Bolstering the Health System's Capacity to Manage Crisis Situations
As part of the IDI Eli Hurvitz Conference on Economy and Society, a session was held on December 16, 2020 with the participation of Health Minister Yuli Edelstein, Director General of the Ministry of Health Prof. Chezy Levy, and a number of experts in the field of health who are responsible for preparing the health system for emergencies and crises.
MK Yuli Edelstein | Flash 90
Highlights
Minister of Health Yuli (Yoel) Edelstein: “I do not regret my decision to become minister of health. That this system, which has suffered from underfunding, managed to deal with the pandemic in this way, is an achievement.”
When asked in what he would have invested a NIS one billion budget increase, Edelstein replied: "In terms of the Israeli health care system, one billion shekels is not an astronomical sum. I think that if they had asked me to focus the investment, I would have invested in reducing the gaps between the center and the periphery, shortening the waiting time for an appointment with a specialist doctor, and increasing medical equipment in the hospitals."
Regarding the issue of decentralization to local authorities, Edelstein added: “We realized very quickly that making smart decisions in a meeting room in Jerusalem is one thing; what happens on the ground is something else. Local authorities are at the forefront and are connected to the Ministry of Health’s dashboard. At the time, the head of the council approached me with a request that local authorities conduct epidemiological investigations and I said to myself: “Who will conduct the investigations? An official from the collections department?” I changed my mind after discussions with professionals, and we now see hundreds of local authority workers doing epidemiological investigations. Cooperation with local authorities is good for everyone.”
Edelstein noted: “I miss the social solidarity between the various sectors very much. The second wave taught us a lesson. It was previously very popular to explain that members of the ultra-Orthodox community were “spreaders” of the disease. But surprise, surprise! This time around the index in the ultra-Orthodox sector was lower than in Arab society; in the second wave, the situation changed. The virus is not political, ethnic, national, or nationalist. We try to adapt to different societies and different sectors with the help of rabbis, opinion leaders, heads of local Arab municipalities, celebrities in general society –anyone who can help.
Regarding the vaccine, he expressed: “Doctors, who have authority, are very important to us, and the heads of the health maintenance organizations have already announced that they will be vaccinated first. This helps us a lot. There are a lot of athletes, artists, and heads of municipalities who have also volunteered to be first. We are preparing for this seriously with a logistics and information campaign. There are quite a lot of people who are afraid, but I am sure that a very high percentage of the population will get vaccinated and be rid of this trouble. At the moment what we have is the Pfizer vaccine and I hope that the Moderna vaccine will soon also be available. I suggest that no one does independent research; the citizens of Israel are not being given something that is not safe.
Professor Chezy Levy, director general of the Ministry of Health: “This is the most intense year I have ever known. Dealing with COVID-19 is a worldwide phenomenon. You learn to understand the power of things and the importance of every word and decision you make. One of the things I had a hard time dealing with was the media. The public has lost faith, but when you deal with the crisis there are dilemmas: not every dilemma is a misstep and not everything that is published was really said. The public has lost faith in the government but must act responsibly and wear masks. We have seen an increase in morbidity due to weddings and gatherings in all sectors; it gives me sleepless nights as I wonder what I did wrong. The public is not to blame; the onus is on us to make the public behave responsibly. One of the things that disappointed me was that people from the Ministry of Health spoke their professional truth and then became the targets of various committees of pressure to fire them for no injustice on their part. Their only offense was that they represented their firm and professional truth and this led to a decrease in motivation and an increase in frustration. One day I will write a book about these things; it is a great privilege to be here during these events and moments.”
Alon Messer, deputy director of the Ministry of Finance’s Budget Division: “The health system was a top priority in terms of budget growth, and what can be learned is that the public health system must be preserved. A strong and good public health system must be established. Countries where the private health system has thrived at the expense of the public have ended this crisis very badly, and we must not get there. If I look at the coming years from a budgetary point of view, it will be challenging. We have regressed years; the government will have no choice and there will be greater pressure to allocate budget additions from the civilian budgets including the health care system. One of the issues that is relevant and needs to be addressed is the interface between the community and hospitals and home hospitalizations. The government’s great challenge will be to join forces, and I think this is our opportunity to learn lessons.”
Dr. Hans Kluge, WHO Regional Director for Europe: “It is the WHO (World Health Organization) headquarters in Geneva and delegated powers, that is managing the crisis at the world level. It is the WHO headquarters that has outlined the policy and translated it into tools through which each country will be able to implement policy. One of the lessons is the speed required; you need 20 branch-offices that can quickly implement critical policies. Countries with a similar history, culture, and system of government have dealt with the crisis in a similar way. There is no one country that can only learn or only gain knowledge; we can all learn from the conduct of each country.
We are not yet seeing the end of the tunnel for resolving the crisis and therefore recommend countries to constantly learn and criticize their own conduct during the crisis. First, a strong health care system equals a strong and critical economy. We’ve been saying this for years. The war on epidemics is not through hospitals but a whole community of supportive infrastructure. Second, this is a wonderful opportunity to create an infrastructure of digital health and reliance on technology. Third, solidarity must be created within and between countries because no one is safe until everyone is safe. If solidarity does not come from the heart, it will come from the mind, because if a country is surrounded by countries where the plague is at their borders, borders will no longer be a factor.”
When asked whether it was right to make lockdowns at an earlier stage and whether it was time to change the world’s perception of a global village and restrict border crossings, Kluge said: “There is no such thing as an island nation. Even if the borders were closed, this would not stop the virus, but it would give national health systems a little more time to prepare. There are important actions that are more basic than closing borders: maintaining hygiene, wearing masks. For example, in Europe over 67% of the population are wearing masks, while in Singapore it is 85%. If the percentages in Europe go up, we can avoid additional deaths. International and national solidarity are necessary; this is the only way to prevent the epidemic from spreading, along with strengthening civil society.”
Professor Sigal Sadetsky, former head of public health services at the Ministry of Health: “Beginning in December when we thought it was a local event, we tried to assess its consequences and closely followed the developments. There were some critical factors that changed the picture, such as the rate of infection and the coping of the countries of the world with the pandemic that very quickly turned out to be a global crisis. Each country has dealt with it in a different way according to its capabilities. We had to adapt to new and more effective methods and make life-saving decisions quickly.”
Moshe Bar-Siman-Tov, former director general of the Ministry of Health: “Our first conclusion is that a national health security manager should be appointed. We want each of the local authorities to have health security officers who are employees of the local authority and subordinate to the Ministry of Health. We think we need a modern legislative framework that will give complete and flexible answers and define the circumstances in which decisions are made according to professional considerations and the right balance in order to generate minimal human rights violations and maximum transparency of information and prompt guidance. We also understand that in an emergency in which we are dependent on public behavior, communication is a critical component of the decision-making process. We think that a national public health information system should be established in which there are intermediaries whose job it is to explain the logic behind decisions. The Ministry of Health needs to have an open arena and to see that the actions taken are effective. In addition, a dedicated headquarters must be established in the Ministry of Health that will train people and define what the basic units are and what the interface is between the public and community health systems."
Dr. Dorit Nitzan, director of the WHO European Regional Health Organization: “In terms of governance, we see that the pandemic found Israel unprepared, as the legal arrangements required to improve its health system have not been completed. No uniform and unified system has been activated for control, monitoring, and coordination throughout. Such a system, which we recommend establishing, based on work in calmer times, partnerships, and anchored in the community, was lacking. At the same time, Israel’s health system is considered one of the best in the world. Despite the massive spread of the pandemic, corona rates in Israel are among the lowest in the world. The most important conclusion is that this is an opportunity to leverage the health care system to strengthen health security. It is a term we would like to enshrine in legislation.”
The Eli Hurvitz Conference on Economy and Society – formerly the Caesarea Economic Policy Planning Forum – is widely recognized as Israel's most influential economic conference. For 27 years, the conference has served as a crossroads where public discourse and professional knowledge in economics and society meet, with the aim of improving decision-making processes in the administration and improving the quality of Israel's social and economic policy for the benefit of the entire public. The conference this year focuses on: macroeconomic policy in times of economic crisis; the labor market; the Israeli education system; governance in a time of crisis; strengthening the health system's readiness for crisis situations; and the relationship between local and central government. The conference is the apex of research and theoretical and practical research by working and thinking groups comprised of senior officials in the Ministry of Economy, Ministry of Labor, Ministry of Finance, the Prime Minister's Office, academics, IDI experts, civil society representatives, and other partners. Together, the teams led research and developed policy recommendations on issues closely related to the conference sessions, which will be presented during the conference, held online this year from December 14 to December 16.