© Adel Hana/APSuhad Saidam adjusts one of her face masks on a youth at her sewing workshop in Gaza City, Monday, Dec. 14, 2020.
JERUSALEM -Israel, like many high-income countries, is moving quickly to roll out newly approved coronavirus vaccines, with Prime Minister Benjamin Netanyahu scheduled to get the symbolic first shot Saturday. But next door in the West Bank and Gaza Strip, the prospects for vaccinating almost 5 million Palestinians are far less certain, as financial, political and logistical hurdles could delay inoculations against the raging pandemic for months.
The split highlights not only the tense disparities between Israel and the Palestinian populations it effectively controls, but the growing divergence between vaccine haves and have-nots as the world enters the pandemic endgame.
The United States, Britain, Russia and other developed countries have already begun administering vaccines to health-care workers, the elderly and other priority groups. Other nations are receiving shipments now.
But poorer populations could be waiting much longer. Internal World Health Organization documents leaked this week warned that vaccines might not reach some countries until 2024, a delay that could hamper global efforts to contain the virus.
"Nobody is safe until everyone is safe," said Gerald Rockenschaub, the WHO chief for the Palestinian territories. "It's in everyone's interest to ensure that countries that can't purchase vaccines on the global marketplace have their needs met adequately."
Few places offer a starker side-by-side example of the gap than Israel and the Palestinian territories.
The Israeli government, starting with some 4 million doses of the just-approved vaccine from Pfizer-BioNTech, is ready to begin inoculating up to 60,000 residents a day through its national health programs. Amid plans to issue "green passports" that will allow the vaccinated greater freedom of movement, hope is rising in Israel that the pandemic is entering its final stages.
But Palestinian leaders say they can't afford either of the first blockbuster vaccines to hit the market. The Pfizer-BioNTech vaccine costs about $20 a dose, and another made by Moderna that was endorsed Thursday by an FDA panel will run between $25 to $35 a shot, according to a WHO review.
Palestinian leaders and international activists say Israel is obligated to ensure that Palestinians are vaccinated as quickly as possible.
"Israel bears moral and humanitarian responsibility for vaccinating the Palestinian population under its control," said Physicians for Human Rights in an appeal to Israeli leaders Wednesday.
In an interview, Israeli Health Minister Yuli Edelstein rejected that argument. But he acknowledged that it was in Israel's self-interest to expand vaccinations into an adjacent population that sends thousands of workers into Israel on a daily basis.
"There is no responsibility, but it is in our interest to help as far as the coronavirus is concerned," said Edelstein, who is among Israeli leaders scheduled to be publicly vaccinated Saturday. "We've been doing it for the last year, with equipment and with medicine."
Edelstein said the country may be able to pass along some of the vaccine stock it is accumulating, but not until it inoculates its own 9 million citizens, including the 20 percent who are Palestinians living in Israel.
"We can't deny an Israeli citizen a vaccination because we want to help someone else," he said. "But if there will be extra or a feeling that everyone is feeling safe, then we will."
© Ahmad Gharabli/AFP/Getty ImagesA paramedic with Israel's Magen David Adom medical services performs a swab test at a drive-through coronavirus testing center in Jerusalem on Dec. 14, 2020.
The Palestinians need not just financial assistance, but logistical help as well. The Pfizer serum, for example, must be shipped and stored at minus-94 degrees, a cold-chain effectively unavailable in Gaza, where electricity is available only eight hours a day.
"We just do not have the technical capabilities for that," said Ali Abd Rabbo, director of the Palestinian Health Ministry in Gaza. "We have held sessions with the Israeli side in this regard, but until this moment there is no agreement."
The Palestinians are instead pinning their hopes on a global consortium of 92 low-income countries working to deliver more affordable vaccines. Both Hamas, the militant group that governs Gaza, and the West Bank's Palestinian Authority have signed up for the program, which aims to vaccinate the most vulnerable 20 percent of each participating nation.
The effort, known as the Gavi Alliance and backed by the WHO, the United Nations and the Bill and Melinda Gates Foundation, is reviewing 14 vaccines still in development around the world. The WHO expects to approve at least some of them for emergency use in January.
But it could well be months before mass vaccinations begin under the program, even as Gaza and the West Bank face a surge of infections.
"We expect something to become available by the end of the first quarter [of 2021], but it's really difficult to predict," Rockenschaub said.
Palestinians are also exploring other options. The Palestinian Authority has asked the United Arab Emirates to share some of its supply of a Chinese-made vaccine, according to Salwa Najjab, a West Bank physician and member of the Palestinian coronavirus task force. And Russia has reportedly offered to make up to 4 million doses of its Sputnik vaccine available, although public health officials said details were vague and formal assurances lacking.
Whatever arrangements they make with vaccine providers, the Palestinians face the added barrier of Israeli control. Any vaccine will be subject to review by Israeli regulators who have previously blocked the importation of unapproved drugs.
Health professionals said they expect Israel to recognize vaccines that are approved for emergency use by the WHO, but others may be stopped at checkpoints.
"We don't have control over our borders," Najjab said. "We need to coordinate with Israel on that, and everybody is afraid that we can't get the vaccine."
The Coordinator of Government Activities in the Territories, the Israeli Defense Ministry agency known as COGAT that coordinates with Palestinian officials, would not comment on any of the specific vaccines. But, in a statement, the agency said it should not be viewed as hindering the Palestinian effort.
"Israel has not denied any request for medical assistance that has reached its doorstep," the statement said.
steve.hendrix@washpost.com
shira.rubin@washpost.com
Hazem Balousha in Gaza City contributed to this report.