Vaccine Bartering: Israel’s real-world evidence exchange with Pfizer

In the global race to secure COVID-19 vaccines, Israel, the 100th most populous country behind Papua New Guinea and Serbia, is the world leader in COVID-19 vaccine doses administered per capita. In a span of just 7 weeks, Israel, to date, has administered a total of 5.3 million doses, inoculated nearly approximately 30% of its total population, and 80% of citizens 60 years of age and older. In context, Israel has administered 58.9 doses per 100 residents, far exceeding the UK’s 16.5 doses and the US’s 10.6 doses. Which begs the question, how exactly has Israel beat out these bigger countries in the race to secure the coveted COVID-19 vaccine supply?

Israel struck a unique deal with Pfizer – vaccines for health data. On January 7, 2021, it was announced that Israel made an agreement with Pfizer to expedite deliveries of its COVID-19 vaccines so that all citizens over 16 years of age can be inoculated by the end of March 2021 in return for the health data of citizens taking part in the vaccination program. Formally named the “Real-World Epidemiological Evidence Collaboration Agreement,” the deal describes that the Project’s objective is to “measure and analyze epidemiological data arising from the Product [Pfizer-manufactured vaccines] rollout, to determine whether herd immunity is achieved after reaching a certain percentage of vaccination coverage in Israel.” As part of this collaboration, the agreement stipulates that Israel’s Ministry of Health will “use its best efforts to ensure timely reporting [of Project Data] to Pfizer” and “will assure rapid distribution, deployment, and use of the Product.”  In exchange, the Ministry is “relying on receipt of Product doses […] and on the product delivery rate by Pfizer to allow maintaining vaccination rate sufficient to achieving herd immunity and enough data as soon as possible.” Beyond this, however, the exact bargain between Israel and Pfizer is unclear.

As one can imagine, this agreement has instigated fierce debate in Israel among data privacy experts, researchers, and citizens weighing the potential benefits of having highly valuable real-world evidence on vaccination efficacy against the potential abuse of millions of personal medical records. The only solace the agreement offers is in its limited definition of “Project Data” (defined as any de-identified data provided by the Ministry of Health to Pfizer in the framework of the Project) and a 7 item list of the governing regulations concerning data use. Understandably, critics question why the agreement made no mention of what measures Pfizer is taking to keep the data secure or that Pfizer’s use of the data is limited to studying the effects of the COVID-19 vaccine.

Despite engaging in this novel arrangement, Israel is not new to the big data scene. Israeli health plans utilize a universal electronic medical record system and cover about 98% of the population. Although operating independently, Israel’s four HMOs and their affiliated hospitals have for the past two decades used the same electronic medical records platform, with access to patient records available at each point of care as needed. To Pfizer’s delight, this has resulted in a wealth of data about patients, conditions, and treatments. But Israel’s privacy and data protection laws, the same named in the agreement, fall behind those of the surrounding EU, allowing for much more latitude in the use and disclosure of its citizens’ data.

Although we cannot predict if and how Israeli’s health data will be used by Pfizer, or if a precedent has been set encouraging less-wealthy countries to trade citizen privacy for pharmaceuticals, we do know that Israel’s rapid vaccination roll-out (as a result of this agreement) appears to be working – Cases and hospital admissions in Israel are falling steeply among vaccinated age groups. Data collected by Israel’s Ministry of Health show that there was a 41% drop in confirmed COVID-19 infections in that age group and a 31% drop in hospitalizations from mid-January to early February.