Call Me Back - with Dan Senor - When IS Post Corona, anyway? Part 1 - Vaccination Nation

Episode Date: January 12, 2021

As we post this podcast, the US has vaccinated about 2 percent of its population, Canada is at 0.5 percent, France is at 0.001 percent, and Israel? 20 percent. By the end of this week, Israel will have vaccinated two-thirds of its population over 60 years old and most of the country’s medical staff, at which point they will all be called back for their second vaccination.According to international studies, Israel’s healthcare system has been ranked among the most efficient in the world. And due to big data and AI, the Israeli health system is certainly one of the most digitally advanced.What will we learn from Israel about a key stage of Post-Corona once it gets there?

At this rate, at what point will Israel be at post-corona? If you define the post-corona as at what point do we get to 7 million people vaccinated with two doses, then we're looking at mid-April or so. And so I would say that the sense is this is essentially behind us. Welcome to Post-Corona, where we try to understand COVID-19's lasting impact on the economy, culture, and geopolitics. I'm Dan Senor. How will we know when we actually arrive at the post-corona phase? How do we even define such a thing? Well, the milestone along the way will be getting entire populations vaccinated. One country may show us the way.

Israel, which officially launched its vaccination campaign on December 20th, is outstripping the rest of the world by orders of magnitude. As we post this podcast, the U.S. has vaccinated about 2% of its population. Canada is at 0.5%. France is at 0.001%. And Israel, 20%. By the end of this week, Israel will have vaccinated two-thirds of its population, over 60 years old old and most of the country's medical staff, at which point they will all be called back for their second vaccination. My mother, who lives in Jerusalem, goes back for her second jab on Friday. At this rate, some experts project Israel could be officially in post-corona by the end of March, far earlier

than the rest of the world. According to international studies, Israel's health care system has been ranked among the most efficient in the world. And partly due to big data and AI, the Israeli health system is certainly one of the most digitally advanced. To help us understand what is going on and where it's going, we welcome Yonatan Adiri, who is the founder and CEO of Healthy.io, a fast-growing global digital health startup headquartered in Tel Aviv. Previously, Yonatan was the chief technology officer for Israeli President Shimon Peres. Yonatan has spent a lot of time studying the

intersection of public policy, technology, and entrepreneurialism in the life sciences. How did Israel become vaccination nation? What will we learn from Israel about a key stage of post-corona once it gets there? This is Post-Corona. Well, it's great to welcome my friend Yonatan Adiri here from Tel Aviv. Good morning, Yonatan. Good morning. Good evening. How are you? Good evening. Good evening here in Israel. Hi, Dan. Thanks for having me. I'm doing fine, getting into the third closure here in Israel, and hopefully the last one. So I want to jump into a lot. We've got a lot of territory to cover. Before we do,

I went over your bio in the introduction. Healthy.io, Yonatan is the CEO and founder of Healthy.io, which is a startup in Israel in the digital healthcare space. And one of his products actually already has FDA clearance over here in the US. He was also formerly the chief technology officer to Shimon Peres when he was president of Israel. Describe to us what Healthy.io does. Healthy.io is the global pioneer in turning smartphone cameras into clinical grade medical devices. And our first product is a urine test that you can do with a smartphone. And we serve healthcare systems in, you know, around the world. Our main client right now is the national healthcare system in the UK.

And so beyond the tech piece of it, I've been busy in the last six or seven years since I left government, working and liaising with different healthcare structures around the world in introducing testing at home. So there's a bit of a vantage point that's been born on one end, you know, from the trenches of this business, and the tech development and innovation and AI that goes into that. And on the other hand, that that, you know, 30,000 feet healthcare system perspective that comes from my previous background in government. So I want to just staying on government, because one of the things that's so interesting about your perspective is you're on the front lines of the digital health care space as an entrepreneur, but you also have the perspective as a policymaker in government. So just briefly, what did you what was your role with President Perez when you were in government?

So I had the privilege of working under President Perez, who's, you know, founding father of the state of Israel, one of the founding fathers. And back in 2008, 2009, he saw the next decade, i.e. the decade that we just left behind us, as the decade in which originally as a diplomatic advisor, and then subsequently as his CTO, as his chief technology advisor, working with the president to realize that vision of how do you help the world through the Israeli innovation, and how do we create global collaborations, some of them bilateral with the US, obviously, Germany, Brazil, Korea, Japan, UK. So using innovation to help Israel and using that same innovation that helps Israel to help the world, which is potentially, based on the conversation you and I have had over the last few days, could be happening right now with Israel's vaccination story.

So I want to dig into that. Just to set the table, and we'll get into the numbers, about, as of the time of this recording, about a million and a half Israelis have been vaccinated already, on path to north of two million within a few days, and obviously we'll do the math on what that means for how quickly the entire population will be vaccinated, but this whole process of the COVID experience for Israel, like many countries, has existed in three waves, some more positive than others in terms of how they were managed by the government. Can you just walk us through the three waves of Israel's COVID experience? So I think that's right. I think, first of all, what's going on right now is really a manifestation of, as you described

it, right, like the ability of tech and policy to meet and generate, you know, real value for the citizens of Israel and subsequently also to have global importance. Israel tackled the COVID crisis as it faced three waves. The first wave in around March, April, beginning of May, that was tackled very quickly, very swiftly, predominantly by the public servants of Israel as the political system was aligning itself. We didn't have a government. We were just coming out of an election cycle. And that was a, I would say, fast and furious response by the Ministry of Health

and the Ministry of the Prime Minister, sorry, the Office of the Prime Minister. Very quick closure, leveraging Israel's position as sort of like an island country and leveraging its community healthcare deployment. Very quickly, we went into, we went into less than 100 cases per day. May and June were, I would say, very optimistic, almost utopian. We felt we kind of

left it behind us. The country was preparing for the winter. We all thought wave number two is going to come in winter with the flu. And that was, I would say, the predominant mindset. The system was debriefing. There were lessons learned. It was kind of like a whole positivity going on in Israel. And then in the end of August, we started seeing numbers climb. And September was a very tough month. The second wave hit us earlier than expected, not correlated with the winter.

And earlier than in most other countries. Correct, correct. And we were in a way like a time capsule or like a time machine throughout the whole evolution. Hopefully also the vaccination effort will serve as that time machine for other countries um but when that unfolded in september um it challenged all of us as a society individually as a system um and you know there's also like a symbolic meaning these are jewish high holidays september and October. People want to celebrate.

They want to be together. And just to put this in context, because we just went through this in the U.S. with our Thanksgiving and Christmas holidays, which are these unifying, universal holiday experiences where the health authorities had to warn people. This is when people travel the most. This is when people convene with extended family and friends. So we were at peak risk, potentially peak risk, during the Thanksgiving and Christmas holidays. So just for our listeners to understand, who haven't spent time in Israel, that's what the September and October is for Israel. That's correct. And so the national, I would say, feeling, it was almost like bipolar. We went from sort of like a panic, but a lot of trust in the decision makers in March, April, May, to a utopia in July and August, June, July and August, and sense of preparation for the winter.

And then got hit in September and early October. And there was a very, I would say, a very tough lockdown of about two and a half to three weeks. And then the level of, I would say, disease contamination went back into durable levels in terms of how the healthcare system can cope with those numbers. And we had a great Q4, right?

We went into October, November, and December, and we're going to talk a bit about the vaccine operation that started in mid-December. And we were expecting those to converge. So third wave to kind of be very mild and coincide or correlate with the vaccination. So we didn't anticipate the need for a third lockdown. And as I said in the opening, where we're getting into that lockdown, I would anticipate this one

to take 10 days to two weeks with the aim of having both graphs correlate. So the numbers of new cases going down as the number of vaccinated folks going up, and therefore the burden on the ICUs and the hospitals should decline exponentially as of mid-January, when that one and a half million number you cited would go through their second dose and therefore have elevated immune systems. So just in terms of the impact on the Israeli economy and on Israeli society, just describe it, how you see things, not only as an entrepreneur who's trying to build a global business out of Israel during a pandemic, but also as an Israeli who's raising children and has living and healthy parents living through all of this. What has been the impact? You know, I think ultimately it comes down to what's going on right now. And I think there's a lot of sense of national pride, and I mean it in the most beautiful sense, not sort of

nationalistic, but just a communal sense of pride, that while Israel is, you know, 0.11% of the world population, we're currently more than 10% of the total vaccines distributed and administered globally. So I'll say it again, we're sort of punching above our weight. There's a lot of sense of pride in how our community systems, our hospital systems coalesced to deliver the vaccines at a pace that is both on a per capita basis, staggering, but also nominally ranks Israel very high. And so I would say that the sense is this is essentially behind us. This lockdown is a technicality. Sort of from this point on, it's a technicality.

And I think that, you know, COVID in a large degree has been and is a challenge for policymakers, but it is also a public psychology challenge. And that impacts a lot. The trust in government decision making, the trust in your community is a lever or an asset in how you deal with COVID. In the last few weeks, since the vaccine operation started here and has been really operating meticulously at every level of the population, we reached a point there's a lot of positivity and there's a sense that, again,

this is behind us and challenges we have in front of us are technical in their nature. President Paris had this beautiful saying about the peace process. us and challenges we have, you know, in front of us are technical in their nature. You know, President Paris had this beautiful saying about the peace process. We all see the light and we insist on building a tunnel to get there. And with COVID, I think we were in the tunnel. And now we see the light. And I think we're starting to feel that the remaining journey in the tunnel is like really marginal. And I think that determines a lot of how things are, you know, day to day, but also operationally here in Israel these days. So just to get more granular on the numbers, can you just walk us through where Israel is at and why these numbers are so impressive relative to the experience

of other countries on the vaccination campaign so far? We should start from the fact that the basic numbers, right, is there's about 9 million people. And we're at the point right now where we're doing 150,000 vaccines per day. So it's one and a half percent of more than it's almost 2 percent of population per day being vaccinated. And that is really remarkable. We've been able in the last three weeks or so to vaccinate 17% of the population, which is an important number,

but one can look at it also in a different light, which is, I think, even more impressive. Those are two stats that I think represent or reflect the sheer success of this operation. One is how many people above 60 got vaccinated, right? What's in your denominator? And there we're at 70% soon. And why is that so important?

Because as we know, COVID, or at least in its current mutation, it's predominantly impactful with people above 60 in terms of deteriorating health care conditions that then burden the health care system. And so if you can manage to vaccinate that priority group, so chronically ill folks or people above 60, you've reduced the odds of hospitalization challenges by far more than the linear numbers of how many people got vaccinated. I think that's important. That was priority number one for policymakers. That was the group. So you can say 16% of the total population got vaccinated.

Another way of looking at it is 70% of the folks above 60 got vaccinated, which I think is also great. And I think the third piece here is even if you kind of consider the full population, Israel has two and a half million people under 16. So it's a very young country. So ultimately, given that the FDA only approved the Pfizer and Moderna vaccinations for a population above 16, then you're left with 7 million people. So do the math. We're almost at 2 out of 7 million as a total population eligible for the vaccine. And I think now you understand why people are

very proud and why there's a sense that this is behind us. So at this rate, at what point will Israel be at post-corona? If you define the post-corona as at what point do we get to 7 million people vaccinated with two doses, then we're looking at mid-April or so. I mean, it takes us about three weeks to vaccinate one and a half million people. And then we have to do that twice. So that's roughly six weeks. You do the math, gets you to mid-April. In my perspective, and from a national perspective, mid-February is In my perspective and from a national perspective, mid-February is where I would say 90% of the burden of the disease is behind us because we'll have most of the people over 50 and with baseline conditions, fully vaccinated in two doses, that should be roughly 3 million people.

From that point on, from the day-to-day perspective, coffee shops, restaurants, all that would be able to open up. And then it's a matter of just completing the sort of safer population vaccination. It's a couple more months. So if you define post-COVID as, you know, 7 million people, you know, two doses, that's probably April, May. If you're looking at, you know, most of the folks over 50 and with underlying condition, probably mid-February even. Okay, so I guess the big question is, how did this happen? How was Israel so, it seems to be so ahead of the curve?

Because you watch the vaccination implementation programs going on in the United States and around the world, and it leaves a lot to be desired. And Israel seems to be the opposite. So was it an assertive, well-thought-out plan, or does Israel have some natural advantages that enable them to execute on something like this a little more smoothly and efficiently than other countries? Like, explain to us what Israel got right and what advantages Israel has in the process of getting it right. Well, I think, you know, I think it's important to recognize when you look at the snapshot of the operation that each and every nurse that vaccinates, to borrow on the phrase, is really standing on the snapshot of the operation, that each and every nurse that vaccinates,

to borrow on the phrase, is really standing on the shoulders of giants as she vaccinates. And those giants are the forefathers who built Israel, because the foundations of the healthcare system are what enables this to run. And I'll keep it brief into three areas that I think sort of make the Israeli healthcare system what it is and enable this phenomenal pace of vaccination. I think first and foremost is the ethical choice that the forefathers and foremothers of Israel put in place still, you know, in the nascent days of pre-state Israel. The healthcare system of Israel predates the state. It's from the 1920s. And it was constructed around an ethical point, not just a matter of utility. There was a sense

among the pioneers that healthcare is a human right, and we should all coalesce and provide for community healthcare as one of the tenets of our community. That, in turn, was built into the equivalent of what in the U.S. you would call an HMO, or the Kaiser Permanentes of the U.S., or the Geisingers of the U.S., full health care plan that is vertically integrated. Israel built that as a foundation, even in the pre-state days. So I think the first piece here is an ethical understanding that as a community, we have a responsibility for each other when it comes to healthcare. That's the basic layer that built

the foundation. That is a fair observation, but I would say that applies to most of the Western world. As you said, Healthy IO does business with the National Health Service in the UK. Citizens of the UK talk about the National Health Service in these glowing terms, in patriotic terms, the way you're talking about healthcare. And I think you could say the same about Canada's healthcare system, which I lived with for a number of years growing up. I mean, a number of healthcare systems have that feature and yet seem not to be delivering. Yeah, so that's why I'm saying there are three terms here that all have to converge.

Each and every condition here would not suffice. You have to have all three. So I think there's an ethical and foundational element here that's number one. Without that, it simply doesn't work. The second layer is, and I think the French system is struggling with that, and some other systems in Europe are struggling with that right now, as all social democratic or fundamentally socialist ethos-type structures.

I mean, ultimately, at the end of the day, the Israeli HMOs were built out of the fact that, you know, Israel was inspired much like the Kibbutzim by this notion of, you know, societal benefits and inspired by some socialist visions. In the long term, there's a state of decay these organizations kind of fall into. And Israel was brave enough in the mid-'80s to understand that that structure

simply doesn't fit the GDP, the size and scale of population, and bravely, bravely enacted fundamental reforms into how healthcare is being delivered in Israel. And that introduced a competitive delivery system of healthcare. So it's a state-sponsored healthcare. But as of 1994, that reform did three things. A, it is paid by income tax. So no deductible, right? So 70% of Israelis actually get free healthcare, subsidized by progressive tax.

That was number one. No longer will a person have to pay when he or she comes in, no fee for service. Number two, there were four organizations that were kind of bolstered and enhanced by that law, so there is a competitive market. Well, at the end of the day, all those four delivery organizations are sponsored by the state. They compete with each other. What are those? I'm just trying to, for our listeners, for them to understand.

They're called, in Hebrew, the kupat cholim? Correct, correct. So the actual translation are their health funds, right? Is that what you would call them? Correct. So they're equivalent, close to an HMO in the United States? The closest thing in the United States is Kaiser, right? Non-profit as an entity, but run as a business and has all the right incentives so

capitation i'm not going to go into all the mathematics here but if you're a physician you're not paid per service that you provide but per people that you serve so if i serve a thousand people i get a thousand dollar per person so i'm incentivized to actually see them as less as possible and focus on prevention right so all these incentive systems were put in place and the competitive piece you were touching on you know the british system or the french incredible systems and they are rightly so they are very proud but it's a single system treating 40 million or 60 million people that is very hard whereas in israel with order of 10 million people,

four organizations are competing. And they're offering different services. And like, I would move from Maccabi to Kulalit. These are two HMOs that compete with each other. I think that was an important point of the reform back in the mid-90s. And the third piece of that reform was putting that again front and center. And again again i think at the end of the day health care has to do with ethics has to do with the with the national conversation people lost a lot of trust in the health care system in the 70s and 80s due to this decay of the original model and the legislation of the 90s and the political activity there regained trust and if you look at the uk right now there's something similar happening there if you look at the uk right now there's something similar happening there

if you look at western europe let's say a lot of the a lot of the people that are looking at the at the efforts and they're like we need to regain trust in our health care system we need to regain trust in our political system and i think that's in the post-corona era this next decade is going to be we're going to see a lot lot of manifestations of this kind of lack of trust in different parts of government function. By the way, some legitimate, some are not. So we spoke about the ethical and foundational piece. We spoke about the bravery, politically speaking, of reforming that service and providing access to everybody, which happened in the 90s. The third piece is digital, digital, digital. As of 2000, the entire Israeli system, that's 99.5% of the people in Israel, have a digital EMR,

electronic medical record, going back 20 years now, already 20 years of data. That was mandatory and paid for by the government. 2008, that system gets connected to pharmacies and to hospitals. So while other countries do have digital backbones, some would be focused on inpatient and not outpatient. So you'll go to the hospital, your EMR, your physician, when you go back to the community, will not know what you've done in the hospital. You'll have to come back with the discharge paper or the discharge CD with your MRI or CT and blood tests. In Israel, the system is aligned. That's as of 2008, you know, across the system, hospital visits, whatever, and with the pharmacy chain. So when you go, you swipe your card and you pay a small deductible depending on your, again, your kind of socioeconomic status, take your drugs and go home, take your meds and

go home. 2012, this system goes mobile. And the mobile apps that the Israeli healthcare system has are fantastic. And they compete, you know, head to head with, you know, the top, I would say, 10 apps that you would consider in the Google Play Store or the App Store. And who administers that app? Each and every kupat cholim, each and every, they see that as part of their competitive moat, right? Which is incredible. A healthcare organization sees their digital arm as part of their competitive moat, like when they run ads on TV. Remember, these are non-profit, state-sponsored organizations.

They would say, you should consider moving to Maccabi because our app allows for you to consult with your physician in the after hours. And that is, to me, the fight for the consumer that has driven so much efficiency as we saw in the last decade, right? From Uber to Netflix, there's a Netflix effect in the Israeli health care system. And that was put in place in 2012 as it went into the mobile, but ultimately in 2000. And we're going to talk a little bit about what that does. But ultimately, those three decisions, the ethical piece and the foundational, the reform from the late 80s, early 90s that expanded access and created that competitive capacity, and then the decision to go digital and how the healthcare delivery organizations embrace that digital domain is, I think, at the core of the success we're seeing right now. And can you just describe how you were helping your parents get registered for their schedule of their vaccine appointment?

Because you had a firsthand experience in working with the app and getting them organized for the vaccine. So just explain how that works in real time, like right now. So here's the story. I'm the youngest of four boys. And about a month ago, I went to pick up my kids from my parents, and I realized they were arguing about how they were trying to get a hold of Maccabi, that's their provider, on the phone. And it was impossible. And I mean, think about it, Dan, if you're relying on a phone

infrastructure, by definition, your call center, when everybody's calling, you know, you have 4 million people under coverage and you have, I don't know, a thousand people in the call center, there's going to be three, four hour waiting time. There's no way around that. That's, you know, like basic mathematics. And I kind of, and my dad, my dad closed his garage three years ago, and he relied on my mom for their entire life for taking care of that stuff, right? So he's like, do we have a vaccination date already? Why don't we have it? And she's like, well, I've been on the phone for three hours. They didn't answer. I was like, sit there. And I remember my mom's ID. I asked her for her password on the Maccabi app.

I'm also on Maccabi. And I literally, within 10 minutes, set up their vaccination date, if you will. And it was incredible. And again, talking about pure front-end digital, it asked me, what do I want to optimize my vaccine for? Distance from my house, GPS located, yeah? Or first vaccine appointment available. So do I want to get vaccinated within a week in Be'er Sheva, which is

like an hour drive? Or would I want to, you know, would I rather get vaccinated in two weeks, you know, within a 10-minute walk of my house? And that's a point to say that also Israel's healthcare organizations are big believers in community care. So there are a lot, it's, if you will, decentralized care. There are a lot of small first response community offices for the healthcare providers.

So literally within a 10-minute walk, you should be able to meet, kind of see a small clinic that would give you there, that would provide services. So I asked my parents, what do you want to optimize? And they said, we want to optimize for, I say, well, you know, if it's, you know, a month from now in Herzliya, which is where they live, or tomorrow in Be'er Sheva, we'll go to Be'er Sheva, no big deal. And luckily, there were appointments available in Herzliya within a week. I set up the appointment and then the craziest thing happens.

I finish and I'm thinking to myself, these were the early days, December 20th. So do I have to call now and set up an appointment for three weeks later or does that get set up? As I sort of click yes, there's a pop-up saying you have a second appointment scheduled because the system actually calculated the 21 days and the location and asked me, would you rather do this one in one of those three preferable locations that the algorithm figured out for you? Having a tech company myself, urine testing at home and, you know, being involved in building those type of apps. This is a digital feat to be proud of. Even if you're a startup, you know, that has

the best, smartest folks as our team is, let alone if you're a healthcare delivery organization. And, you know, tomorrow they're doing their last, their second dose. Wow. Okay. Yeah. Kola Kavod for them and you. So circling back then to today, why did the vaccines become priority number one for the prime minister? I mean, what, like, what was his guiding principle? Why, why the messy second wave and the messy September and October, and yet seeming so far excellence at this stage? I think this is, if I may, Dan, a general observation around the mismatch between government and what we're expecting our government to deliver.

And this event of lack of knowledge, this kind of like morphing reality that we were thrown into as of March. The level of expectations we have from our government, even in Israel that has known wars and terror campaigns, and we're adept at this type of fog going on, right? But we expect our government to deliver and we have certain expectations.

And in a situation of almost near perfect information, that's our standard expectation. I think what happened, I think that's the source of the rupture of trust in many, many states is that government structures have been, you know, post Second World War are not well designed to cope with this fog of war.

I mean, consider Switzerland, for instance, an incredible country. It's been so long since the federal government had to take an authoritative position towards the cantons. Right? Think about Germany. With all its might, it's a federative country. When was the last time that Berlin had to impose a process on all the states? Germany is made of states. to is exposing a big mismatch in the way we run government and the way there is expectations from government and then kind of, you know, pile on that social media trust and all that stuff. What I think Netanyahu did super well, and that also applies for the government at large

and all our, I'd say, government institutions, but think as the chief executive, right, as the top executive. He really very quickly realized that this is a chaotic situation we're going into. And in a chaotic situation, a morphing reality, you have finite resources. What do you spend the resources on? Trying to gain clarity every day and every given second, which I think is a bad use of resources because you spent all those resources getting into clarity and then the thing morphs and then you're back in square one. Or do I try to understand the, I would say,

four or five driving dimensions here and I only invest in those which are fundamental. I would say four or five driving dimensions here. And I only invest in those which are fundamental. So no matter where this thing morphs, or if it morphs into that level, we're in really bad shape. And I only focus my agenda there. And I think that is how you run a company.

That is how you run a country in times of chaos. To be clear, you're not, not shall we say a knee-jerk defender of prime minister netanyahu you're just you're just coming out this is a perspective someone who served in government and has run and is running a company and so you just you appreciate that sort of prioritization and focus i i would i would say even more than that i think uh you know it's like john rolls's veil of ignorance right Like you need to look at this stuff by plain outcomes, right? And then look back, right? You either spend your time trying to control, invest a lot of resources in, how do I contain this?

Or do you invest most of your resources in two things? First, securing resilience. So no matter what thing, you what thing evolves in the next episode, you can move. And secondly, he's trying to identify those Archimedean points that are going to be important no matter what happens and how this unfolds. I'll give you three. Public trust. That's something we need to invest in because no matter how this thing morphs, without public trust, nothing works. Two is keeping the population above a certain threshold of sustenance.

So, you know, do you care about 3% more debt to GDP ratio at that point? Or do you basically go out there and say, well, guys, don't worry, unemployment is going to go through June 2021. So give people that breadth, understanding that no matter what, for the foreseeable future, we have your back. And the third is, I think, identifying what's going to be the defining moment of the exit. So it's basically just visualizing how the story ends. Exactly.

And recognizing that as much noise and contention there is along the way, what people will ultimately remember and will ultimately recover and heal the country is that ending, not the process to the ending. Yeah. And in defining that, I think what you're trying to do is, you know, there's no use of trying to plot out all the scenarios, right? It's like a labyrinth. You definitely know where it ends and you can move your way backwards. So in that, like, what is the end game here? The end game has to have a vaccine involved.

There is no end to COVID without a vaccine. And I think Netanyahu got that and put a lot of his effort there. And as vaccines came, they relied on that healthcare system that knows how to deliver. How did Netanyahu get these vaccines? I mean, to me, that's one of the great mysteries. Nobody knows, right? There's a bit of a mist and a cloud around how he did it. And I wouldn't pretend to know.

But I think if I had to kind of having been in those rooms if i had to imagine that conversation it's a conversation in which three things come into play a lot of tenacity right i need to talk to the president or the ceo of this company that's where i'm going to throw my my weight right to everything we spoke about you know so far knowing that this is it kind of like you know rallying by putting those resources there knowing that this is the defining moment so getting ready there and then at the end of the day your experience and everything you bring with you and then seeing the nuance that a lot of other people wouldn't have seen and i think other countries have done tremendously well in other parts of how to deal with COVID simply

because I look at Angela Merkel. Her understanding of how to inspire trust in her community is where she put most of her weight. And I think she provided the world with several displays of leadership that are of historical context, I think. We'll look back, we'll look at who was the leader that inspired the most trust. I think we'll look back and we'll say Angela Merkel. We'll look at the leaders and say, who kind of tried to take the risk? Who tried to be at the cusp, at the cutting edge of dealing with it? We'll look at Sweden and you'll say, wow, like they were the biggest risk takers. I think Netanyahu at some point, you know, kind of realized this is going to be chaotic.

I need to focus on one or two or three things. And where I'm going to be the change maker is the vaccines. So he kind of chose that, focused all his energy there. And as Herzl said, if you will it, it is no dream, right? Like made it happen. And who actually had responsibility for administering all this in the government? Like, who's in charge? I get Netanyahu made the decision.

He's focused on getting the vaccines. And then there's the execution. Who's doing that? So I think Israel delivered on a lot of its, I would say, hidden forces here. First, it's this ability to coalesce when things are dire. So a lot of people came in. Private sector came in. One of the advisors to the prime minister in August through October was Amnon Shashua,

the founder and the chairman of Mobileye, acquired by Intel. One of the smartest people, you know, the Israeli academic system has delivered. You know, we have a couple of Nobel laureates in Israel in the chemistry field and in the game theory field, Professor Oman. There has been a community effort here in Israel. Israel has a thriving, you know, public debate. So all those voices were heard. So I think that is a major part of, like, how this got administered. Everybody weighed in. Some with criticism, some, you know, we know better.

We have this very tenacious and, you know, sometimes acerbic type of public debate, but it allows for everybody to be the CEO, everybody to think like the prime minister. And that delivered a lot of good ideas. National Security Council, Ministry of Health, and the Kupot, the actual healthcare systems, through this command and control center

that was a joint, still is a joint command and control center, delivered on that. So one important thing here, Israel also gained a lot from the fact that one of the biggest generic drug companies is based in Israel, that's Teva. So logistically, being able to store at minus 70 centigrade, being able to deliver logistically has been also part of the fact that we have those companies here in Israel that know how to do that. And so at the end of the day, and we'll talk about it when we kind of look into the future, the operational piece here has been astounding as well.

So just on these advantages that Israel has, the geography of Israel helps too, right? Half of the population lies within about, you know, basically a triangle that's, I'm trying to put it in U.S. terms, it's about the equivalent of like one-seventh the size of New Jersey, and that covers Jerusalem, Tel Aviv, Haifa, some of these major metropolitan areas. When you're dealing with a cold chain where the vaccine having to travel long distances and you're operating in a country where most of the population is never more than two, three, four, maybe hours away from a distribution center, that helps. That helps. But I think, again, if you look at even distributing it in Manhattan, even think about which is super dense. That's not going to be an easy feat.

And it has to do with logistics, but it also has to do with the fact that, and we'll talk about it later, there is no textbook, Dan. There's a textbook for urban planning, right? So when you plan a new neighborhood, there's been years of research of how many schools should there be per 10,000 people? And in a two-mile radius, how many, you know, how big, how wide the diameter of the sewage should be? You know, there's all that textbooks and playbooks of how do I administer populations when I do urban planning? It's been many, many years since humanity had to adapt

and write a textbook of how to administer a vaccine against a live and thriving virus. And I remind you that the previous vaccines against smallpox or other things, you know, those diseases were here for a long time. They weren't evolving and morphing when the vaccine was developed. And I think the closest thing for the American crowd listening

is the Jonas Salk polio vaccine, right? Because still, this was a smaller population, mostly children, but he developed a vaccine where people had seen their children suffer enormously. And so there was no textbook of how to do that as well. It wasn't as large scale as this is, but I think kind of trying to draw a parallel, we're developing the vaccine, we're developing the means of administering it as the disease is alive and thriving and mutating. So there's been no textbook there. And I think Israel should share this, you know, beta, it's still in beta, textbook on how to operationalize vaccine administration and not wait for version 1.0 to be sealed somewhere in, you know, May and then kind of debrief and write up the textbook. Too late. They should be doing it in real time. So let's talk about the data,

because you talked about the sophistication and the ease of use from a health consumer standpoint of the apps and the digital applications and the digital interface. In the process, Israel is gathering mountains of data through this experience. And so explain the value of that, both internally for Israel and potentially externally for the world. Yeah, so I think the first piece here is, it's not only that we're vaccinating a lot of people, and you'll see Israel kind of starring and leading in the next few weeks on all the charts, you know, per capita, per 100 million people. The thing that gets neglected is that Israel so far is the only country in the world where every vaccine is once administered, attached to an electronic medical record. Now, that is an incredible data set being forming, again, in real time, Dan. I mean, if you think about it, the trial for the vaccine was 40,000 to 60,000 people,

half of which got a placebo, were 1.5 million people being administered. And so the data is 200 times that of the clinical trial generated in three weeks. And when that is formed in real time, the value of this data is enormous in three layers. I would say actually even four. The first, which we talked about, is this operational piece. We can now share, because it's all GPS located and we all, you know, we kind of know when and when a person came in, you know, into the station, we have data points that might sound trivial, but like,

what's the average time to vaccinate a person? Because we know when a person came in, he checked in on the app. When he left, he checked in on the app. And in between, the bottle was taken out of the freezer and was barcoded on the same system. This is a treasure trove from an operational standpoint. We also know what's the radius to serve certain amounts of people. How big is the line that is formed when you're inviting 10,000 people per day for 20 stations of vaccination. These might sound trivial. This is the kind of FedEx, UPS, Amazon Prime type stats. They are essential for delivering the vaccine, and they also are driven by the digital backbone.

So there's an operational element here. I think it's critical. It is going to be critical in the next three months. Potentially later, as more countries kind of experience that, each country is going to have its own method. But there's a diminishing value to this operational data. Therefore, I firmly believe it should be shared as quickly as possible. We should invite, you know, delegations who are doing the same to see this,

to see the network operating center, to see the data in real time. And I would also add that it's sure Israel is a small population that is vaccinating people at a very fast rate. But for a small population, it is probably the most diverse population in the world. So you have over 70 nationalities represented in Israel. So you're vaccinating people from Ethiopia and Australia and the United Kingdom and Morocco and, you know, Persian descent from Iran. I mean, the ethnic and nationality mix paired with all that data is pretty interesting in terms of the vaccine's impact. Exactly. So I think here's where the medical piece here is interesting, the data. So we spoke about why the data is important operationally. Now there are three. And again, I get excited when I talk about it because, A, it's my profession, but also this is truly humanity in the trenches together against this thing.

This is the first time since human creatures were, you know, roamed the earth that we are changing the immune system as the virus is trying to kill it. Right? In previous, you know, events, the virus had a set immune system and it could mutate and attack it and find the right you know calibration between how deadly it is and how uh contagious it is you know all viruses that's how they operate they try to find that position that position right if they kill you too quickly they're not as contagious if they're very contagious don't kill you you're not serving their purpose right right? We're the host of the virus in the end. For the first time in planet Earth's history, the immune system is changing as the virus is mutating. So we are in this together as humanity. That's how I see that. And therefore, those three layers I'm

going to talk about are, I don't see them as Israeli layers. They are a contribution Israel can make to the world just because it so happens that we're first and we're doing it pretty well so far. Number one is safety. Every vaccination administered has an EMR associated with it. That means... Electronic medical record. Right.

That means for my father, who's of Iranian descent, right? And like you said, with all the genetic mix of that, he comes in, he's 75 years old. There's 20 years of data there. So there's probably 20 blood tests that he did in the last 20 years. There's urine tests, there's this MRI, there is this kidney condition, liver condition,

whatever he has can now be cross-tabulated with how his body responded to the vaccine. So when you vaccinate one and a half million people, and every day, let's say, 500 people die in Israel of natural causes, how do you know that these people did not die from a side effect? With all the anti-vaccine and lack of trust, you're seeing that in France, by the way. A lot of the challenges for the French operation is the people are really hesitant,

and they're afraid. And it's been hard to generate that trust. In Israel, we all know that if there is any correlation between death or severe, you know, side effects to the vaccine, we will know about it very quickly. 150,000 people get vaccinated each day

and their state of affairs medically in the day after the vaccine, a week or 20 days or months, is correlated with their data in real time. The health care services send you a text message via your phone a week later to ask for your symptoms. Did you have side effects? Did you not? This is incredible data that can tell us about the safety of the drugs. So I think that's, you know, the first universe is immediate medical data as it pertains to safety.

The second layer, which I think you were touching upon, is critical. This is the first mRNA vaccine ever administered in history. There's going to be a lot of cool stuff coming in the next decade based on mRNA methods of delivery. Not only vaccines, cancer treatments, you know, you name it, right? Chronic illness, chronic disease solutions. There's a data set now that's very diverse from a

genetic perspective that has 20 years back, but also has perspective data that can be used by companies who are developing mRNA treatments to do two things. First, to see retrospectively what happened, right? And see if there are any correlations for certain things that they'd want to see in terms of safety and the body's response. Secondly, when you want to do patient selection for your next trial, if you have that data set, that's incredible. Just a company called Flatiron Health

three years ago was sold for $2 billion to Roche because they had a small subset of I think a few tens of thousands of people with specific oncological conditions. So there's a price tag, if you will, on the data for clinical trial selection. That was the second point of how valuable this data is. So first is safety. Second is the whole mRNA domain. It's a black hole. There's no data. Now there's data. The third

thing, which I think is also super cool, is perspective data so the data in israel gets denser right there's dna data coming into the system and all other biomarkers are being collected by the way this is all de-identified there's no surveillance state type of activity going on in israel in that sense because it's proprietary for the healthcare delivery organizations and then and you know we integrate into their systems they you know they work in the highest global standards of cybersecurity and de-identification so this data is being collected it's being collected in a de-identified way which I think is important to understand that there's no thought of using the data or

leveraging the data in a way that there aren't there aren't there aren't privacy there aren't privacy concerns there aren't privacy debates in israel or correct because health care and i go back to the ben-gurion decision right to the forefathers and foremothers decision health care isn't right there's no my healthcare organization cannot refuse to treat me or me having a higher premium because I have a precondition whereas if you look for instance

at the Chinese model today they're operating an incredible data collection apparatus, they have a very advanced system of healthcare, digital but they're not shy about it, they're saying well I know data about you and I want you to eat better, therefore your premium is going to go up.

It's a new type of, yeah, it's a new type of kind of like policymaking, which is interesting. I mean, arguably some of it makes more sense and then, you know, in a different context of privacy, if it's accepted by the population, then it has its, you know. I have huge concerns with it,

but another point I would make is that while China's system is rich in healthcare data, it doesn't have the history that Israel has. So it's rich in terms of volume, but it doesn't have the history. Kai-Fu Lee, who wrote that book, AI Superpowers, about China and the US, and he's in China, and he's a tech investor in China. I mean, even he, when I walked him through the richness of Israel's health data, meaning it goes back a couple decades, he said even China, for all their vacuuming up of data, doesn't have that kind of history. That's correct.

And that's important because health care or your personal health data, when it's aggregated and de-identified, the context is critical for understanding what happens. So, you know, if it starts today, you know, it's also, you're right to say there's also this ethnical diversity, right? That, you know, also is interesting. And so as we collect new biomarkers and DNA data, thinking about it, maybe there are correlations.

You know, this is kind of like the famous unknown unknown. Right. If in the second part for the mRNA, there are going to be queries. Someone's going to say, well, I don't know. I'll use this data set to find out. The third layer is, well, maybe the data will reveal things that we don't know we don't know. Maybe people who were, you know, who were sick with COVID before getting the vaccine and didn't have symptoms, they might have a genetic, you know, marker that can predict that. And we don't know that. And we might only find out in 2030 when all those biomarkers will kind of present themselves through a correlation in the data. And when you look at

those three layers, the safety data, the research data for mRNA, which is a huge promise for all of us in terms of treating diseases, not only vaccines, and the perspective data, the unknown, unknown elements that can emerge of that data, that gets me very excited and determined that this data should be shared and this data should be put in use of the best research institutes globally. So just wrapping up then, Yonatan, since Israel will be kind of the movie trailer for the rest of the world on what post-corona looks like or could look like, potentially, you know, I think of New Zealand every year on New Year's, you know, that you see New Year's in New Zealand long

before you see New Year's over here in the United States. And so pretend you're New Zealand in New Year's. Pretend your Israel is the first real look at post-corona. so pretend you're you're new zealand in new year's pretend you're you're you're israel is is the first real look at post-corona which could be relatively soon what does that look like to you first there are great fireworks um and the fire the metaphorical fireworks for me is the ability to reunite as families. I think that's the first thing, the post-corona era, within, I would hope, a couple of months, three months. Meaning children being able to see their grandparents. Yeah, not only see, but kind of comfortably see without, you know, feeling that there's a risk to

that and people being able to kind of have that engagement again, I think that's the first site of... Danny Gordes, who runs Shalem College in Jerusalem, is a writer. He wrote this column for Bloomberg View where he described people over 60 at a vaccination center in Jerusalem. And the medical administrators were handing out toys and games for children. And he's sitting there thinking, why are they handing out a bunch of games to people over 60?

It's because guess what? You're now going to be able to go see your grandchildren soon. And so we want you to be equipped with stuff to re-engage them with. And that was the mindset. It was about reuniting generations. Yeah. And I think that's the fireworks effect. Like for me, the New Zealand fireworks of New Year's, as to take your metaphor, is this families being reunited. That's the first thing

we're going to see. And again, depending on, you know, no South African mutation, challenging the vaccine and all of those things that can emerge, given that this is a first for humanity, that we kind of empower our immune system while the virus is mutating at such pace. Putting that aside, I think that's the first thing we're going to see. And I think going back to Netanyahu's decision, I think the defining factor,

I mean, if you remember in March and April, investment banks and the bloombergs or cnbcs were wondering what's the what's the global economy going to look like at the end of this thing is it going to be a u-shape is it going to be a v-curve um and then you know the theory the hypothesis of the k-curve emerged. And looking back, they were right, the folks who hypothesized the K-curve, right? So we saw companies all kind of collapsing in the beginning. And then there was a split, there was a fork in the road, if you can imagine the letter K. Some companies skyrocketed. And some companies, you know, really deteriorated and are still struggling. The

companies who succeeded, the defining factor, what was that point where the point of separation between are you ascending and propelling or are you descending and struggling was how digital the companies were and how advanced their brand and capacity was to treating people when they're at home, right? That was the differentiating factor.

I would argue that the efficiency in which you administer the vaccines is that determining point because nations are going to experience a K-curve recovery in post-corona, right? GDP, if you will, will recover as a K-shape, GDP for nations. And I think that's also what Netanyahu understood. There's a whole myth now around where is, was Israel willing to pay more for each vaccine? And there's a myth going on that Netanyahu said, you know, if the going price was 15, I'll double it and I'll pay 30. Let's say for the sake of simplicity, 10 million Israelis times $15 extra.

That's 150 million. A day of closure of the economy in Israel, this is a $370 billion economy, is worth a billion dollars. Right, so a billion dollars a day. Every day you can open, you gain back, under your theory, about a billion dollars of GDP.

Yeah, and therefore to me, the post-corona, the post-COVID national, day you can open you gain back under your theory about a billion dollars of gdp yeah and and therefore to me the post-corona the post-covid national um perspective should be influenced by this k-curve notion and one of the differentiating factors that would would kind of that fork in the road is going to be how well you administer the vaccines, because that would allow for a rebound of trust, a rebound of society, and then ultimately a rebound of the economy. And at the end of the day, much like, you know, the dot-com bubble or the 2008 crisis, the question is how, it's not a question of flexibility, it's a question of resilience. How quickly do you go back to your original posture?

And from that point on, how quickly do you leverage the new reality that emerged? And I think a lot of that boils into the vaccination effort. Yonatan, this has been an illuminating conversation. You've provided us with a lot of history, but also a roadmap, which I think at a time where most of the world is in some state of frustration or despair, sort of painted a picture of how to do this right and where it could land and when it could land. So it's both enormously educational and really interesting. So thanks for taking the time. Thank you very much for having me. And I hope that, you know,

when people hear this conversation we had, we can, both of us can inspire optimism, because from, at least from the way it looks like from Tel Aviv today, this can be behind us in a couple of months. From your lips to God's ears. Stay safe, Yonatan. Thank you. Take care. 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. Our researcher is Sophie Pollack. Until next time, I'm your host, Dan Senor.