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Opinion

Israel's vaccination rollout shows the world how it is done

COVID-19 will accelerate the digitalization of Asian health care

| Middle East
A woman receives a vaccination in Tel Aviv on Feb. 18: Israel's vaccine program is the envy of the world.   © Reuters

Sigal Atzmon is founder and CEO of Medix Global.

Every single Asian country understands the importance of health care digitalization. It reduces costs, improves diagnostics, helps governments to frame public health campaigns, enables researchers to develop new drugs and gives patients a better understanding of their health.

But there has been a sizable gap between governments' ambitions and reality for a number of years, even in city-states with well-managed public health infrastructures like Hong Kong and Singapore. This is not the case in Israel where digitalization underpins the entire health care system.

When it comes to COVID-19, this is now benefiting the country in two very important ways. Firstly, Israel's vaccine program is the envy of the world. As of Mar. 14, 59.7% of the 9.3 million population had received at least one dose of the Pfizer BioNTech vaccine.

Secondly, the successful rollout means that Israel is confident enough to start reopening its economy again. Citizens who have had both shots, or who have recovered from COVID-19, are eligible to download an app developed by the Ministry of Health. This gives them a unique QR code, which lasts for six months. Scanning it gains citizens entry to gyms, theaters, restaurants and bars. It is also helping to encourage greater vaccine take-up.

A woman shows her vaccination status QR code on her mobile phone at a gym in Tel Aviv on Feb 21.   © Reuters

In Asia, the vaccine rollout program is only just getting underway for a number of reasons. However, what is striking is just how paper-based it is.

In Singapore, elderly citizens are receiving letters with a web link to register for the vaccine. Once they have done that, they receive a short message service with a unique booking link. In Japan, the government plans to issue vaccination tickets and then mail them from mid-March.

The Israeli system is far more streamlined. Citizens receive their vaccination notifications by text. This links to an app where they book their first and second jabs. If they do not respond to the first text, there is an automatic escalation system, which prompts a second text, followed by a phone call. Elderly non-tech users can use a call center.

The inoculation process is also digitalized. Nurses input patient data onto an app using their Smartphones, using two-factor authentication to prevent data breaches. When they return home, Israelis receive another text linking to a survey about possible side effects.

Israel is highly digitalized because of its strong public health ethos. Every citizen has to join one of four medical insurance providers known as kupot holims, Hebrew for patient funds. These cater to every medical need from primary to tertiary care, meaning general practitioners to specialist surgery.

The four also compete for patients and digitalization helps them to stand out. Citizens use the app provided by their medical insurance providers to book appointments, message their doctor, order prescriptions, receive test results and view their medical data. Data is pooled at a national level so any authorized health care provider can access patients' electronic health records. There is no waste. Tests do not need to be repeated because a clinician cannot access a blood test sitting on a general practitioner's computer.

This is not the case in Asia. Singapore has been progressively rolling out its National Electronic Health Record system since 2011. However, only about 27% of privately licensed doctors use it.

It is a similar story in Hong Kong. As of end-February, 1.387 million of the Territory's 7.5 million population had signed up to the government's electronic Health Record Sharing System. Studies in both jurisdictions show that the older the doctor, the lesser the enthusiasm. They are not as tech-savvy and more concerned about the administrative burden of migrating data onto a new system.

Data interoperability is also an issue. This is something that economically advanced countries and regions like Taiwan are grappling with. There are a lot of legacy IT systems and they cannot speak to each other. Countries like Japan and India are at an earlier stage of the digitalization process but have ambitions for technological leapfrogs.

The Japanese government wants to expand digitalization by adding more services to the My Number identification system, a personalized ID system that embraces social security and tax. Health insurance will be added this March and the government hopes that it will improve the card's take-up rate, which has been around 20% of the population.

In India, Prime Minister Narendra Modi announced a National Digital Health Mission in 2020. Every Indian will be issued with a personal health ID, eventually enabling patients and practitioners to access data via an app.

Countries that get their data right will benefit medically and economically. Israel now has over 20 years of data to draw on and the government uses it to craft targeted health care messages based on age, gender and disease profiling. Medical insurance providers have even assigned patients scores based on their likelihood of suffering severe COVID-19. Israel consequently has a progressive health care landscape emphasizing prevention and continuity of care.

It is also efficient. Israel spends 7.5% of its gross domestic product on health care compared to double-digit figures in Europe's richest countries and the U.S. Asian countries still average less than 5% of GDP, but are rapidly scaling up as economies advance and populations age.

Asian governments are aware of the challenges and are meeting them head-on. I hope COVID-19 acts as an accelerator. Israel developed a COVID-19 app in a few months. It does not have to take years. Track-and-trace apps have not been popular globally because end-users do not like quarantining. Many governments also missed a trick not creating vaccine-related apps since people want jabs.

But there are still possibilities to create digital passports, as citizens want life to get back to normal. Such apps can be a springboard for speedier digitalization. Crises create opportunities and there is no bigger one than COVID-19.

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