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Which version of the Pfizer vaccine is Israel using now?
Howard Richman, 11/21/2021

Israel was the first country in the world to inoculate the vast majority of its citizens with the Pfizer COVID-19 vaccine and the statistics were amazing. On May 6, I mistakenly reported in American Thinker:

Israel achieved herd immunity by vaccinating almost 60% of its population using the U.S.-made Pfizer vaccine. According to a chart published by Worldometer, the COVID death rate has fallen to almost zero in Israel.

But in early July, the number of COVID-19 cases in Israel started to rise exponentially. There were two theories about why this occurred:

  1. The COVID-19 virus evolved into the delta strain through natural selection because that strain avoided the antibodies created by the alpha-targeted vaccine.
  2. The vaccine simply stopped working 6 months after administration.

At the beginning of August, Israel started testing the second theory by massively administering a third dose of the same alpha-targeted Pfizer vaccine which had earlier failed. For the next month the number of COVID-19 cases continued to rise rapidly. By September 1, Israel had more confirmed cases of COVID than any other country in the world according to statistics calculated by the Daily Mail.

Fortunately, during the first two weeks of September, the rate that COVID-19 cases were rising in Israel started to slow. In mid-September the number of cases per day peaked according to statistics published by Worldometer.com. By early November, the number of COVID-19 cases in Israel had fallen back to a low level. Other countries have experienced seasonal waves of COVID-19 cases. This wave surged when Israelis were using air conditioning and receded when they would have stopped doing so.

We don't know why the Pfizer vaccine appeared to work in September after it had seemed to stop working in July. Perhaps the booster renewed the effectiveness of the alpha-targeted Pfizer vaccine. Perhaps the tailing off of air conditioning use was responsible. It is also possible that Israel switched in September to a version of the vaccine which targets the delta variant. On August 24, Israel's coronovirus czar Zarka had told Times of Israel that Israel would eventually switch to Pfizer's delta-targeted vaccine. Specifically:

Zarka said he expects that by late 2021 or early 2022, Israel will be giving shots that are especially adapted to cope better with variants.

We also know that the Pfizer's delta-targeted vaccine exists and is being tested. According to Advisory Board:

Currently, Pfizer-BioNTech is working on two reformulated vaccine candidates, one targeting the beta variant and one targeting the delta variant. According to Vox, results from the clinical trial testing the delta-specific vaccine are expected in the fourth quarter of this year.

Pfizer would be reluctant to make public any news that its delta-targeted vaccine was being used in Israel. That version has not yet been approved by the slow-moving public health bureaucracies in the United States and Europe, and Pfizer would not want to get stuck with old alpha-targeted vaccines that nobody wanted. An epidemiologist interviewed by Advisory Board suggests that this would be their motivation:

Separately, Benjamin Linas, an epidemiologist at Boston University, said another reason development of delta-specific vaccines has been slow is because public health officials and drugmakers were concerned unused doses of the original vaccines would be wasted if people only wanted "new and improved" versions of the vaccines.

Adding fuel to speculation that Israel had switched to the delta-targeted vaccine, on September 23 Pfizer Vice President Dormitzer privately told selected scientists in a Zoom call that Pfizer was using Israel as a "laboratory" to test its experimental vaccines:

Pfizer continues to refer to Israel as its laboratory in all matters relating to vaccinations, which are considered experimental. 

Did Israel start giving the delta-targeted booster to Israelis in September?  If so, we probably wouldn't know. Pfizer would not want any announcement that would diminish demand for its alpha-targeted vaccine.

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Comment by Maya, 11/24/2021:

The Delta-specific vaccines aren't being tested in Israel, certainly not in a widespread way. You have to be told if you participate in a vaccine trial, and I asked in a large coronavirus discussion group for Israel and everyone confirmed that they had received the regular Pfizer vaccine. Furthermore, the last election in Israel was extremely close, so any politician who could take credit for bringing a new and more effective vaccine to Israel would be doing so from the rooftop. Israel serves as a laboratory for Pfizer in that they have only administered Pfizer vaccines and are carefully studying the results and releasing them in a very transparent way. Ironically, Israeli days will probably prevent a Delta-specific vaccine from being widely distributed, because it shows that a booster makes the original vaccine highly effective against Delta as well. The one thing that changed in September was that middle-aged Israelis received their boosters; all my friends in Israel received their second shots then. 

Response to this comment by Maya, 11/24/2021, 11/24/2021:

Thank you for your thoughtful comments. I'm guessing that Pfizer and Israel panicked when the boosters were not working after a month of administration. Their reputations were on the line. If the switch was made quietly it wouldn't have been announced for reasons that I explained in my commentary. 

One set of statistics to watch would be the effectiveness of the boosters in the U.S. and Europe at preventing breakthrough cases. I just did a Google search and couldn't find any statistics about the number of breakthrough cases, even though about 20% of Americans have already received boosters. 

 

 

Response to this comment by Howard Richman, 11/24/2021:

Whoops, my name didn't come through. I'm the author of the other response.

Response to this comment by Maya, 11/24/2021, 11/25/2021:

Why does there need to be a conspiracy to explain this?

I don't remember the exact timeline, but over the summer Israel started recommending the booster shot. Naturally, they went from the oldest (and first vaccinated) down to lower-risk groups. It was late August before my friends who were *eager* to receive the booster received it, and then the Israeli government mandated the booster for a wide portion of the population (such as teachers). It wasn't until October when the Israeli government mandated the booster to receive the green pass to enter restaurants, movie theaters, etc. Like any country, Israel isn't set up to give the booster shot to its entire population at once, nor does the entire population willingly get the booster.

Futhermore, we all know that it takes a few weeks for the vaccines to take effect and activate the immune system. As Jesse noted, there's also a pattern to covid waves, and the sharp decline was mostly due to this particular wave playing itself out.

Basically, you don't need to propose that Israel is secretly administering a bew vaccine to its population to explain what happened. It makes perfect sense that the effects of the booster shots only began to impact numbers after a month or two.

In fact, the published findings from the Israeli booster program are probably the biggest reason why Pfizer likely WON'T be releasing a vaccine specific to the delta variant, because they show that that the original vaccine works fine with a booster. It makes no sense whatsoever to assume that Pfizer would "panic" and pretend that the original vaccine is working when it isn't-- if they could prove that everyone needs a new delta variant vaccine, they would earn more money. 

Furthermore, Israel now requires US tourists to receive the booster in the US before you would be allowed to enter Israel. If they knew that the US booster was different from the Israeli booster and that it didn't work, they would have no reason to require it and hurt their tourism numbers.

It's quite dangerous to propose conspiracy theories to explain something that doesn't require a conspiracy theory, because conspiracy theories like this one might convince vulnerable people to ignore the actual data about the benefits of getting a booster shot. The simple fact is that the Israeli data shows that getting a third Pfizer shot identical to the first two shots is essential to maintain the vaccine's protection against infection. That's exactly what they say their research shows, and this is exactly how Israel is serving as a "test lab" for the Pfizer vaccines-- they administered the first shot before everyone else, so they've also been the first to see that its effects wear off over time. 


Comment by Jesse Richman, 11/24/2021:

I think Maya's comment makes some very good points.  It's important to distinguish between two quite different things: the possibility of testing being done on alternative vaccine candidates (quite likely and I hope it is happening) and the possibility that most people in Israel are getting a reformulated vaccine without anyone knowing it (almost impossible). 

Is Pfizer testing reformulations of its vaccine aimed at improving performance against variants?  There is some evidence that it is.  And I certainly hope it is -- continued progress in vaccine design can only help improve the ability of the world to combat Covid-19 and other viruses.  So it is likely that such tests are under way on a limitted scale.  And once such tests are completed, I believe Pfizer would have EVERY incentive to trumpet them if they demonstrated success. A substantially more effective vaccine would give Pfizer a huge competitive advantage in the global competition to sell vaccines.  That advantage would outweigh by-far any costs the company might bear in the short term from the transition.  Put simply, the non-anti-vax portion of 7 billion people would be beating on their door if they had a vaccine substantially better at fighting Delta. 

However, it is exceedingly unlikely to the point of complete implausibility that most people in Israel are getting a reformulated vaccine. This would be completely at contradiction with the way vaccine development works. 

First, one ALWAYS tests the vaccine on a smaller population before extending the tests to a larger population.  Even if a very large test was being carried out in Israel right now, the number of people involved would be tiny compared to the overall population. 

Second, as Maya noted, informed consent requirements would dictate that people getting the reformulated vaccine would have to be told in some way that they were part of a study.  As Maya noted, this just hasn't happened on a nationwide scale. 

All of this makes it exceedingly unlikely that any testing of vaccines had much to do with the decline in cases Israel experienced starting in mid September.  

The tests to evaluate the Pfizer vaccine's efficacy in 2020 involved 42,000 volunteers.  That's about how many people were testing positive for Covid-19 every three or four days in Israel during the peak of its most recent surge in cases.  Vaccinating that many people with a third dose simply wouldn't have the scope or scale to account for the drop off in cases Israel has experienced since that peak.  And furtheremore, it is extremely unlikely that testing of a new vaccine would be confined to a single country.  The earlier tests were in multiple countries, and such an approach simply makes sense because virus waves come and go, and by spreading testing across multiple countries the odds of getting good data go up. 

Like you I am a social scientist who is not an epidemiologist, but it looks to my uninformed eye like the decline in cases in Israel is probably due to a combination of two primary factors.  (1) The seasonality of the virus.  Israel had a peak in 2020 that began going down at almost exactly the same time as its peak in 2021.  This suggests to me that the drop is probably partly seasonal.  Perhaps when the summer weather cools and people turn off their air conditioning, cases drop.  The same phenomenon can be seen in the Florida data for the last two years. (2) increased vaccination with the standard Pfizer vaccine as more people get their first doses, and more people get their booster doses. 

Response to this comment by Howard Richman, 11/24/2021:

I appreciate your awareness of the seasonality factor. It definitely explains why COVID cases seem to go in waves. As to testing, the delta-targeted version is hardly at all different from the original. It could be approved without testing if a country's government wanted to move quickly.


Comment by Howard Richman, 12/11/2021:

A British study regarding the sucess of boosters against the delta strain of COVID was ambiguous. In the test tube, the antibodies produced by the Pfizer vaccine booster were effective against the delta strain but much more effective against the original strain. The jury is still out on whether Israel quietly switched to a booster that was effective against delta or stayed with the original. I'm still of the opinion that they switched at the beginning of September and that is why their booster was so successful, but I may be wrong.

Response to this comment by Howard Richman, 12/11/2021, 12/17/2021:

How is "the jury still out" when literally nobody else other than you has claimed that Israel is using a booster specifically tailored to Delta? The Israeli government has been very transparent about its vaccine program, side effect, etc. 




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