progressively to categories of adults.

At the time, some scientists spoke against the decision, arguing it lacked clear evidence of any benefit and that the focus should instead be directed towards convincing the unvaccinated to accept their first shots.

But the gamble soon appeared to pay off. 

As the booster campaign ramped up, new Delta infections, hospitalisations and deaths began to dramatically tumble. More than a third of the Israeli population has now been triple-vaccinated.

Soon, a clear pattern began to emerge among severe cases of the disease and those dying as a result of it — they largely did not include people who had received three shots of the vaccine.

"Almost 95 to 99 per cent of the cases that we saw in the hospital here were those patients who were unvaccinated, or those patients who had not received the booster shot," said Dr David Katz, the director of the COVID-19 unit at Shaare Zedek Medical Centre, a major private hospital in Jerusalem.

As the booster campaign continues, Israel has announced it will be changing the rules around its vaccine passport or "green pass".

When the green pass program was first introduced in March, Israelis had to use the app to show proof of double vaccination in order to enter public venues like restaurants and bars or attend large gatherings.

But the definition of "fully vaccinated" has changed, so Israelis will now have to show three doses on their green passes — their original two plus a booster — in order to access the same places they did only a few months ago.

The system isn't perfect. Compliance can at times be patchy — not all businesses check for vaccination status, for example.

But Prime Minister Naftali Bennett has made it clear the system will remain for some time, telling local media, "it keeps us safe and [allows us] to keep Israel open".

Either way, the streets of Israel's cities are alive.

Ultra-orthodox Jewish couples ride packed buses, friends laze under trees in the trendy Dizengoff neighbourhood of Tel Aviv, and Palestinian children chase each other across the cobblestones of Jerusalem's ancient Old City.

A glimpse into the future

As the fourth wave tapers off in Israel, questions are now turning to the role of booster shots in the long-term life of the pandemic.

As new variants emerge and spread, will reliance on updated booster shots become the way wealthy countries manage the pandemic for many years to come?

There isn't enough data yet to decide that for sure, or even to determine if there will be a need for another dose at all, according to Professor Cohen.

"We know that scenario from other viruses, like flu — we get vaccinated every year so that you adapt the vaccine to the strain or the possible variants," he said. 

Even if Israel's booster campaign was the most important factor in so quickly overcoming the country's summer Delta surge, it's unlikely any type of booster vaccine will be able to sustain that alone, said Ron Balicer, chief innovation officer of major Israeli health fund Clalit Health Services.

A balance of mask mandates, enforcement of the green pass system and widespread testing with a combination of PCR and rapid antigen tests have also played a part.

For Australians, who have begun to emerge from some of the world's longest and harshest lockdowns as Delta swept the eastern states over winter, the Israeli experience offers some hope that lockdowns may not always be the first option governments reach for.

But one thing seems incontrovertible: while there is no silver bullet to managing COVID, vaccines remain the most important tool to doing so.

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