We are all anxious to get back to some semblance of normalcy. In response, our government officials have begun easing restrictions and reopening shuttered businesses and suspended institutions. Similarly, healthcare authorities have started advising Americans about how completing immunization might allow us to relax and return to more intimate human interaction.

Meanwhile, 7,000 miles away, Israel leads the world with 40% of the population and an even higher percentage of older citizens already vaccinated. While these current figures satisfy the lower estimates for full herd immunity, at the breakneck pace of Israel’s efficient vaccination program—an impressive 1% to 2% of the total country daily—even the loftiest targets for herd protection are just weeks away. Israel has become the proverbial canary in the coal mine, foreshadowing the future for the rest of the world as we scramble to catch up with the prodigious Middle Eastern nation.

Unfortunately, there is an alarming conundrum: despite the large percentage of the Israeli population who have already received the vaccine, new cases remain twice the number per capita in the U.S. (only partially explained by more testing), and the number of deaths due to COVID-19 appears to be declining less than expected.

In contrast to recent studies which have shown good outcomes in Israel, the broader epidemiology is indeed troubling. Like trends in many countries, Israel is seeing a predictable gradual drop in both cases and fatalities following a steep post-holiday spike, but the precipitous fall in numbers that demonstrate clear vaccine efficacy has not yet occurred. With so many Israelis already inoculated, one might expect the epidemiological curve to be markedly distinct from other countries.

One explanation that has been offered blames human behavior, the primary confounding variable in the analysis of the pandemic. In accord with the precedent followed around the globe, Israel began its massive vaccination roll-out with jabs for its healthcare workers and the elderly. Some experts speculate that this may have led to younger citizens indulging in risky behavior, inadvertently increasing the spread of disease and dampening the overall effectiveness of the vaccination program.

It is also conceivable that herd immunity does not lie at 50% or 60%, but will ultimately require, as Dr. Anthony Fauci has proposed, 85% of the population to be vaccinated. If true, here in the U.S.—where only 10% of Americans have been inoculated—we have a long way to go before we can even begin to let down our guard. Not only must we greatly improve the logistics of vaccine roll-out, we are also faced with convincing the overwhelming majority of vaccine-hesitant individuals to submit to a jab.

A third, more disheartening, possibility exists: if drug companies, as some critics have argued, distorted their research with questionable research practices, our high expectations for vaccine efficacy could be grossly inflated. In the case of the Pfizer study, for example, the vaccine advisory panel discussion indicated that volunteer bias may have resulted in recruitment of a population unusually predisposed to hyper vigilant behavior, significantly reducing their viral exposure. Furthermore, since many vaccine recipients report telltale reactions to the vaccine and in light of the fact that testing was ordered by investigators based on subjective identification of participants who appeared to have contracted COVID, it is also possible that clinical trial findings were wildly skewed by a confirmation bias. Similar issues could have impacted the Moderna research which yielded outcomes curiously analogous to the Pfizer study.

Assuming the Israelis can sustain their laudable rate of vaccination, we may have some answers to these burning questions before the end of this month. In the meantime, the dip in U.S infections and deaths from a combination of some degree of natural herd immunity and the passing of time since super spreader events in December and early January is finally giving Americans a glimmer of hope for a brighter future in 2021. We will, however, still have to be patient as the now familiar, pervasive, and maddening uncertainty about the future of just about everything continues a bit longer.