One of the most vaccinated countries in the world has this week seen its highest number of coronavirus cases ever.
Israel - the poster child for vaccination - recorded more new Covid-19 infections on Wednesday than at the peak of its second wave when few in the country of nine million were even jabbed.
The nation – wholly dependent on Pfizer – has a rolling average of 9300 daily cases.
Where it once broke vaccination records, Israel has now broken a grim new record – the country with the highest seven day average of new cases per million.
Infectious diseases experts have said Israel may prove that the effectiveness of vaccines do indeed wane over time.
"This is a very clear warning sign for the rest of the world," Dr Ran Balicer of Clalit Health Services, one of Israel's main healthcare providers, told Science magazine last month
"If it can happen here, it can probably happen everywhere."
However, the country's politicians are insistent no new lockdown will be introduced and have pointed out that despite the surge in cases, serious illness and death among vaccinated Israelis remains low.
Highest cases per million globally
On Wednesday, Israel recorded 11,250 new Covid-19 cases with a seven-day average of 9308 cases, according to the country's health ministry.
That's higher than the seven day average of cases of 8624 cases on January 17, the second wave peak, only a month after the country's vaccine program began.
Daily fatalities were at 31 on Wednesday with a rolling average of 21 deaths per day.
The country is now recording 1891 cases per million people, according to Oxford University's Our World in Data project, the most anywhere globally and three times the level in the US, for instance.
Talking to reporters, Israel's coronavirus co-ordinator Salma Zarka said September was going to be a "challenging month" for the country with children now back to school and a major religious holiday approaching.
He said he expected a further jump in cases and said some restrictions on mass events should be considered. But he didn't support wholesale lockdowns.
"There is some optimism but … any gathering has potential for more infections, so cautious optimism is a better description," Zarka told the Ynet news site.
Why Covid cases are rising in vaxxed nation
On first blush it might seem baffling why a country lauded for its vaccination rates is now seeing a large surge in cases.
But there appear to be a number of factors at play in the Middle Eastern nation.
"It seems that some mistakes were made when we thought we won the war, and now we understand we only won the battle," Zarka told The Times of Israel.
"The war is still here, and we have to continue and to explain and push all the people to get vaccinated."
The key issue is jabs. Israel has fully vaccinated 78 per cent of its adult population. It's a lot and according to Australia's national plan, at that level we would be close to only "minimum baseline restrictions".
But Delta appears to be transmitting nonetheless, aided by few if any restrictions in the country.
And despite Israel's reputation as being one of the most jabbed nations, it actually no longer has bragging rights. Other countries have streaked ahead.
Vaccination rates in Israel surged between December and March but then began to plateau after around 50 per cent of the total population, not just adults, had received two jabs.
In the six months since March, inoculation rates have been sluggish. Today only around 60 per cent of Israelis in total have had two doses leaving millions still with no protection.
It has now slipped to 22 in the global vaccination ladder, with the UK, China, Canada, Ireland, Spain and Denmark among others having vaccinated more residents.
At 82 per cent, Malta is the only country to have got over the 80 per cent total population mark, but Singapore, the United Arab Emirates, Qatar and Portugal are closing in fast.
Serious cases in vaccinated far lower
The Israeli health ministry has pointed out the number of serious cases in Israel appears to be falling. And among those aged over 60, serious cases in the unvaccinated was running at 15 times greater than the vaccinated.
The mortality rate in countries with high vaccination rates has plummeted, even those seeing rising cases.
"The severe disease rates in the vaccinated are about one-tenth of those seen in the unvaccinated, which means the vaccine is still over 90 per cent effective in preventing severe disease," infectious disease specialist at Sheba Medical Centre, Professor Eyal Leshem, told Canadian TV station CBC.
Cases are also thought to have spiked after parents were asked to proactively test their children at home before sending them to school, which revealed high number of asymptomatic cases in kids.
Around half the new diagnoses in Israel are in children. However, children – even those unvaccinated – are far more resilient to covid and few fall ill.
There are no vaccines approved for children below 12 anywhere in the world currently. But Israeli Prime Minister Naftali Bennett said this week he hoped a shot for 6-12 years old would be available within months.
Some restrictions have now been reimposed including masks in certain situations and only allowed the vaccinated into indoor spaces.
Concerns vaccines are waning
The other concern is whether the vaccines ability to slow transmission is beginning to wane given many in Israel received their jabs more than six months ago.
Some of the new infections are in those who were vaccinated earliest.
Israel is now offering a booster shot to the already double dosed elderly and vulnerable. And it could be working.
"What we're seeing on the ground – in my hospital and other hospitals – is that while the number of cases continue to increase, we've seen a stabilisation in the number of severe cases," Prof Leshem said.
"The most plausible reason is that this older population that was boosted is more protected against severe infection, hospitalisation and death."
The aim, he said, was to get to a state of "equilibrium" with covid.
"Covid circulates globally so it will be very challenging – if ever – to eradicate.
"Most of the population will be infected at some point. Hopefully, this will be after they are protected with vaccines and therefore infection will be mild."