International comparisons shed light on responses to pandemic and strategies for vaccination and reopening.
TPG International Health Academy (TPG-IHA) hosted its second virtual educational health summit for health plan and provider leadership on March 31, 2021. The summit focused on how Israel, Canada and Japan responded to COVID-19 pandemic over the past year. The international comparisons provided insight into vaccination strategies, strategies for dealing with the emerging variants, and lasting effects of the pandemic on the healthcare sector and other aspects of society.
Nadav Davidovitch, M.D., Ph.D., M.P.H., director of the School of Public Health at Ben-Gurion University of the Negev, Michal Laron, Ph.D., a senior researcher at the Myers-JDC-Brookdale Institute in Jerusalem, and Bruce Rosen, M.D., director of the systems research group at Myers-JDC-Brookdale, provided information and perspective from Israel. Elizabeth Keller, business development executive for Amazon Web Services, was the Canadian presenter, and Sayaka Hikida, M.D., an infectious disease emergency specialist trainee at the Ministry of Health, Labor and Welfare, shared insights from Japan.
Data published by John Hopkins Coronavirus Resource Center for the period starting March of last year through April of this year show striking differences in COVID-19 cases, deaths and vaccination among Canada, Israel, Japan, and the United States. On a per capita basis, Israel experienced some of the highest case rates in the world as it experienced three, increasingly larger distinct waves of the pandemic. Cases per capita were slightly less in United States and significantly lower in Canada and Japan. But the United States had far many more COVID-19 deaths on a per capita basis than the other three countries, notwithstanding the declining numbers over the past three months.
How has your country responded to COVID-19, and what strategies are there for vaccinations and re-opening?
Davidovitch: Israel started out with the highest rate of per capita cases, so we went into countrywide shutdown and dedicated 80% of our healthcare system to treating COVID-19 cases. This resulted in a significant decline in cases.Unfortunately, we opened too soon, which resulted in a second, larger and more deadly wave. At that point, Israel decentralized much of the management of COVID to the four health plans in the country with each assuming responsibility for testing, education and vaccinations. Not long after exiting the second lockdown, the country celebrated the High Holidays which many of us feared would open the door for a third wave, which it did. At that point, the government instituted a mass polymerase chain reaction (PCR) testing process to determine the extent of variant strains of COVID-19 to better target prevention and treatment efforts and vaccination priorities. As soon as vaccines were available, they were administered using these priorities and as of April 1, over half of the population is vaccinated, and we are beginning to plan for a “new normal.”
We also implemented a “Green Passport” that would allow people who have been vaccinated to attend various cultural and sporting events, and this has served as a “reward” for people getting the vaccine.
Going forward, we need to focus on the genetic typing of COVID variants to manage them and we need to increase international cooperation if we are going to be successful in getting through this, and future, pandemics.
Laron: The impact of COVID-19 and the subsequent lockdowns has had a significant impact on the behavioral health of Israelis. Many people reported eating more, with an average weight gain of seven pounds during the last year, exercising less and, particularly with children, spending more time watching screens. Reports of depression and a feeling of loneliness were also much higher than normal.
On the positive side, people were eating as a family more often and using telemedicine services at a much higher rate. With the opening of workplaces, schools and restaurants, there is a general concern about interactions in closed spaces with people who have not [been], or do not plan to be, vaccinated as we try to move to the new normal.
Rosen: I would like to comment on an article in the March 30, 2021, New York Times that showed a very optimistic perspective on how quickly the U.S. population would get to a 90% vaccination rate. I believe that is far too optimistic, based on Israel’s experience. Vaccination resistance is real. I think we need to work on outreach and education to those who are hesitant but I don’t believe that we’ll get to a 90% vaccination rate.
Keller: Like Israel, we shut down, but Canada has remained mostly shut down since the beginning (of the pandemic). Nothing is the same as it was prior to March 2020. Our company works with 40,000 physicians, who had to go through training very quickly to do much of their work through telehealth. Keeping people at home had a great impact on the incidence of COVID-19 and the number of deaths. I attribute the ability of Canadians to comply with stay-at-home orders and other preventive measures to our “obedient” nature where we defer to the government. Initially, we did a poor job of preparing, though we knew COVID-19 was coming. We also did a poor job of managing COVID in long-term care facilities and among the aged. We continue to do a poor job of contact tracing, which would allow us to better control the disease's spread. Our vaccination rollout has been slow, as we do not manufacture the vaccine in Canada, and are reliant on other countries for it.
On the positive side, there has been significant economic support from the government, which should lessen financial pressure on Canadians.
There has also been a high usage of telehealth visits with 80% of Canadians receiving at least one visit during the year. Going forward, I’m concerned about the long-term impact of the shutdowns on delayed medical procedures and the education of our youth.
Hikida: While the number of cases and deaths related to COVID-19 is much lower in Japan than most other countries, we have experienced three distinct waves and are concerned that we are now entering a fourth wave.
The focus in our country has been on contact tracing and having anyone entering the country go through a quarantine period. We began our vaccination efforts during the middle of February and, as of the end of March, have vaccinated less than 1% of the population. Currently only healthcare workers are eligible for the vaccination.
I attribute the response of Japanese citizens to COVID-19 preventive measures to three things. The first was the immediate quarantine of the passengers on the Diamond Princess cruise ship when it was docked at the Yokohama port in Japan. COVID-19 was rampant among the passengers, and the Japanese government issued an emergency declaration that the disease was a severe threat to the population. The next was the death in March 2020 of the famous Japanese comedian, Ken Shimura, from COVID. Finally, the postponement of the 2020 Tokyo Olympics added to how serious the government and people approached the disease. However, despite the seriousness of the disease, there were some people who violated the quarantine, and this resulted in the different waves of the cases in the country.
I don’t believe that the Japanese will have a vaccine passport because we do not want to discriminate against people who can’t or don’t want the vaccine. We hope to have enough of a vaccine supply to allow everyone who wants it to get vaccinated by the end of the summer. As of now, the government is going ahead with the Summer Olympics, which are scheduled to start on July 23, although that decision is proving to be a controversial one.
Perry Cohen is CEO of The Pharmacy Group and the TPG Family of Companies and a member of the Managed Healthcare Executive® editorial advisory board. TPG International Health Academy (TPG-IHA) hosts educational summits around the world for U.S. healthcare executives about healthcare conditions and systems in other countries. Future summits, both virtual and in-person, will focus on Estonia, Italy and Japan.