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Israel rolls out Pfizer covid pill, using digital health records to identify those most at risk

January 11, 2022

JERUSALEM — As omicron infections surge, Israel has begun rolling out a newly approved Pfizer drug, using digital health records kept on nearly every citizen to identify those who are at high risk from covid-19 and are likely to benefit most from the treatment even before they become dangerously ill.

Israel is one of the first countries to put Pfizer’s Paxlovid anti-viral pill into use, and doctors affiliated with the four publicly funded health-care networks here are now dispensing more than 100 courses a day, less than a week after the pill won approval. The drug is being dispatched to qualified patients’ homes almost as soon as they test positive for the coronavirus.

Israeli health officials say it’s too soon to tell whether the treatment is heading off serious illness in significant numbers. But none of the recipients — all of whom are immune-compromised or otherwise deemed at the highest risk — have yet needed to be hospitalized, according to Clalit Health Services, Israel’s largest HMO covering almost half the population.

In clinical trials, Pfizer reported that the pill reduced death and hospitalizations by 89 percent. Some medical experts have hailed the new covid treatment as a significant breakthrough and a last line of defense when the virus has dodged vaccines, boosters and masks to infect a highly vulnerable person.

“It’s a very promising drug,” said Ian Miskin, an infectious-disease specialist who oversees the Paxlovid program at Clalit. “This gives us something to turn to when everything else has failed.”

The drug is also being dispensed in the United States, where it was approved by the FDA last month, and other countries. But critics have said the pill is not reaching clinicians quickly enough to ease the strain on hospitals, which are buckling in some places under increasing admissions and staff shortages.

The first shipment of a reported 20,000 courses of Paxlovid arrived at Israel’s Ben Gurion Airport last week, making the country one of the first to obtain a supply.

Israeli Prime Minister Naftali Bennett personally lobbied Pfizer’s chief executive, Albert Bourla, to secure an early shipment of Paxlovid, according to Bennett’s spokesperson Keren Hajioff, just as the previous prime minister Benjamin Netanyahu did to obtain the Pfizer vaccine.

Pfizer would not comment on the specifics of its agreements with Israel. A spokesperson said Israel received Paxlovid early because the country was one of the first to give it regulatory clearance.

Doctors say there’s still much to learn about a treatment that was originally tested on unvaccinated people infected with the delta variant but is being used here mostly to treat vaccinated patients who have contracted the omicron variant, which seems to be more transmissible but causes less acute illness. Israel is seeing some of its highest infection rates of the past two years, and hospital administrators are warning that beds are filling up.

To flatten the curve, physicians are targeting patients who have tested positive and have underlying risk factors but are not yet seriously sick. There’s a window of a few days to find and treat those who fit the bill.

Doctors say that dispensing the drug is proving complicated, in part, because there’s a long list of medications that don’t mix well with Paxlovid. Many prospective recipients are older and take other medications, such as hypertension drugs and anticoagulants, and these patients may have to change or suspend those treatments to take Paxlovid.

“It’s very involved,” said Galia Rahav, a physician at Sheba Medical Center outside Tel Aviv who has been consulting with HMOs on Paxlovid. “Sometimes you have to talk to them for an hour. I had a patient yesterday whose daughter is a pharmacist, and we finally decided he wouldn’t take it.”

Before these conversations even occur, computers cross-tabulate reports of positive coronavirus tests with existing medical files, then flag those individuals who might be most at risk and most likely to benefit from the drug.

Simcha Neumark learned how Israel is zeroing in on prospective recipients just a few hours after he tested positive for the virus. Because he has a chronic disease treated with immune-suppressing drugs, the 33-year-old banker from Jerusalem has been navigating the pandemic with extreme caution. Worse, the coronavirus vaccine has proved a bust in his case. None of the three jabs he got in Israel or the two in his native Brazil prompted an immune response. “My body just won’t produce the antibodies,” he said.

And so, he recalled, the sore throat and fever he developed last week were scary. The positive coronavirus result that arrived by text message late Friday was terrifying. He feared he might end up on a ventilator.

Without prompting, his HMO, Meuhedet, sent him a text message noting he was at high risk and that it would closely monitor his condition. The next day, as Neumark’s symptoms grew worse, a Meuhedet doctor phoned. The consultation turned to Paxlovid, a drug still hours away from being approved for use by the Health Ministry. Neumark would become the first in the country to take it.

“They said I was a perfect case but that it was totally up to me,” he said.

His temperature had climbed, and his throat was burning by the next day when his wife ran out to meet a taxi on the street. She came back with a 30-pill course of medication, six a day for five days. He took the first three immediately.

Within 17 hours, his symptoms were almost gone, he said. “Now I’m just tired,” he said. “It’s like I went from covid to mononucleosis.”

The fast rollout of the drug has once again made Israel a test case, a role the country has played several times during the pandemic.

The world watched closely when Israel began administering the first shots of the Pfizer-BioNTech vaccine on a national scale in late 2020 and again when it launched booster shots in 2021 and a second round of boosters for some this week. Pfizer, under an agreement with the government, has collected anonymous data on vaccine performance from the electronic health records of almost all of Israel’s 9 million residents.

“Israel is a very small country with a well-organized health-care system,” said Hajioff, the prime minister’s spokesperson. “We are very quick at adapting and at collecting data that is useful to us and to other countries as well.”

This news originally appeared in The Washington Post.

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