How Israel launched a world-leading Covid-19 vaccination campaign: lessons from the ground
Israel has vaccinated a vastly greater percentage of people against the coronavirus than any other country so far. In this edition of The Promotion Fix, newly immunised columnist Samuel Scott interviews a top health official there and shows what marketers can learn from the successes.
‘Order early, pay a lot, digitise distribution and stretch the supply.’ That was how one journalist here summarised Israel’s world-leading success in vaccinating the population against coronavirus so far. Marketers could learn a thing or two – or several – from the campaign.
In 2019, Les Binet and Peter Field famously showed the relationship between top-of-the-funnel advertising spend on brand and bottom-of-the-funnel spend on activation. Both are important and necessary. Still, the bottom’s success usually depends on the top being successful in the first place.
In this column – my first since receiving the vaccine myself – I look at how effective infrastructure, distribution, pricing, positioning and promotion have all contributed to Israel vaccinating more than 20% of the people as of Sunday. I will go from the top of the funnel decades ago to the bottom of the funnel that was the jab in my shoulder last week.
How Israel combined digital infrastructure with creativity
Marketing is a lot more than communications even though the industry tends to discuss only that single set of practices. But any successful ad campaign still depends on everything that had come before.
A company might release an award-winning ad campaign that stimulates mass consumer interest. But if the corporate infrastructure and distribution practices fail to put the product on store shelves, then nothing else matters.
Israel has had universal health care since 1995. All citizens must register with one of the country’s four healthcare funds (somewhat similar to HMOs in the US and provider trusts in the UK). The detailed history is here.
For an income-based monthly national insurance payment, everyone is legally guaranteed to a certain level of care and highly subsidised medications. The system also incorporates competition because the funds offer various higher levels of service that are more expensive. People can change funds once per year.
Each fund’s clinics are located throughout the country – often with multiple ones in every city and town, giving them a wide presence with local attention. People here support the healthcare system at a level that rivals the British love for their National Health Service.
“Israel's health system and vast experience with implementing programs facilitates the massive [vaccine] roll-out,” Dr Diane Levin-Zamir, the national director of the department of health education and promotion for Clalit, the country’s largest health fund, told me. Every winter, Israel vaccinates against the flu and has done the same against measles and polio in the past.
“The system is centralised with the Ministry of Health coordinating the directives while the four health service organisations were recruited to administer the vaccines on the local and community level,” she added. “Multidisciplinary health teams were recruited to contribute work hours above and beyond their regular work schedules in order to operationalise the vaccine initiative.”
Levin-Zamir is also the chair of the Ministry of Health’s national health promotion council as well as an associate professor at the University of Haifa’s School of Public Health.
Without this existing nationwide infrastructure in the first place, Israel’s vaccine drive today would probably not have succeeded. But what helped even more was what the marketing industry calls ‘digital transformation.’ Israel implemented it 20 years ago.
I have not used the US healthcare system in a long time, and I am barely familiar with the British one. But I can describe the Israeli process here. I make appointments with my primary physician or specialists within seconds on the Clalit website. When I arrive at the clinic, I swipe my card at a machine that resembles an ATM to get my number in the queue.
The doctor swipes my card and reviews my information and medical history. When I get prescriptions at the pharmacy, the person swipes my card again and sees what the physician has prescribed. After I received my first coronavirus vaccine, the system later automatically created an appointment for the second dose and coordinated with me over SMS. I have not seen a piece of paper at a Clalit clinic in 10 years.
“The digital infrastructure that has been in place in the Israel health system for over two decades allows for online coordination of a complicated operation, as in the case of the coronavirus vaccine rollout,” Levin-Zamir said. “In general, the public has trust in the health system, enabling their positive responses particularly when, in this case, the health system informs them of new vaccine developments.”
So-called ‘digital transformation’ is not throwing your entire promotion budget online. It is rebuilding businesses and internal processes with digital technology. In strategic terms, that was Israel’s source of advantage at the very beginning.
But that is still prologue. Just as certain market leaders happened to benefit the most during lockdowns from already having both near monopolies and efficient distribution methods, Israel happened to have good infrastructure in place long before the coronavirus pandemic.
When marketers talk about ‘creativity,’ they are almost always referring to brand advertisements and the people who make them. But ‘creative’ is not actually a job title or department name. Anyone can be creative while doing anything – even something as mundane as product distribution. And Israel thought outside the pizza box.
When the first vials of Pfizer vaccines arrived here, they were in large, frozen pallets. Israeli teams – with Pfizer’s approval – repackaged them into separate, insulated containers that were the size of pizza boxes. That way, Israel could send all the smaller shipments throughout the country much more quickly and easily. Doctors and nurses also found a way to squeeze more doses out of each vial.
How positioning and pricing played a role
But let’s take a step back. Here is a vaccine positioning table that I created based on publicly available information.
Usually, a company that is first to market has a strong advantage. But rightly or wrongly, governments seem not in a rush to use Russia’s vaccine following reports that its authorisation process was rushed. And the Russian government – objectively speaking – likely has a disreputable brand at the moment. (Perhaps for good reason.)
According to the BBC, Pfizer and Moderna look to make large profits on their vaccines while Oxford-AstraZeneca just wants to break even. Further, Pfizer and Moderna have high prices while their vaccines need to be stored at very low temperatures. Oxford-AstraZeneca is cheaper and can be kept in standard refrigerators.
But after Russia, Pfizer got there first. So Israel jumped at the opportunity. (Oxford-AstraZeneca's vaccine seems more suitable for use by poor countries with less money and fewer advanced labs.)
Anyone who has worked in public relations, business development or sales knows the importance of communicating a mutual benefit. And according to local reports, Israel reportedly did so by offering Pfizer a lot of money and research data.
An anonymous Israeli government official reportedly told The Jerusalem Post that the country was paying Pfizer roughly $30 per dose. A Reuters report put the price at $62. That is anywhere from a 50% to 200% markup. (Pfizer did not respond to a request for comment for this column.)
Marketers rarely discuss international currency fluctuations, but pricing power is always important – on both the buyer or seller sides. In February 2009, one Israeli shekel was worth $0.24 and £0.17. Today, it is $0.31 and £0.23 – meaning that Israeli currency now buys 29% more stuff in dollars and 35% more stuff in pounds. Such as coronavirus vaccine doses.
Israeli was seemingly able to take advantage of its preexisting position in international finance. And that was another strategic source of leverage.
Over the past decade, investment into Israel’s growing high-tech sector has greatly strengthened the shekel – and the recent US and UK political turmoil has had a smaller effect as well. While high street businesses and small companies will obviously use only their local currencies, global ad agencies and large corporations should always keep retained earnings in various currencies to leverage such changes.
Still, Israel reportedly also convinced Pfizer to sell the country many vaccines with a promise of information. Israel seems to have used its existing healthcare infrastructure to position itself as the most valuable buyer in more ways than one.
“Israel will act as a large world testing laboratory, with the results from this huge research serving to set vaccination strategies in the rest of the world and also assisting the pharmaceutical companies in continuing R&D for coronavirus vaccinations and other treatments,” the Israeli business publication Globes reported last week.
“Israel has committed to send the pharmaceutical company data and details especially gathered for them including the consequences of the inoculations, side effects, efficacy [and] amount of time it takes to develop antibodies, according to different types of population, age, gender [and] preexisting conditions. The agreement extensively details the various parameters that will be sent to Pfizer.”
"I am asked all over the world how Israel does it," Israeli Health Minister Yuli Edelstein said last week. "The reasons are that we were prepared on time, signed on time with the leading companies and convinced them that if they gave us the vaccine, the health funds would know how to administer it in a very short time. That is exactly what is happening."
How Israel communicated the importance of vaccines
Communications, of course, usually occurs at the end of the marketing process.
One of the longstanding debates in philosophy is whether humans make moral decisions based primarily on reason (Immanuel Kant) or emotion (David Hume). Well, in a different context, the advertising industry discovered long ago that Hume is usually correct when it comes to purchasing decisions.
Most consumer products are bought simply out of habit. But brand advertising is a weak force that can slowly change a large population’s behaviour over time with repeated emotional and memorable messaging rather than logical statements. (Just see this hilarious Red Devil vacuum ad.)
Here a basic messaging guide that I once created after having too many facepalming conversations with certain ‘covidiot’ acquaintances.
The statements are factual and accurate. But they are entirely unconvincing and forgettable based on the number of people I see in Tel Aviv and online who still question vaccines, refuse to wear masks and protest against lockdowns. Think emotionally, not rationally. (Even in the B2B world.)
Such messages above are merely the places to start. Communicators should then tailor the messages to their specific audiences in emotional, relevant ways. Here is one example of what Israel has been doing to encourage people to get vaccinated.
The Facebook page of Herzliya, a suburb just north of Tel Aviv, published this photo of the mayor receiving the vaccine. The two Hebrew signs behind him say this: “I, too, got vaccinated against coronavirus.” Clalit clinics have these signs all over the place.
Such language is powerful here. It encourages individuals to join an important group effort. Most Jewish people consider ourselves to be members of a close-knit tribe. Modern-day Israel was also largely built by people living and working together on collective farms called kibbutzim. After independence in 1948, the first political party to lead a government was a socialist Labor Party that ruled politics for the next 30 years.
On 19 December, prime minister Benjamin Netanyahu was the first person here to be vaccinated. And what did he say on live television? “If everyone cooperates, keeps the rules and goes to get vaccinated, we’ll get out of this and we could well be the first country in the world to emerge from this. Let’s do it together.”
For another good, localised example of messaging, look at this Australian ad campaign that encourages mask wearing.
It speaks for itself. And Scotland could probably run the exact same thing. For England, it might instead have statements such as “Put a mask on your stiff upper lip” or “Keep calm and carry on – with a mask.” But I will defer to my Scottish and English counterparts on all this.
Still, in contrast, look at this UK government messaging from May 2020 as the coronavirus pandemic continued to worsen.
On just the rational side, the message is muddled and unclear. What, precisely, does “stay alert” and “control the virus” even mean? On the emotional side, the design is forgettable and borders on repulsive. But Jodie Whittaker’s advice to children in lockdown as The Doctor in March 2020 more than redeems the UK.
Sadly, 40% of people in France said in December that they would not take a coronavirus vaccine because of fears over side effects. But such misinformation has not been a large problem in Israel. (My few ‘covidiot’ acquaintances notwithstanding.)
“The Ministry of Health and the HMOs – specifically Clalit – invested tremendous resources in convincing the public of the reliability of the vaccines through evidence-based information based on the principles of health literacy [and] including cultural appropriateness to accommodate Israel's multicultural society,” Levin-Zamir said.
“Opinion leaders and role models took the lead in becoming the first to become vaccinated, which was publicised widely in mass and social media. The changes in information are transparent to the public as new recommendations are communicated – for example, as each new type of vaccine is introduced with its specific instructions. Online information, use of social media and community infrastructures for sharing information are paramount.”
Further, word quickly spread in Israel that hospitals and clinics often have leftover vaccine doses in the evenings that must be used quickly before they expire. Reportedly, anyone who happens to be waiting will often be vaccinated – even though the official regulations may state that only people above a certain age or those with certain pre-existing conditions can receive it.
Now, Israelis love to create private groups on Facebook and WhatsApp. The parents of the children in a given school class often have one. The mothers living in a given neighborhood often have one. Circles of friends often have one. There is even a closed Facebook group called Coronavirus Vaccines Between Friends with 55,000 members.
Whenever people receive a surplus vaccine or hear of a nearby place that has them, they often share the information in those online groups and tell people to rush to those locations as though there is going to be a nationwide hummus shortage. And many more get vaccinated. Yes, it is an example of Israeli ‘chutzpah’ – the Hebrew word for ‘nerve’ – but it works.
Stay strong – this is almost over
I write this column not to brag about Israel’s success – though, I must admit that I am proud. I am much less familiar with the vaccination situations in the US, UK and elsewhere, but I hope that what I have found here will help everyone else as well in some way. If there is one thing that the pandemic should teach the world, it is that we are all in this together.
This past year has been hell. Even though Israel is rapidly vaccinating the population, we are still in the middle of a third nationwide lockdown that will likely not end until weeks after most people here have received a vaccine. It is not easy. ‘Digital transformation’ may have allowed us to have anything delivered to our homes, but it is not healthy to be trapped inside all the time.
Still, I will be lucky enough to receive the second coronavirus vaccine dose in a few weeks. Starting in February 2021, I will be able to travel and speak at marketing and business conferences like it is 2019. I hope that all of you will soon be able to do the same.
Stay strong. You got this. And if you need a supportive ear, feel free to message me. As I was walking home after receiving the initial vaccine dose at a clinic here in Tel Aviv, I had to stop myself from bursting into tears more than once. The light at the end of the tunnel is growing larger for all of us.
The Promotion Fix is an exclusive column for The Drum contributed by global keynote and virtual marketing speaker Samuel Scott, a former journalist, newspaper editor and director of marketing in the high-tech industry. Follow him on Twitter. Scott is based out of Tel Aviv, Israel