In July, Alroy-Preis replaced the fiery Prof. Sigal Sadetsky, who stepped down from the position with a long letter detailing how management of the coronavirus crisis was plagued by frivolous and populist decision-making.
“I knew what I was going into,” Alroy-Preis told The Jerusalem Post on Wednesday. “I knew there would be heavy costs personally, and I probably would not see my family for many months. I talked about this with my husband and my kids – I have four boys – and so they all kind of encouraged me and said you need to do something important for the country and we are behind you.”
But she admitted that sometimes her younger two, who are seven and nine, ask her if she is going back to her old job as deputy CEO of Carmel Medical Center soon.
“It is not easy,” she said.
When Alroy-Preis stepped into her position, the COVID-19 pandemic was climbing toward what would ultimately be the peak of its second wave. There were more than 1,000 new cases per day, and government and health officials were struggling with whether to lock the nation down again – a move that ultimately took place two months later, in September.
A public health expert with deep ties to the United States – she studied at Dartmouth and served as the New Hampshire state epidemiologist for three years – Alroy-Preis was unknown to most Israelis outside the medical community. But the sole female in a top leadership role at the Health Ministry, she quickly became a household name.
In January, Israeli officials were forced to apologize to Emirati officials after Alroy-Preis joked during an interview on Channel 13 that “in two weeks of peace [with the UAE], more people died than in 70 years of war.”
The comment, said in jest – after all, Israel and the United Arab Emirates were never at war – was aimed at the government for allowing thousands of Israelis to travel to and from the Gulf state at a time when the pandemic was raging. In two months, more than 900 Israelis who returned from the UAE were diagnosed with COVID-19, resulting in over 4,000 new cases, ministry data showed at the time.
In December, during one of Israel’s semi-lockdowns, Alroy-Preis strongly attacked fellow epidemiologist Hagai Levine at the Knesset’s Constitution, Law and Justice Committee after he questioned the ministry’s decision to close down the country.
Alroy-Preis stressed, “We are using the word ‘lockdown’ even though this is not a lockdown if people are going to work and people are going to classes, so there isn’t a lockdown.”
Her “there isn’t a lockdown” line became the focus of a skit on the popular political satire series Eretz Nehederet, where she is played by actress Alma Zack.
“It is obviously not easy to see yourself,” Alroy-Preis told the Post. “At the beginning, I was hesitant and said I cannot really watch them doing me. And then my seven-year-old came and said you have to see this, there is something really funny, and he brought Eretz Nehederet, and I said if he can joke about it, I probably can joke, too.”
But most of the year has been anything but lighthearted.
In government meetings, which as Sadetsky wrote were wrought with politics and populism, Alroy-Preis said she played the role of the professional.
“I try to give the best professional recommendations and then insist on them,” she said. “We were all the time balancing health and economics and the well-being of kids – trying to balance all these things while making sure that people are not dying or getting infected in ways that were preventable.
“Our role is as the professional people who give recommendations, and [the politicians’] role is to make final decisions,” she continued. “But if we think they are making the wrong decision, we will insist on why we think what we are suggesting is the way to go, and back it up with data and explanations.”
It did not always appear that the professionals won, but she said that, looking back now, they and the country prevailed. With more than five million Israelis fully vaccinated, Israel is recording less than 100 new cases most days and the economy is nearly completely open.
But that does not mean the pandemic is over, even in Israel.
THE NEXT big challenge will be when to administer the likely needed third shot of the coronavirus vaccine.
“It’s a really important and hard question,” Alroy-Preis said. “The way we would know about it is either by a direct way or kind of getting clues from different things.”
The first way is to follow the vaccine companies.
“Pfizer itself and Moderna and all the companies, when they do a Phase III study, they continue to follow people and to follow their titers and infection rates. With the original study, we will know if the effectiveness continues,” she said.
Pfizer recently released data that showed the vaccine is still 91% effective after six months, which means there is some decline from 96%, but “it is not worrisome in any way.”
Health funds and hospitals are doing follow-up serology studies on the people they vaccinated, which will also provide a clue. The ministry is also planning to complete this with additional studies on specific populations such as the elderly.
Israel has also been following the first two million people who were vaccinated and seeing their infection rate over time.
“We don’t see the infection rate going up in that population, but once we do start to see that, then we will know a booster shot is needed,” Alroy-Preis further explained.
She said that Israel might also need a booster that is effective against a new variant, if one comes along that is resistant to the existing vaccine.
While theoretically a very infectious variant that evades the vaccine completely could undo Israel’s stunning efforts, “in real life it is probably not going to be zero or one,” Alroy-Preis stressed. “When we are getting the vaccine, our body is actually creating more than one type of antibody toward that new protein that it recognizes as the stranger, and so if that protein would change slightly, you would still have a range of antibodies that the body created that would attack that protein. It has to change dramatically in order for the vaccine not to recognize it at all.”
What is more realistic, she continued, is for there to be a variant against which the vaccine is less effective – even 40% or 60%.
In recent weeks, the Indian variant raised alarm and led the ministry to ask the government to stop all unnecessary travel to and from the country. But while the variant is a cause for concern, Prof. Eran Segal, a computational biologist at the Weizmann Institute of Science, told the Post that the Pfizer vaccine is likely effective against the variant, at least to some extent, “because the key mutations in the spike protein are known mutations that appear in other variants, and we know that the vaccines are effective against them.”
On Thursday, the ministry reported that 41 cases of the Indian variant had been found in the country, including four people who were infected despite having been fully vaccinated.
Another component of keeping infection down in Israel is inoculating children, something that Israel hopes to roll out at least for 12- to 15-year-olds next month, pending Food and Drug Administration approval. Alroy-Preis said that she will certainly vaccinate her own eligible children.
IT WILL also be important to control Israel’s borders more effectively as the country removes its final rules.
“[The plan is] to close from the outside and open as much as we can from the inside. The infection [rate] is really coming down, but one really does depend on the other,” she explained.
She added that “closing the borders” does not mean shutting down the airport, but, rather, using hard criteria of testing, isolation and electronic bracelets, as well as ensuring that Israelis do not travel to and from places with high infection or suspicious variants.
“We need to create this island,” Alroy-Preis said. “We have had such a huge achievement, and we do not want to lose it by allowing infection to come in from the outside.”
This also pertains to Israel’s land crossings, through which thousands of Palestinians enter every day. She said that Israel earmarked some six million Moderna vaccine doses for the Palestinian population, and the ministry is “trying to vaccinate as many [Palestinians] as possible.... It is our responsibility and our role here – not only for epidemiological reasons, but definitely also from that perspective.”
She said that since vaccines are seen as a national resource, inoculating the Palestinians is something that requires government approval.
“What we are doing is trying to increase the Palestinians we are vaccinating through the system of workers and authorizations and things like that,” she said. “We are saying that if you want to come to work in Israel, we are offering the vaccine and we want you to take it. And again, trying to increase the number of people who can be vaccinated under the current guidelines – people who are coming for commerce, not just workers.”
ISRAEL’S SUCCESSFUL vaccination campaign, she said, proved how good the country’s public health system really is.
“I honestly did not think we would be able to vaccinate over 200,000 people a day,” Alroy-Preis said. “It is amazing, and it is one of the things that makes me very proud.”
If coronavirus does largely end for Israel, what will Alroy-Preis focus on next?
“I think there are a lot of health consequences of the pandemic – mental issues, dietary changes, lack of mobility – things that influence heavily on public health,” she said. “We will need to do a lot of rehabilitation.”
Will Israel survive and thrive?
“We are strong,” she said. “I think with a lot of intentional effort, we will be able to get things back in order.”