Call Me Back - with Dan Senor - Vaccination Nation: Is our Post Corona future unfolding now in Israel?

Episode Date: March 5, 2021

To learn more about 'Vaccination Nation' visit startupnationcentral.org

An mRNA-based vaccine, which is now obvious. A year ago, if you'd spoken to any expert, they would have said 2030 at best, 2035 at best. And here we are on the podcast talking about this as a very kind of obvious thing. It is anything but obvious. If this disease struck 10 years ago, not 100 years ago, we wouldn't have been talking about 42 days.

Welcome to Post-Corona, where we try to understand COVID-19's lasting impact on the economy, culture, and geopolitics. I'm Dan Senor. Is our post-corona future playing out right now in Israel? So far, more than 70% of Israelis age 16 and older have received at least one dose of the vaccine, and many of them two jabs, including my nieces, my sisters, and my mother in Jerusalem. How has Israel done this? Well, Israel's prime minister negotiated with Pfizer to obtain millions of vaccine doses early. Israel paid a premium for this upfront supply, but also agreed to provide

the company with indispensable clinical data, made possible by Israel's robust digital health infrastructure. Now the Prime Minister has set a goal of getting Israel's economy completely reopened by the spring. What have we learned so far from Israel's experience? Hospitalization rates and death rates of seriously ill patients are already declining. According to a new study from Clalit, one of Israel's health funds, fully vaccinated people are 90% less likely to develop severe cases of the disease, and virus transmission is coming down too. So now Israel is dealing with a range of new economic and societal issues as it enters the post-corona phase. To explain what may be heading our way, we have Yonatan Adiri returning

to our podcast. Yonatan is the founder and CEO of Tel Aviv digital health startup Healthy.io. He was also a top technology and diplomatic advisor to then-president Shimon Peres. Has Israel become the world's post-corona laboratory? What can we expect over here from what Israelis are learning over there? This is Post-Corona. Yonatan, welcome back to the podcast. Hey, Dan, great to be back. You're like the, I was telling you over the weekend, you're like the Alec Baldwin of the Post-Corona podcast. Let's hope it's all around good news. Yeah, the fans are demanding more Yon jonathan so we bring back what the fans want the market speaks so jonathan when we last got together on this podcast which was early january

of this year you did two things one you provided tutorial on how is Israel was dealing with the vaccination campaign, what we in that episode, where we coined the term vaccination nation, I'm proud to say. And you also made some bold predictions about how Israel would lead the world in vaccinations and the world would learn a lot from Israel. So before we get into a number of the issues we want to talk about in terms of what the world is actually learning or what the world could be seeing based on the trailer that is Israel Now, first tell us, where is Israel at now? Here we are at the beginning of March 2021, so something like two and a half months since we last spoke. What's happened? So I think first let's recap what we thought back in late December would be the, I would

say, the crux of the Israeli vaccine administration effort. One is the foundational digital element of it, which is beyond how many people get vaccinated, is the fact that every vaccination is associated with a full-fledged electronic medical record that has 20 years of patient data. And so there was a lot to learn about the very fundamental operation of disseminating vaccines, like how long are the lines, the digital appointments and all that. There's the element we discussed on, you know, how can Israel help the world figure out through real-time data in orders of magnitude multiples on the amount of people that were in the clinical trial, is it safe and is it efficient? And there's a lot to talk about right now on that.

And also, you know, that being a great case study for mRNA future drug development that is not just a COVID vaccine. So kind of looking back, we predicted in late December that Israel by mid-March would be at around 70% of all its eligible population vaccinated, and in about 50% of total population, that is, you know, including the people under 16, vaccinated by the second dose already, and had crossed the 80 to 85% vaccination rate for all those at risk. So people over 60 and people with chronic conditions. Glad to report back to you and to our listeners that that prediction has been met and even greater than that. We're at that point already, 70% of all the eligible communities have been

vaccinated with the first dose, 50% with the second, and we're at about 90% of all those at risk. As anticipated, that did indeed deliver a significant reduction in mortality among these groups. And you can actually, I mean, the Israelis... And a reduction in hospitalizations, right? Exactly. I think that's important, right? Because ultimately the whole solidarity effort here is to keep our healthcare system intact so that, you know, normal people can go and get treated, you know, outside of the corona challenge, you know, pregnant women, birth, cancer treatments, and so on and so forth. And in that sense, we're seeing really phenomenal results when it comes to the vaccine. We're

seeing also how the data correlates with the populations that got vaccinated indeed. And just the mood in the country, describe the user experience, if you will, the patient experience for any Israeli that is eligible and wants a vaccine. You made a bold prediction when we last spoke about how easy it would be for anyone who's eligible, who wants a vaccine. It would be a very user-friendly experience. Has that borne out? So a couple of funny stories here. Three weeks ago, I went to get my second dose, and I did it at a hospital instead of my local HMO, which usually takes about 12 minutes at the HMO. And that's the storyboard nationwide. Everybody's like, oh, this is like, I go in, I go out, it's a 10 minute thing. And I'm sitting there and it's all digitally managed. It took about 50 minutes, right? Like less than an hour. And there was a lady there who came in and complained that this is taking an hour, right? And so anecdotally, and then, you know, this is like, it's such an absurd that this is taking more than 10 minutes that people got used to the fact that you're in, you're out, it's a digital appointment.

And, you know, 10 minutes later, you get a text message. 48 hours later, you get prompted by the app. Do you have like, you know, side effects? Everybody got used to this digital envelope throughout those three to four weeks and collects the data in a way that helps other people, you know, prepare. The second anecdote, which I think is another great example of, you know, how those law of unintended consequences, you know, you can do 50 to 60%, but then it becomes a bit harder. Within the population at risk, people over 60, there is a subgroup of people who are geriatric and are actually being treated at home.

Sorry, it's not so easy to get them into the vaccine station. And, you know, a lot of people have tried to figure out how do we vaccinate them? They're at high risk. And one of the most beautiful example of creativity, solidarity, and technology, the decision was made that we, you know, when a person of that specific situation signs up for a vaccine, we bring the vaccine to their home, but we don't want to miss out on six vials, right? Sorry, on six doses from the single vial. So there has been an effort whereby this person calls his neighbors and his house becomes an ad hoc, you know, nano vaccination station, right?

So that, you know, he gets, he or she, they get vaccinated and five more people get vaccinated around them who could otherwise have gone to their local HMO, but now they get vaccinated at home thanks to their neighbor who's, you know, most likely in his, you know, mid 80s, et cetera. So I think these are two like good anecdotes that show you like to the extent we made that the baseline is a 10 minute thing set up via app, you know, encompassing already 5 million people in the last eight weeks. And so if it goes beyond the 15 minutes, it's a complaint already. And we don't

forget about the frail and elderly and we try to be creative around you know those nano stations again enabled by digital but also i think by the creativity and the solidarity of the hmo uh teams and it's i also heard some stories my mother was telling me she there were these stories about like how they're motivating trying to motivate young young adult israelis to get vaccinated so doing things around bars you go to a bar or near a bar and you get a if you if you get a shot in the arm you get a shot down the throat a shot in a shot exactly as you progress the you know it's kind of like any other product right there's an early adopter and then there's that chasm, right? How do you break the chasm for the last 20%?

That 20% is distrusting. That 20% has a lot of issues. And the government and the system made a great effort of being very creative. Some of it had to do with like serving dinner at the, you know, Chulint for the Orthodox, Kanafe for the Arab population. How do I sort of turn this into a social event? There's been a lot of creativity around that. How do I get to the entrance to the Shuk, to the market with a mobile station? How do I convert a blood donation van

into a vaccine station? And in that sense, I think, you know, it's still not fully there. I think we're missing on, you know, groups of the population, but we're getting there. But that big part of that, it sounds like is empowering local leaders in these communities to figure out how to, you know, what will work in those local communities. It's interesting, the U.S.,

where the success of the vaccination campaign has been very uneven at best, where it has worked in places like West Virginia and Alaska, for instance, and other states too, the empowerment of local leaders within local communities to make decisions about what will work in that community to trigger enthusiasm for taking up the vaccine has proven to be successful. Okay, the New England Journal of Medicine just came out with, just published a big peer-reviewed piece authored by a number of Harvard epidemiologists and other experts. Why was this piece such a big deal? And what was the big takeaway?

So if you remember, and our listeners, if you remember, you know, last time we said that this is going to be interesting because every vaccine is going to be entered into an EMR. So we could actually potentially- An electronic medical report. Yeah, yeah. So potentially, you know, with every day having about 150,000 people vaccinated,

we can really have a time series of half a million people within three weeks and create a digital version of a clinical trial with a control group and a live group and actually have the people under control really have almost identical characteristics of those who got the vaccine. And just to be clear, in the clinical trials, the control group was about 40,000 people. So off the bat, you're at 10 to 12x the size, and then continue. And in doing a trial like that, what you're trying to do is control variants so that the impact will got the vaccine, except for the fact that this one got a vaccine and this one still hasn't. So they use the time series of those who still haven't been vaccinated.

So they basically compared Jane Doe, who's 55 and has diabetes, to Jane Doe, number two on the control, who didn't take the vaccine yet and has the same comorbidities, lives more or less within a mile radius of the one receiving the vaccine. So the difference in disease... And they can get really granular. Exactly. Like Jane Doe lives their life this way. Jane Doe has this many children.

Jane Doe is obviously life this way. Jane Doe has this many children. Jane Doe is obviously this age. That's what 20 years of digital data on health delivers to you at a very, I don't want to say easy, but a very accessible way to run a trial like that. and it is unequivocal that both efficiency and safety of the Pfizer vaccine has been, you know, effective in the wild, if you will. And this is the first peer-reviewed evidence at that scale that gets published. And really, we, in our original conversation, have predicted that this will come out very, very quickly. So, I mean, just to give you a sense, this was published last week after peer-reviewed, being peer-reviewed, which means probably the data was delivered in late January, right?

That's, you know, six weeks since vaccine number one was administered. This is unprecedented historically. You know, this is in line with humanity taking 42 days to develop the compound of mRNA for the vaccine. You know, we've risen to this challenge as a humanity within 42 days. And we've been able to deliver this study that proves efficiency and safety in the wild within six weeks, or let's call it also order magnitude 40 days.

I think that's just, you know, a phenomenal human achievement. I'm overall, you know, clearly many people have lost their lives, their livelihood. There's no reason to be, you know, joyful. But I think this is a clear message of the light at the end of the tunnel. This is a clear message that the light at the end of the tunnel. This is a clear message that this is within our reach. This is within the reach of the scientific community. And it is within a reach of a healthcare delivery system that knows how to, per your point from before, be hyper localized and delivering in a local setting. We're going to talk about what Israel is seeing that the rest of the world is probably going to see in a few months, what Israel's seeing now.

But just broadly on the scientific community globally, there seems to be something extraordinary that we've learned about how we develop vaccines, specifically messenger RNA, mRNA. And so can you just explain why this is, why at least the vaccine development process during coronavirus is such a breakthrough? Because just before coronavirus, think polio, think measles, if you want to develop a vaccine you you had to get a culture of it and and develop basically a diluted version of it to and it would take something like 10 years to develop and then months to manufacture but in this particular case with coronavirus

they never actually worked at least with Pfizer they never worked with the live virus. They got the genetic code from the virus, which is just data, and it essentially got emailed to the researchers to put it into their program, and then that led to the manufacturing, which, as you said, took 42 days rather than 10 years. Yeah, and I think there are three things that are phenomenal here that we need to really kind of keep in mind. The first is that this is the first time that, you know, humanity responds by upgrading the immune system while the virus is at its peak mutation rate. You talked about measles or smallpox or whatever. We usually would have developed

or have developed a vaccine after tens of millions of people died already. So the virus has already reached its peak. It reached the optimal point, killed tens of millions of people, and then we developed a vaccine. This is the first time in history we're doing that in parallel.

That's the first thing I think we need to be very proud of as humanity. That's the first thing, like we're doing this in parallel in the first time. The second piece, and that relates to, you know, think about it. 10 years ago, how much would it cost you to send a text message, right? Text message 10 years ago, right? iPhone 3, right? If this disease struck 10 years ago, not 100 years ago, we wouldn't have been talking about 42 days. The state of affairs of AI, of computational biology, pre-CRISPR, early days immunology, very low AI capability, very low computation, almost no cloud to speak about, bandwidth, high resolution, like all the things we take for granted, right?

And to quote Jeff Bezos from his, not resignation, I would say the reposition letter from a few weeks ago, he said one of the greatest things he has done in Amazon was how quickly his radical innovation has become obvious. And I think this is what we're seeing right now, like an mRNA-based vaccine, which is now obvious. A year ago, January, February 2020, if you'd spoken to any expert, they would have said 2030 at best, 2035 at best. And here we are on the podcast talking about this as a very kind of obvious thing. It is anything but obvious. And again, this is something that 10 years ago would have been a mere impossibility.

There have been breakthroughs in immunology, there have been breakthroughs in, you know, CAR T treatments, it's not like this, the field hasn't emerged. But doing that so rapidly so efficiently is something that has become you know uh possible only in the last three to four years at this cost effectiveness you know you you you i was recently rereading mark andreessen's famous essay software eats the world which is you know he wrote about 10 years ago and it relates in a sense to exactly what you're talking about right because because this this is almost like mrna allows us to treat vaccine development and updates to vaccines as software development it's like this could lead to a future where vax development and therapeutic development is is happening on people's laptops.

Like you basically have whiz kids working on laptops doing these updates. The fact that the FDA last week already spoke favorably of should there be mutations that will warrant a, if you will, an upgrade for the mRNA in the existing vaccines, it will look upon it favorably as a software update, so to speak, as opposed to a full clinical trial, 30,000 people, efficacy, et cetera. So we're at the point that also the regulator has adopted a view whereby this method is safe. We need to make sure that what you put in the quote-unquote container is safe. It's like FDA, like NTSB, it regulates the truck, and then somebody else regulates what's inside the truck, right?

Like if it's meat, it needs to be refrigerated, whatever, but the truck is regulated by it. So FDA is slowly and gradually adopting a view about mRNA that we've approved the truck, so to speak. Now, whatever you put in that container, we need to assess that, but the method has been established. And if that will indeed be the case, I think we're going to see some radical bioinformatics, you know, arriving into the treatment space. And ultimately, I think we will have found out five years from now that there has been an enormous acceleration of cure because of what we've seen with the mRNA vaccine.

And that, to a large degree, thanks to that study that you've just discussed in the New England Journal of Medicine, I think that goes far beyond the 30,000 people EUA approval from the FDA. This is in the wild. When we last spoke, we talked about, you know, can Israel get most of its population vaccinated quickly and before the rest of the world? Then if yes, what was Israel going to learn from all this data from a vaccinated population, which you just talked about? And now we actually, because of how fast moving Israel is, we take those two issues for granted. And now Israeli society is into the thick of a whole bunch of complicated legal and societal issues about how they govern a mostly vaccinated population. Can you, because that's heading our way.

This is heading to the West. So tell us what you're seeing in Israel. So I think there are three important, I would say, unintended consequences that, you know, quite frankly, personally, I did not anticipate back in December. The first is as we crossed a certain threshold among the at-risk population, and there was a bit of a reduction in the panic phase, right? It was like, this is under control. There started to be a conversation around the legal elements related to, okay, what do we do with people who don't get vaccinated, right?

As we emerge out of this crisis somewhere in April, and this is early January conversation, as this thing became, you know, there were a lot of doubts in early January. But as those doubts kind of, as that cloud, you know, evaporated, the conversation shifted into the idea of the green passport, right? We're going to start sporting events. And this is happening right now as we speak, sporting events, cultural events, based on- So explain what the green passport is.

So the whole idea behind the vaccination is that it ultimately allows for us to go back to normal, to normal education, you know, commerce, culture, et cetera. How do we do that? Every person who got vaccinated twice, and it's been two, it's been a week since the second vaccination, uh, receives a form of ID that grants him or her the, the right to participate in closed audience, uh, events, like again, sporting events, et cetera, cultural events, and also going to work in closed audience events, like, again, sporting events, et cetera, cultural events, and also going to work in kind of recovering the economy. Depends on that.

I never thought in December that the conversation would get to the point that this is a discriminatory element, that we must not ask people whether or not they've been vaccinated, right? Don't single me out. Like, I want to choose if I get vaccinated, don't peer pressure me, etc. And so that is something that, you know, I did not anticipate.

I think that overall, when you look at the numbers, we're steady at 150,000 vaccinated per day. I mean, the effort isn't really shifting, but, you know, the media and the kind of public discourse highlights, you know, these type of provocations. And the jury's still out on how well we're going to deal with that. And I think it's a very fine line, right? You want to allow people to make that choice. But you want to also communicate to them that, you know, much like it looks very weird to us right now that someone will go into a bar and smoke, right? Because they're impacting us. You're not telling that person don't smoke.

Just don't smoke in an area where that poses a risk. And there are certain things you can't do when you smoke. I think we're going to try to reach that point of equilibrium. But it is something that I didn't anticipate at that volume and at that scale. That said, when you look at it from the bird's eye view, most people get vaccinated. The second thing we didn't anticipate, and I think it's related to the first one, is that averages aren't going to matter, right? It's sort of like the death of the average, if you will. We're used to measuring populations by the average person who gets vaccinated and kind of all the policy tools are not personalized,

they're aimed at, you know, average, you know, shmuel. The death of the average is very important here because we have anticipated that once we get 70% of the people vaccinated, you know, Shmuel, the death of the average is very important here, because we have anticipated that once we get 70% of the people vaccinated, you know, just to kind of keep it simple, 70% of market activity will go back. And that is not the case. Because there are certain populations that kind of lopsided the average. So you have 80% on average, but there is a whole population that's like at 30%, which is a certain part of the Arab population, the Bedouin population, right? Or a certain profession. So it's not enough to have 70% because if teachers and teacher assistants don't get

vaccinated, and the fact that the average person did, you know, doesn't really matter for the extent to which we can have an economic recovery. And we're seeing that right now. Exactly. Exactly. And so hotel workers fall into the 30%, it could decimate an industry. Exactly. Exactly. And that, when you kind of connect that to the issue of like human rights and not forcing

people to vaccinate, those two conflate and they create a real issue. And I think, you know, decision makers, policymakers, and the ads that you were referring to earlier are trying to target that issue with great tact, you know. And it's important not to kind of push people, you know, away and to allow for that level of sovereignty for people, you know, it's their body but also signaling the uh the the price that people around them are paying again i sort of see that as like the smoking the non-smoking kind of i remember i mean growing up it was a thing you could when you fly a plane someone there were people who could book smoking section yeah as though like smokers had rights on planes they

could have their own seating section and then it like, we don't care how addicted you are to tobacco and nicotine. If you want to smoke, you can't fly. So, you know, that process took probably, I don't know, 25 years. I'm too young to sort of have experienced that. Probably took 20 to 25 years, right? The evidence, whatever. We're experiencing all of that in fast forward. Like the fact, you know, we're talking about an effort started in early

January, the whole public concern in January was can we deliver, but as soon as that concern was, was kind of met, and it was clear that we can the public discourse immediately shifted into, you know, well, if I choose not to get vaccinated, what's going to, you know, can I be sanctioned, et cetera? So can you take the thank you for smoking type, you know, domain with all the fake news, social media and all that, and kind of cram all that into one quarter, January through March,

so that somewhere in April, the whole thing will kind of subside, trust will be regained, and that would be like a fringe issue as opposed to a central issue. I think that's a big deal. And I think in a lot of countries in Europe, you're going to see that playing a major role, this notion of, you know, don't tell me what to do. There's human rights, there's privacy, and there's all that.

And I think it's a valid debate and it cannot be confrontational. Again, because of this death of the average thing, right? Like we're all, you know, one, there's a famous song in Hebrew, we're all like part of one human, one living tissue. You can't leave people on the side. It's not a socioeconomic thing. We all depend on each other to such an extent that we can't just... We're all interdependent. Yeah, we can't just, you know, kind of push that

as much as it makes sense logically, right? Because if those folks choose not to, that impacts us directly, and we need to work with them actively, locally, with the spiritual leaders, with some institutes of society where we actually don't feel comfortable in a normal routine to engage with, we'll need to do that right now to get everybody across a certain threshold that works. with Pfizer for early vaccines for Israel. The reason the prime minister made it such a priority was, in your view, he had a sense for this term. You took the K-shaped recovery and applied it to countries. It's not just about market recoveries. It's actually about the recovery of entire countries. There's going to be K-shaped countries. And you thought the government of Israel

identified Israel as having an opportunity to be one of those countries. And you thought the government of Israel identified Israel as having an opportunity to be one of those countries. So first, just to refresh our listeners, what did you mean by, why don't you explain what a K-shaped recovery is in terms of how we understand it, the term that was used by Peter Atwater, and then how you applied it to countries. So we went back to December on our call. Let's go back further to March, right? And again, it looks like ages ago, but it's less than a year ago. March 9th, as COVID was becoming apparently, it has become apparent that this is a big deal.

The Dow dropped almost 8% on one day. The next day, another 9.9%. By March 12th, another 13%. Late February, late February, March, the stock markets went basically off a cliff. In aggregate, down about 36%. Correct. Correct. Correct.

And there was fear, right? basically off a cliff and in aggregate about down down about 30 36 correct correct correct and so and there was there was fear right there was fear that this is going to be like a lost decade and there were speculations are we going to go back u-shaped v-shaped and whatnot looking back you know just the top 10 digitally savvy companies the amazons the docu signs the zooms the apples of the world, have gained $4 trillion in market cap between March 2020 and February 2021. Not only that they were not, you know, that they haven't suffered, they have flourished. And so the recovery at the end was not U, it was not V, it was not a decade, it was K-shaped, meaning parts of the economy you know rose very fast and some have

declined and are still you know failing to kind of and faltering they're not able to climb uh climb back people misunderstand or misinterpret the rally right so the rally off the lows if the lows were in february march the rally off the lows were about 67% in global stocks, which was a huge rally globally. And in a very short period of time, I mean, a matter of months. So people think there's been this incredible global rally. But to your point, what's driving that rally is a handful of really big, powerful tech companies that were almost tailor-made for the lockdown economy and have flourished. And that's, again, a death of the average argument, right? Like most companies have not flourished.

The few that have have flourished to such an amazing degree that they mask the actual state of affairs of the economy. And that is under two stimulus packages, right? 1.9 right now, trillion and the one from before. And so we're being masked when it comes to that. I think we're going to see a similar emergence of national economies. And much like the defining factor for the companies that flourish on the top of the K, right, was how digitally savvy they were, how strong their infrastructure was, etc. States are going to, like national economies are going to go through a similar process.

So I'll give you an example. The Israeli economy is a, call it $400 billion economy GDP-wise, order magnitude. Every day of this economy being closed is more than $1 billion of lost economic activity. The entire vaccine operation, including what was the actual purchasing of the vials and everything, was order magnitude $1 billion, right? So that's one day of market activity. So even if we paid $10 billion, that's 10 days, but you can actually regain economic activity 10 days ahead of everybody else

or 10 days ahead of an alternative scenario, then it pays for itself. That was the baseline that I think Netanyahu and the government saw, that coupled by the fact that in a chaotic environment that's unfolding, you look for that anchor that you can bet on. That was the vaccines. But what I think we're going to see in the next six months is that those countries that are going to have an efficient vaccination, now that we know that the vaccine is super efficient, we're also going back to the New England Journal of Medicine publication, those are

going to vaccinate, you know, fast and efficiently and are going to insist on that infrastructure. Their economy is going to bounce back, recover a lot faster. And those who do it really fast would actually have a compounded effect, much like Amazon had and Apple and others, because the time it will take for the others would leave those early adopter countries that have vaccinated fast and went back to normal, top of the hill for a longer period of time. So, you know, we're used to global competition, right, on resources, capital, tourism, investment, which is shared by, let's say, 40, 50 very developed economies. If you're sort of one of the only developed economies standing on top of that vaccine mountain, so to speak, and you're done, right? A lot of the influx of capital that can't go to economies that haven't recovered yet will go your way.

At least that's my theory right now in terms of how that's going to unfold. And obviously, a lot of that will have to do with trust and would have to do with institutions. And there's a lot of foundational work here also from Amazon, right? Didn't just explode this year because it's digital. It exploded because it had so many customers, et cetera, et cetera, right? So all other things being equal, the differentiator of the recovery that will determine if you're rising fast on the cake or are you faltering for the next number of years, in my view, is going to be how efficiently

you disseminate the vaccines, how you deal with the legal issues, how you deal with the mutations, how you deal with this death of the average element. I mean, disseminating the vaccines to everybody. You don't leave anyone behind. And if you manage to do that, and Israel's talking, you know, April 10 to be like done, basically, you're not only going to have, you know,

you're not only going to reap the rewards of your $400 billion GDP, you actually might see unprecedented growth over the next couple of years until the catch-up effect globally is at play. What you're saying makes sense to me in certain sectors, certainly in Israel's technology sector. But when I think about other sectors, which albeit aren't nearly as large and dominant in Israel's economy, but still employ a lot of people, like its tourism industry.

So in a good year pre-COVID, Israel's attracting three, four, five million tourists a year. It represents at its peak about six, seven billion dollars in contribution to GDP, which is, you know, one and a half half two percent of its economy so that's a big number and employs a lot of people so even if israel gets that k-shaped takeoff if a bunch of other big countries don't get the takeoff it doesn't it mean that to the extent that israel's tourism tourism industry is important it doesn't really matter because it can't have people traveling into the country because those less than stellar performing populations, as it relates to vaccination, can't be traveling in Israel,

and Israel won't want them traveling to Israel. So I think the casing point is the UK, for instance, right? And let's talk about continental Europe. So I don't remember the numbers, but tourism contribution to the GDP in Italy and in France is more than 10%. It's a massive part of their economy. And that is because everybody can travel there. And so if you're from if you're, you know, a lady from the from the countryside in the UK, you probably spend your summer in, you know, France, Italy, etc.

The UK is doing really well on the vaccination effort. They're doing it well. There's a good chance Boris Johnson, the Prime Minister, spoke of May 17 as kind of a little bit of going back to business, non-essential travel, and somewhere early June, going back to traveling. Where will all those British tourists go? They cannot go to continental Europe. It hasn't been vaccinated to the extent that that would make sense. If Israel indeed meets that target, there's already a conversation between Israel and the UK about a green passport corridor. That in and of itself would be enormously significant for the Israeli tourism industry.

We have seen early signs of that with the UAE post-Abraham Accord, UAE-Israel relationship and kind of tourism actually going one way into the UAE and back, but just giving you a sense that when you have nowhere else to travel, most of your travel concentrates in a certain corridor. That actually creates a lot of efficiency. What were the numbers like? I think 120,000 people over like eight weeks, which is really crazy.

Between just two countries. Yeah. Between two small countries. And again, you said three to four million people is an annual nationwide tourism for Israel in and out. And so I think what we're seeing between Israel and the UK, those conversations that were on record a couple of days ago in the media, are a very interesting indication. Now, will that be long lasting? I mean, are we going to see that in 2025? I think that really depends on how well we execute on the opportunity that might be generated by the fact that we're ahead of the curve in regaining economic activity.

In some areas of the economy, we did really well over the last year in understanding that this is a crisis, which is a horrible thing to waste, as the idiom goes. In some others, we've been disappointedly sticking to the status quo. So when it comes to tourism, will we seize the opportunity of being early vaccinated country and partner with other countries who've climbed that mountain? I hope we will. And I think we'll see a big dividend if we do that. And you were talking about the tech industry.

The tech industry had the best year ever because it's very good at seizing on these opportunities. $10.5 billion foreign direct investment invested in Israeli startups in 2020. It's incredible. The rate of increase between 2019 and 2020 was higher than the rate of increase in the US. When we wrote Startup Nation a decade ago, we marveled that Israel was attracting two, two and a half billion dollars in venture capital

on an annual basis, which was still the highest per capita in the world, in a year of a pandemic, Israel does five times that number. And I think what's exciting and what we can learn as an example, if you look at the incredible companies that were built here this decade, like Wix, who's now the biggest, I think they're the biggest market cap Israeli company these days, or Fiverr, right? Those companies have enabled people worldwide to survive through COVID, right? If you think about Fiverr connecting people from India, offering microservices to people in the UK who are trying to survive and kind of have their small mom and pop shop at the end of the road transition into a website, right?

Wix has done the same. And so they're on top of that K curve. Can we as a national economy, are we going to follow the Wix and Fiverr example as a country? Or are we going to succumb to, you know, the status quo, given the political dynamics, given, you know, if you will, the fact that we've been so successful so far that people are now like energies are back to kind of, this is behind us. Let's go back to normal. And I, I have an allergy to this, you know, statement, let's go back to normal. This is an enormous opportunity to gain that you kind of regain trust,

regain solidarity. And, and, you know, I think we have everything we need to spur a decade of incredible growth. And it would be a shame to, again, to succumb for the status quo in that context. The other opportunity here, I think, I was just reading this book by historian Douglas Brinkley about America's space race.

And he looks at some declassified memos that Kennedy's advisors wrote to him in the early 60s that basically argued the, you know, other countries want to follow and partner with countries that are sort of breaking new frontiers, that are ahead of everyone else. One of the reasons we had to put a man on the moon was because people will want to partner with us. People will want to collaborate and innovate with us. This is how you lead. And in a sense, everything you're describing, starting with the vaccination campaign right to the K-shaped recovery, I think sends that message to companies and countries, you know, hey, Israel's someone we want to bet on, partner with, co-innovate with. And I think it's such a great point, and I'll add just one small piece from my diplomatic days.

We also have the advantage of being small when it comes to that, because there's a big, you know, the world is going bipolar again or multipolar. There's a game that's played above our head, right? With the superpowers like Russia and Germany and the US and India and China. And, you know, we can partner with other nations, like with fellow nations, based on our technological advancements

and the things you've just described without being empire, you know, like superpower race. And I think that's actually very exciting for many countries who, you know, would want to partner on cutting edge stuff, but would not want to irritate anybody or would not want and would want to do it in a diplomatically favorable way. And I think that's an interesting angle that Israel brings to the table. The technology is equivalent to that you'd find in Japan or Germany or the US, equivalent in the sense that it is competitive, right, at that level. But I would say there are less strings attached, if you will, right? And so diplomatically, I think there's a lot of opportunity. I totally agree with you. Yeah. I mean, Israel is, in a sense, small enough to fly below the grand superpower, grand strategy, geopolitical battles. But yet it's big enough to matter.

I mean, I think that's really important because there are other countries that were apparently vying for early vaccines, like, for instance, Estonia. And they could argue a country like Estonia has phenomenal data, phenomenal electronic medical records, but I don't think they have the data that goes back far enough. Plus, it's a small population, about a million people, and plus it's not heterogeneous like Israel's population is, you know, 70 nationalities, a highly diverse population. So what Israel has to offer, to your point, it's small enough to be a safe bet, but big enough and diverse enough to matter.

I think it's that. I think it's also the fact that the way in which global technological success over the last 25, 30 years has been driven to an extent by innovation that came out of Israel. You know, from the medical space, you know, we were talking about immunotherapy before. The biggest immunotherapy exit that made a difference came out of Israel, you know, four or five years ago. And again, when you talk about Wix and Fiverr and Mobileye and, you know, you can, I mean, Israel has made a sustainable contribution to the world where it matters, you know, telecom, software, internet, commerce, and mobility and healthcare. And so I think our place within the family of nations, if you will, is one of a contributor,

a net-net contributor over the last 30 years when it comes to technology. And I think that combined with our size, combined with where we are, is overall a strong invitation to collaborate when it comes to other countries kind of looking to recover, looking to be on that part of the K-curve as opposed to the part that is on decline.

There's a degree of credibility that Israel has won through active contributions over the last few decades. Lastly, Yonatan, what is Israel learning about these new variants that the rest of the world will be potentially experiencing in the months ahead? I would say the main thing we learned, and that is something that I would want our listeners to kind of keep in mind mind is a lesson in humility. At the end of the day, we are facing a machine of nature, which has had billions of years to,

you know, evolve in such a sophisticated manner. Assuming that, you know, we'll just figure this piece and then we're done, nature always kind of outsmarts us. And I think there's a lesson of humility to have been learned. I think that is why now already Netanyahu and the Ministry of Healthcare is talking about a bank of vaccines for the next few years. They're talking about partnering with Moderna and Pfizer and building manufacturing facilities in Israel, assuming that this will be approved as a software update going forward, mRNA treatments, not just vaccines. And then that's just like, again, an opportunity there. But at the end of the day, keeping that like 80-20 law, right? It's not, oh, we have a great vaccine plan.

We're done. No, it's never that case, right? We have a great plan. Let's see what nature throws back at us as we unravel this, but always be vigilant and always be humble because nature has its course. And the last thing we want to learn, right?

There's a biblical lesson in Hebrew, it's called kochi ve'otsem yedi asul yedze, like, it is I, it is my force, and through the strength of my arm, I have reached this achievement. You know, 80-20, yes, it is science, it is

our strength. We have done this. Science, humanity, and we should be proud about, you proud about the solidarity that it created and the achievement, but leave that 20% and say, well, a lot can go wrong, a lot that we can't anticipate. We need to still be very, very humble because nature is, to an extent, superior to us. We're on the defensive here. And so that's my main lesson from the mutations. I hope that makes sense. Yeah. Yonatan, thanks for joining us, I would say, so long. I'm not going to say farewell, because I'm going to rope you back into another episode. Maybe you'll come back in a couple of

months for a next update with your window through Israel into what we'll be seeing here. So thanks for being with us. Thanks for having me. That's our show for today. If you want to follow Yonatan Adiri on Twitter, he's at Yonatan Adiri, A-D-I-R-I. You can also learn more about his company by visiting healthy.io. And to learn more about Israel's digital health and life sciences sector, and especially startups working to get to a post-corona world, visit startupnationcentral.org. And look for the Finder, which is a database and GPS for Israeli startups.

We'll include all these addresses in the show notes. If you have questions or ideas for future episodes, tweet at me, at Dan Senor. Post-Corona is produced by Ilan Benatar. Until next time, I'm your host, Dan Senor.