Vaccine Equity and Distribution in Israel

Does Israel as an occupying power have a duty to provide vaccines to Palestinians within the territories?

Israel’s Covid-19 response has in some ways been remarkably effective, especially in the context of the struggles faced by other countries in the region, as well as many Western countries, the United States included. However, Israel’s vaccination efforts in Palestinian territory are complicated by the politics of its authority over those areas and relationship with Palestinian officials.

The vaccination rollout in Israel has been cited as one of the most effective in the world, with over 60% of the citizens vaccinated by the end of March. Every citizen of Israel, regardless of ethnicity, is eligible for the Covid-19 Vaccine. Additionally, Palestinian residents of East Jerusalem have Israeli residency status and are also eligible for the vaccine. However, as of January within this demographic, only 20% of those eligible opted for the vaccine, while 75% of eligible Israelis received vaccinations. This discrepancy can be attributed to the circulation of false information in the area warning against the vaccine.

Misinformation regarding the Palestinian Authority’s (PA) request for Israel to provide vaccines has circulated throughout various media sources. On January 5th, The Jerusalem Post was told by a Palestinian Health official that the PA had not asked Israel to donate vaccines or to purchase vaccines on their behalf. Later that day, the Post reported that the PA was considering obtaining vaccines from Israel. On January 6th, two Palestinian officials told The New York Times that the PA had asked Israel for up to 10,000 doses for healthcare workers, but Israel had refused this request. On January 7th, The Wall Street Journal was told by another Palestinian official that the PA had not actually asked Israel for vaccines. The Palestinian Authority’s hesitancy to ask Israel for vaccines has been attributed by some to fears that organizational ineptitudes could reflect poorly on the possibility of Palestinian statehood.

The question of Israel’s role in overseeing and providing healthcare to Palestinians in the West Bank is further complicated by the conflicting demands of the Oslo Accords and the Fourth Geneva Convention.

The Oslo Accords were initially passed in 1993, with later revisions, and granted the Palestinian people the right to self-determination. The Palestinian Authority arose from this agreement and was given partial self-governance in parts of Gaza and the West Bank. Primary healthcare is one of the responsibilities that was ceded to the Palestinian Authority. The Accords state that: "Powers and responsibilities in the sphere of Health in the West Bank and the Gaza Strip will be transferred to the Palestinian side, including the health insurance system” (Article 17 of the 1995 Oslo agreement). After this agreement, the PA created its own Ministry of Health to govern healthcare in Palestinian territory.

On the other hand, the Geneva convention includes a series of treaties and protocols to outline legal action in occupied territory. Article 56 reads: "The Occupying Power has the duty of ensuring and maintaining, with the cooperation of national and local authorities, the medical and hospital establishments and services, public health and hygiene in the occupied territory, with particular reference to the adoption and application of the prophylactic and preventative measures necessary to combat the spread of contagious diseases and epidemics."

These two agreements appear to make conflicting claims about the role the Israeli government should play in Palestinian healthcare. Which should be treated as authoritative?

The Oslo Accords were passed in 2004, and the Geneva Convention in 1949. The Oslo agreement was decided upon with the conflicting precedent in mind, so one could argue it overrides that precedent. However, others argue that the Palestinian Authority that was formed in 1994 was meant to be a 5-year interim body, not a permanent governing entity.

UN experts have said that the Oslo Accords must be interpreted only when consistent with international law, and that the occupying power must retain the responsibility of health services until the occupation has fully and finally ended.

According to the Geneva Convention, Israel must protect the health of its occupied territories “to the fullest extent of the means available to it.” However, it must be “in cooperation of national and local authorities”. It remains unclear whether the Palestinian Authority has directly asked the Israeli government for any vaccine aid.

Initial Vaccine Rollout in the PA:

The Palestinian Authority originally planned to rely on the World Health Organization’s Covax initiative, which plans to vaccinate at least 20% of the Palestinian population as well as other poorer nations. This initiative has provided the PA with 38,000 doses of the Pfizer vaccine and 24,000 doses of the AstraZeneca vaccine. Additionally, Gaza received a donation of 20,000 Sputnik V vaccines by the UAE, and 100,000 doses of Sinopharm COVID-19 vaccines donated by China. The US has recently pledged to replace the AstraZeneca vaccines, which have not been approved by the FDA.

In March, criticisms arose over a lack of transparency on the PA’s rollout of their donated vaccines, with claims that senior officials and professional athletes were given priority over healthcare workers. These claims were countered by Health Minister Mai Alkaila, who asserted that over 90% of the donated vaccines were given to healthcare officials. Throughout February and March over 100,000 doses were given to Palestinian workers who cross the border into Israel daily for work.

There are additional logistical difficulties in delivering vaccines to Gaza, which has been under blockade by Israel and Egypt since the militant Islamist movement Hamas asserted control over the area in 2007.

On June 13th, the 36th government of Israel was sworn in, and on June 16th the new government pledged to supply Palestine with 1-1.4 million Pfizer-Biotech Vaccines. This deal came with the stipulation that the PA will provide Israel with a similar amount by September or October, when their shipment is slated to arrive. That evening, after the city of Ramallah had received 100,000 doses, the PA rejected the deal because of the nearby expiry date of the doses. The vaccines were set to expire by early July, giving the doses two weeks to be distributed. These 100,000 doses have not been returned to Israeli authorities and appear likely to expire before being used. The PA reported that they will instead wait for their shipment of 4 million doses in September.

The Israeli Health Ministry has stated that the PA was aware of the vaccine’s expiry date before the deal was made. After the deal was made, Palestinian media heavily criticized the Authority’s deal, portraying the vaccines as subpar and ineffective. The Popular Front for the Liberation of Palestine group called the deal “humiliating” and claimed it “could have harmed human life.” However, there is no scientific evidence behind this claim.

Currently, it is unclear if the Palestinian Authority will vaccinate its residents before September, if Israel will strike a new agreement, or if foreign aid will have a significant impact before the PA’s Pfizer shipment arrives. The complexities of Israel’s relationship with the PA and the territory in which it operates continues to heavily influence vaccination efforts, complicating the area's recovery from the global pandemic.

Rachel Sragovicz is a Sophomore at Yale University. She is from San Diego and is thinking of majoring in Ethics, Politics, and Economics. She is very excited to be writing for the journal and is looking forward to deleting the Zoom app and going to in-person classes.