In this week’s World of Genomics, we travel to The State of Israel, a country that plays host to some of the world’s most famous holy sites such as the Western Wall, the Dome of the Rock and the Al Aqsa Mosque. Despite this region being strongly associated with ancient history, present-day Israel’s genomics scene is modern and cutting-edge – so read on to find out more!
The population of Israel
Israel, officially known as The State of Israel, is a country in the Middle East located at the eastern end of the Mediterranean Sea. Jerusalem is the seat of the government and the proclaimed capital, although this has not received wide international recognition. The country is small in size, but has a diverse topography, including a coastal plain, highlands in the north and central regions, and the Negev desert in the south.
In the region of modern-day Israel, there is archaeological evidence of early humans that dates back 1.5 million years. Notable Paleolithic sites include the Tabun, Qesem, and Manot caves. The oldest fossils of anatomically modern humans outside Africa, the Skhul and Qafzeh hominins, lived in northern Israel 120,000 years ago. The area of modern Israel and the West Bank is of great significance to the Abrahamic religions, and in the first millennium BCE it was where the kingdoms of Israel and Judah emerged. The area then became part of the Roman Empire in 1st century BCE, and later the Byzantine Empire, before falling under the control of the Islamic caliphate in the 7th century CE. The region was then under the sway of successive Islamic dynasties until the end of World War I, when it was placed under British mandate by the League of Nations. Jewish immigration increased dramatically during the 20th century, leading to the declaration of statehood on May 14, 1948.
Despite ongoing disputes with neighbouring Arab states, Israel concluded peace treaties with several of these states in the late 20th century. Jewish immigration in the 20th century greatly changed the settlement patterns of the country, with most Jewish settlers establishing themselves on the coastal plain and later moving into the interior and the Negev. The non-Jewish population is concentrated mainly in Jerusalem and in the north of the country, where Arabs make up a significant portion of the population of Galilee. Jerusalem has a rich history and spiritual significance to the region’s major religious and ethnic groups. The city is divided into four quarters – Muslim, Jewish, Christian, and Armenian – reflecting its importance to these groups.
Geographic and demographic information
Summary statistics (2020)
- Gross domestic product (GDP):
- Total: 488.53 Billion USD
- Per capita: 52,170 USD
- Population size: 9,364,000 people
- Birth rate: 19 per 1,000 people
- Death rate: 5 per 1,000 people
- Infant mortality rate: 3 per 1,000 live births
- Life expectancy: 83 years
- Male 2020 estimate: 81 years
- Female 2020 estimate: 85 years
- Ethnicities: Jewish, Arab, Druze, Arameans, Armenians, Assyrians, Circassians, Samaritans
(Source: World Bank)
Israel’s healthcare system provides universal coverage to its citizens and permanent residents through its National Health Insurance (NHI) law. Residents choose from four competing non-profit health plans that cover hospital, primary, specialised care, mental health, maternity care, prescription drugs and other services. The system is funded primarily through a national income tax and an income-related health tax. Private health insurance is also popular, with almost all individuals purchasing it for additional coverage. The Ministry of Health is responsible for the overall functioning of the healthcare system and supervises the NHI health plans. Nearly all government health functions are organized by the Ministry of Health, which works with various advisory bodies to advise on health policy issues. In 2017, 63% of health expenditures were publicly financed, while 14% were financed by private health insurance. In 2018, total expenditure on health in Israel was approximately 7.4 % of the annual GDP.
In Israel, the delivery of healthcare services is organized by the four non-profit NHI health plans (HMOs): Clalit, Maccabi, Meuhedet and Leumit. The health plans contract with both general practitioners (GPs) and specialists to provide care to the insured population. The majority of GPs work in multidisciplinary clinics or as salaried employees of the health plans, while others work in independent practices. GPs and specalists are paid through capitation systems (lump-sum payments based on the number of patients in the area) and/or fee-for-service, with the type of payment varying by health plan. Specialist care is provided in community settings, either in health plan clinics or physician’s offices, and patients have the freedom to choose their specialist. Patient payments for co-payments, coinsurance, and services provided by out-of-network specialists are handled through administrative mechanisms. The Israeli healthcare system aims to provide access to quality care for all, with the government heavily subsidizing physician education and addressing physician shortages through financial incentives and increasing the number of residency positions.
To further promote the integration of delivery systems and care coordination, the Ministry of Health has implemented various reforms and initiatives in recent years. One such reform involves expanding the role of nurses in the community. Specialist nurses now have the ability to treat mild cases of acute diseases and provide preventive care. This has helped relieve some of the pressure on primary care physicians and improve continuity of care. To better cater to the needs of an aging population, the Ministry of Health has also broadened the eligibility for long-term care services. All these reforms and initiatives aim to further improve the quality and accessibility of healthcare services in Israel.
Israel is making efforts to tackle the major health problems through a combination of preventive measures, educational initiatives and the provision of clinical services to families. In Israel, the major health problems are non-communicable diseases (NCDs) such as cancers (27%) and cardiovascular diseases (24%) which account for the majority of deaths. Other NCDs include diabetes and chronic respiratory diseases, accounting for 12% and 23% of deaths respectively. In 2017, The Cancer Research Institute and the Israel Cancer Research Fund announced the establishment of The Immunotherapy Promise, a collaborative initiative promoting research into immunotherapy, a treatment approach designed to enhance a patient’s immune system to eliminate cancer cells. The initiative will fund the most promising cancer immunotherapy research being conducted in Israel, which is a leader in the field. In April 2022, an Israeli cancer drug – the world’s first RNA-based drug of its kind – demonstrated potential in boosting the effectiveness of chemotherapy and immunotherapy in mice. The Tel Aviv University research team is pursuing further development with the hope of human trials. The nanoparticle targets both cancer and immune cells, increasing sensitivity to both chemotherapy and immunotherapy.
The prevalence of obesity among adults is 18.8%, and 7.6% among children under 5 years of age. The Ministry of Health has taken several initiatives to tackle the issue of obesity such as promoting healthy lifestyles, updating nutritional guidelines, promoting farmers’ markets and communal gardens, and educating children on the importance of healthy diets and physical activity. There is also a digital toolkit for a healthy workplace, and tax breaks for purchasing fruit and vegetables at the workplace. Preventive medicine, including vaccination, nutritional and developmental counselling, injury prevention, and family support, play an important role in maternal and child health in Israel. Public health nurses provide preventive care to women and children from all socioeconomic classes, and “Tipat Halav clinics” serve as “family health clinics” providing a wide range of clinical services to families.
Israel has a low HIV endemicity, but migration from countries with intermediate and high HIV endemicity has led to an increase in HIV incidence. The Ministry of Health is monitoring the situation and providing comprehensive HIV/AIDS treatment and care services to those affected.
Genomics medicine capabilities
In Israel, the integration of big-data analysis, genomics, and personalized medicine has been a key focus for the advancement of the healthcare system since 2019 (Government Resolution #3709). Several projects are underway, including the clinical genomics initiative of the Weizmann Institute and Clalit HMO. This “bench-to-bedside” initiative aims to integrate clinical data and genomic analysis using big data, with the goal of improving diagnoses and personalizing long-term treatment plans. The national personalized medicine initiative, the Psifas (Mosaic) Initiative, is based on a group of volunteers whose health data will help develop new treatments tailored to the diverse communities in Israeli society.
In 2018, Israel announced The National Genomic and Personalized Medicine Initiative which aims to sequence over 100,000 patients’ genomes by 2023. The initiative is being led by the Israeli Innovation Authority, the Prime Minister’s Office, and several other governmental departments. The goal of the program is to develop personalized healthcare solutions for patients suffering from long-term diseases and to establish a national database for health researchers. The team will begin collecting volunteers’ biological samples, including blood, saliva, and urine, during routine hospital visits and will de-identify the patient information. The initiative will establish scientific and ethical committees to approve research projects and will also partner with Israeli HMOs.
The Ministry of Health coordinates big-data projects to improve population health and has set up the Eitan project to integrate big-data solutions into the healthcare system. The Timna system, the Israeli national project for data collection, storage, and analysis, receives input from certified institutions and anonymizes the data for processing, interpretation, and policy-making purposes. The ultimate goal of Timna is to improve access to health care and establish global policy standards in medicine and health.
- National Genomic and Personalised Medicine Initiative: Aims to sequence over 100,000 patients’ genomes by 2023 to improve personalised medicine services in the country.
- The Bench-to-Bedside Project: A translational research collaboration between the Weizmann Institute of Science and Clalit Health Systems (Israel’s largest HMO) using genomic data for research into disease.
- Israel’s National Program to Accelerate Diagnoses of Critically-Ill Newborns with Suspected Genetic Disease: In collaboration with Illumina, Israel’s Ministry of Health launched a pilot programme in 2021 to implement the use of whole-genome sequencing in critically-ill infants suspected of having a genetic disorder.
- Psifas (Mosaic) Initiative: Psifas means Mosaic in Hebrew, and is Israel’s National Precision Medicine Initiative. This research project aims to collect health data and biological samples from volunteers to accelerate the development of precision medicine treatments for the diverse ethnicities within Israel.
- CRISPRIL consortium: An AI-focused gene editing consortium that aims to develop GOGENOME – an AI system for multispecies genome editing for pharmaceutical, agricultural and other applications.
Notable organisations and companies
- Tel Aviv University National Laboratory for the Genetics of Israeli Populations: Established in 1995 by the Israel Academy of Sciences and Humanities, NLGIP is the national biobank of Israel, and focusses on collecting, establishing and maintaining human B-lymphoblastoid cell lines and DNA samples from healthy donors.
- Rare Genomics Israel: An organisation that supports Israeli patients with rare genetic diseases of unknown origin, and is based on the same model as the Rare Genomics Institute (USA).
- Israeli Innovation Authority: An independent publicly funded agency created to provide funding platforms for local and international “innovation ecosystems.” It has been involved in funding many of the genomics and biotech start-ups based in Israel.
- Ultima Genomics: Founded in 2016 by its Israeli CEO Gilad Almogy, Ultima Genomics is a DNA sequencing technology company.
- Compugen Ltd: Headquartered in Israel, Compugen is a clinical-stage predictive drug-discovery and development company.
- Emedgene: An Israeli company that is setting out to scale genomics-based care and implement this into healthcare by leveraging AI technology.
- NRGene: An Israeli company that applies cloud-based genomics and AI-driven insights in the agro-genomics field.
- Elisabeth Goldschmidt (1912-1970): Known as the “founding mother of genetics in Israel”, she was a German-born Israeli geneticist who founded the genetics program at the Hebrew University of Jerusalem.
- Abraham Bentsionovich Korol: A professor at the University of Haifa, Korol is known as a prominent Israeli geneticist and evolutionary biologist. He is best known for his work on the evolution of sex and recombination, genome mapping, and the genetics of complex traits.
- Leo Sachs (1924-2013): A German-born Israeli scientist of world-wide renown who was based at the Weizmann Institute of Science. He is best known for his work on normal haematopoiesis and the genetic changes that drive leukaemia pathology.
- Raphael Falk (1929-2019): Was professor emeritus of genetics at the Hebrew University of Jerusalem. This German-born Israeli scientist best known for his active research on the history and philosophy of science, focussing mostly on genetics.
Future genomics landscape
The future of genomics in Israel is looking promising. Ultima Genomics, a US-Israeli company founded in 2016, recently raised $600 million in financing. According to Ultima Genomics, they have developed a sequencing machine which allows for genome sequencing at just $100, compared to the $500-$600 cost of other machines. The technology behind this is patented, and it is hoped that this will allow for earlier diagnoses of illnesses, particularly cancer, by enabling sequencing down to the single-cell level.
AID Partners Holdings (AID) had committed to investing $200 million in the establishment of a “healthcare headquarters” in Israel in January 2021. The headquarters was said to focus on innovations surrounding COVID-19, including the clinical trial of prophylactic antibody against ACE2 receptors, construction of GMP-compliant facilities for gene therapy and mRNA vaccines, and the setup of a bioengineering incubator with a venture capital fund. AID rose to prominence in Israel as one of the largest testing labs during the pandemic but in July 2022, it announced its decision to significantly reduce its activity in the country, resulting in the layoff of 400 employees. According to the CEO and co-founder Snir Zano, the decision was made due to differences with the Israeli Ministry of Health.
The Israeli Innovation Authority has committed an additional $14.5 million in funding for the CRISPRIL consortium, an AI-focused gene editing consortium, until June 2023. The consortium aims to develop an AI system called “GOGENOME” for multispecies genome editing in the pharmaceutical, agricultural, and aquaculture industries. The initial phase produced a version of GOGENOME that enabled the design of guide RNAs for gene editing experiments, and the second phase seeks to improve AI learning to refine GOGENOME’s editing specificity. The extension of the consortium is a vote of confidence in the Israeli research community in the field of gene editing. Israel has a flourishing genomics and biotech industry – with many start-ups based in the country, and home to over 350 R&D centres.