COVID-19 and Inoculation in East Jerusalem

A meeting with Ben Avrahami, a research fellow at the Jerusalem Institute who is also in charge of Arabic-language public communications for the Jerusalem Municipality, and Zion Regev, the director of the municipality’s five-year education plan and head of the pandemic situation room in the Jerusalem Education Administration.

Zion Regev—Findings and Conclusions from the COVID-19 Situation Room of the Education Administration

Almost all of the neighborhoods in East Jerusalem are red; meaning they do not meet the criteria for reopening the education system. Most of the morbidity in East Jerusalem, as in the rest of the country, is concentrated among younger age groups. One of the factors that is taken into consideration for the “traffic light model” is the vaccination rate, making it vital to increase the rate of vaccination in order to return to normal. 

Until a few days ago, the percentage of vaccinated people in East Jerusalem was low—approximately 20%. The actual number is probably marginally higher—there are vaccinated people in East Jerusalem we are unable to geographically place. Regarding vaccination rates among educational staff—here too it appears that the vaccination rate in the eastern part of the city is approximately half that of the rate in the western part. However, it should also be noted that the Ministry of Health does not possess data that identifies who is a teacher and who is not. The Education Administration’s data is based on ‘good-faith reporting’ by school principals. 

Significant change in attitudes toward vaccination among residents of East Jerusalem

It is possible to observe a welcome change in the trend over recent days. The municipality has realized that the large vaccination centers are less effective and has therefore begun to deliver the vaccines to people directly. 600 people showed up to get vaccinated as part of a vaccination operation at a school in Abu Tor yesterday (2.15.21). This is a huge number in the context of this kind of vaccination point. This was made possible through the cooperation of school principals, the community administration, the Home Front Command and others. Outreach campaigns surrounding the vaccine have also proven successful in generating interest. The low takeup rate for vaccination is not a consequence of apathy, then, but perhaps of disinformation or concerns. This indicates that a targeted outreach campaign is an effective tool. Indeed, recent days have shown a significant change in attitudes among residents of East Jerusalem regarding vaccination [as of 26 February, the vaccination rate for East Jerusalem has risen to 44% (link in Hebrew)].

What has become clear and unequivocal based on the data available from Magen David Adom (MDA), the Home Front Command and health maintenance organizations (HMOs), is that we have broken through the critical point in terms of opposition to vaccination and today, the vaccine situation looks completely different. The reopening of schools in the western part of the city has led people to realize that it is in their power to ensure a return to normal, and as a result they are coming to get vaccinated. There are a lot of calls and enquiries coming through to the situation room, and demand for us to come and set up additional vaccination points. This was not the case three weeks ago. There are currently plans to introduce such points in Isawiya and Beit Hanina.

Tackling the pandemic brings down barriers

Among the visitors to the vaccination center in Abu Tor yesterday was the mayor, which provided a touching moment. There is no question that the pandemic is bringing down barriers and changing attitudes in East Jerusalem: it is not normal to see so many soldiers from the Home Front Command going into neighborhoods in East Jerusalem in full uniform—yet this is exactly what happened with the vaccines, along with similar recent situations.

Q&A

Q: In order to increase the vaccination rate, is it possible to pursue a strategy of encouraging people to get vaccinated in exchange for cancelling pandemic-related fines? For example fines given for minor offenses such as not wearing a mask etc…you could announce that if they get vaccinated, the fines will be cancelled, and that way a lot of people would come to get vaccinated.

A: Any idea that encourages people to come and get vaccinated is a welcome one. The idea will be raised in the COVID-19 situation room and examined.

Q: What about people who are not registered with HMOs, who have no ID card?

A: Most of the vaccination points being opened today are independent of the HMOs, so it is possible to come with an ID card alone. Regarding those who don’t hold an Israeli ID—a sweeping instruction has been issued to vaccinate all teaching staff who do not have IDs. They just need to provide confirmation that they are teachers. Regarding mixed couples (where one holds an Israeli ID and the other does not)—there is a sense today that everyone involved is very open to vaccinating anyone who shows up. There may be specific incidents here and there where the Ministry of Health does not grant permission. In these cases, they can be encouraged to contact the COVID-19 situation room and it will be dealt with.

Q: Is there a possibility to work from within the community in East Jerusalem and to engage with those who have already been vaccinated, to get them to convince people?

A: That is exactly what works. That is how we are working and every idea that enables us to continue down this path would be excellent. Today there are more and more people who are willing to speak out and say—go and get vaccinated. A week ago that wasn’t there yet. And that is the change—local leadership telling people to go and get vaccinated.

Q: In addition to the work being done in schools, MDA and the Home Front Command have also opened a vaccination point at the Qalandiya checkpoint, and everyone got vaccinated there. Anyone who had a permit, even without a HMO. We have since opened a vaccination point in the Old City and another one in the ‘Ma’ar Mizrah’ commercial district in East Jerusalem. We are seeing high numbers of people coming to be vaccinated there. There is a lot of outreach work going on, through people from within East Jerusalem who have been vaccinated and are talking to the rest of the population.

A: We can see that there are entire neighborhoods that are working like this, and we have to keep striving to get to every place we can, including in those neighborhoods where takeup has been lower.  At the moment there is competition between the neighborhoods and that’s a good thing.

Ben Avrahami—the Municipality’s Outreach Work for Residents of the Eastern Part of the City

Avrahami, who is in charge of Arabic-language outreach for the Jerusalem Municipality, and the Arabic-language Facebook page of Mayor of Jerusalem Moshe Lion, discussed the pandemic and the vaccination drive from the outreach perspective—how the municipality and Israeli authorities utilised social media and the mayor’s Facebook page to tackle low levels of trust among the Palestinian population, unsubstantiated rumors, conspiracy theories and more:

Praise for the HMOs

Alongside the targeted campaigns that Zion Regev mentioned are taking place in the various neighborhoods, there is also ongoing daily work by people within the HMOs, who are working around the clock and deserve an immense amount of credit. The HMOs set up vaccination centers, which still account for the majority of vaccinations. Bringing the vaccines to administrations and neighborhoods in the manner described requires a huge effort, and this in turn serves as a multiplier for the work of the HMOs that shouldered a significant extent of the burden.

Channels of Communication with East Jerusalemites

The Jerusalem Municipality is on the frontlines of the COVID-19 outreach effort among this group of the population. This effort is based on channels of communication with residents of East Jerusalem that have been established in previous years, and over the past year it has been directed toward and fully committed to supporting the State of Israel’s general COVID-19 outreach efforts. The outreach-awareness challenge complements the operational challenge on the ground. The outreach is intended to spur people into action—adhering to the instructions, taking care, breaking the chain of infection, and now, also in terms of vaccination.

The outreach effort is being led by several parties:

1. Jerusalem Municipality
2. The Ministry of Health—that understood the need for far more direct and targeted communication with the Arab population during the pandemic and divided the Arab outreach effort into three key populations: Arab communities in northern Israel, the Bedouins, and East Jerusalem. Three advertising agencies were employed for this effort. The parties working alongside the Ministry of Health in East Jerusalem act in full coordination with the municipality.
3. Home Front Command—set up a dedicated branch within the Jerusalem Municipality for East Jerusalem.
4. Civil society: the community administrations, working with numerous civil society organizations and NGOs that are leading a shared effort in all the neighborhoods.

Understanding Public Opinion—Analyzing Thousands of Responses on Social Media

In order to improve and reinforce the messages of the advertising agency working on East Jerusalem, we regularly update them regarding the social media discourse on the issue. In recent months, we have been constantly segmenting and analyzing the debates and conversations that are taking place on social media in order to enhance our understanding of the debate surrounding COVID-19 vaccines. Two samples were taken from two points in time: 15 January and 15 February. In each sample, we looked at the messages being shared and the responses that had been received over the previous month. We analyzed thousands of responses and statements.

The messages included information on the vaccines, encouragement to go and get vaccinated, false reports regarding vaccines, criticisms of those who do not get vaccinated and information that leads to people not getting vaccinated. The responses were divided into subgroups based on whether they encouraged positive, negative or neutral discussions around vaccines.

The results are clear—the picture has shifted significantly: 

Over the first month (15 December-15 January) almost half of the posts included negative information surrounding vaccines. Reliable information accounted for around a third of the total. Attempts to encourage vaccination were in their infancy during this stage—14%.

By the next month (15 January-15 February) the picture had changed completely. First and foremost—the outreach and reliable information campaign dominates the discussion. There is significantly more effort and information surrounding vaccines and outreach to encourage people to get vaccinated. The percentage of negative messages has been reduced to below 20%.

There is also a shift in the approach and tone of the debate surrounding vaccines: in the sample of the first month, the negative debate accounted for more than 50%, while the second sample indicates a much more positive attitude. The negative discourse still takes up approximately 40%, but there is a marked change in a positive direction. It is expected that this trend will continue to increase over the coming weeks.

Analysis of the negative discourse is important in order to focus attention. The findings are that the large majority, approximately 70%—are not conspiracy theories. Most of those who shared anti-vaccine positions expressed concerns regarding side-effects, the efficacy of the vaccine, its safety, the scaled-back timeframe for the research into the vaccine—the same issues that come up in Israel as a whole. 30% included some variation of conspiracy theories.

Two posts that recurred over and over again were of two videos that discussed rare severe side-effects to the vaccine. Alongside these, and other videos and posts declaring a lack of trust in the vaccine: there were responses to the sight of the mayor receiving the vaccine, arguing that it was not a real vaccine, that there is one vaccine for leaders and another for the people etc. There was also a false story about Arabs receiving vaccines that were past their expiration date. Every interview or half-sentence uttered against the Ministry of Health or Pfizer—quickly shot into the public eye and caused extensive harm.

The Response of the Outreach Program to Conspiracy Theories and Negative Public Opinion

An effort to reach every corner of East Jerusalem, in terms of the platforms, target audiences, and the topics discussed:

• • The Municipality’s primary tool during the pandemic has been the mayor’s Arabic-language Facebook page. The bulk of the effort for the page was focused on video content. The mayor appears in many of these videos, and that has had an outsized role in building trust and building relationships with the residents. Additional video content included leaders, influential public figures and doctors in East Jerusalem. A rich tapestry of people and entities who came together for a positive outreach campaign to support vaccination, a campaign openly and wholly driven on the municipal institutional level, without concealing or obscuring the responsibility of the Jerusalem Municipality for the outreach effort.
  • At the same time—working through the aforementioned East Jerusalem channel of the Ministry of Education. This primarily involves doctors, including Dr. Ali Jabrini—the most familiar authority in East Jerusalem on COVID-19—among dozens of others. A new video clip goes up almost every day featuring doctors, nurses and pharmacists dispelling doubts. Representatives from every neighborhood in East Jerusalem are featured on the page, and specific materials are published for each neighborhood. Also included in the content is calls by business owners to get the vaccine so that businesses can return to normal, and there were even religious leaders who would usually not agree to express themselves through official Israeli channels—who were willing to do so in this case. Each such video places a slightly different emphasis and offers a slightly different perspective and contribution to the social media discourse. Most of the findings are currently being directed toward the month of Ramadan (April-May)—with the goal of going into the holiday vaccinated—”clean” of the coronavirus. 
  • The Jerusalem Intercultural Center, working as“the Committee for the Protection of East Jerusalem”, set up a website with information regarding the coronavirus. Here, the emphasis is on the messaging, and the municipality and authorities do not take front or center. The website contains a questions and answers page with information regarding vaccines, and text messages were sent to residents directing them to this page.
  • There are also attempts to generate a lot of positive noise on the ground—for example through a Ministry of Health billboard campaign in partnership with the municipality: 20 doctors were photographed, and the streets were filled with billboards regarding the safety, reliability etc. of the vaccines. There is also a car with a loudspeaker that drives through the neighborhoods and calls on people to go out and get the vaccine. Getting information out through news websites—Panet and others.

Looking Ahead to Continue Encouraging Vaccination—Specific Challenges 

• The main challenges that remain include reaching a younger population, 16-17 years old, who are a challenging group to reach. The current effort is focused on reaching them through influencers.
• 30-40 is another difficult population group to reach.
• An additional outstanding point to be resolved concerns the neighborhoods that are not cooperating to the same extent, such as Jabel Mukaber, that do not possess the necessary infrastructure or community administration, as well as, obviously, the neighborhoods beyond the barrier. It is important to accept that there are several areas of East Jerusalem where there is still a long way to go before we can reach them.

Comments

Ezadeen El-Saad, Intercultural Center: When we state that messages have come from the Israeli Ministry of Health, it generates a more positive reaction. This way, the message is clear and it is more trustworthy. It’s important to bring the vaccines more and more into the neighborhoods. Through smart work, it is also possible to reach the neighborhoods you mentioned, and the more we involve the local population and people, the bigger the impact on encouraging vaccination.

Hagai Agmon-Snir, Intercultural Center: Civil society in East Jerusalem is doing an exceptional job, and we are pleased to see that the municipality is working together with them in a calculated manner. On the one hand—the activity is being led by the Ministry of Health, on the other hand, people want to hear from people they trust on the ground. And it is important to maintain that balance. There is a medical authority in almost every family in East Jerusalem, and when you see them leading the campaign—that makes all the difference. It is also important to work together with people’s family doctors. 

The event was held in partnership with the Friedrich Naumann Foundation.

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