Cuba’s successful COVID-19 response pandemic and its commitment to the health of its citizens is well known. The Lancet, founded in 1823, a respected peer-reviewed medical journal has published an article on the Island’s experience of the pandemic and its vaccine development. The article, written by Talha Burki, follows:
When the Lancet Infectious Diseases went to press, Cuba was due to launch a phase III trial of its subunit conjugate vaccine against COVID-19. Soberana 02 is one of the four candidate COVID-19 vaccines under development in Cuba. It is produced by the Finlay Institute of Havana. Based on the as yet unpublished results of early stage clinical trials, Vicente Verez-Bencomo, CEO of the Finlay Institute, expects the vaccine to show efficacy in the region of 80-95%. “We are very optimistic,” he said. If all goes according to plan, Cuba could start a mass vaccination program for its 11.2 million citizens sometime this summer.
After keeping SARS-CoV-2 at bay for most of 2020, Cuba experienced a surge in infections in 2021. As of March 8, the country had reported 55,693 COVID-19 cases and 348 deaths. In February alone, there were 23,093 new cases, almost twice the number in all of 2020. Cuba is still much better than most other countries in the region, but a vaccine is urgently needed.
A second phase 3 Soberana 02 trial is planned for Iran, as part of a partnership between the Finlay Institute and the Pasteur Institute of Iran. A phase 2/3 trial has been scheduled for Soberana 01, which was also developed by the Finlay Institute. The Center for Genetic Engineering and Biotechnology (Havana, Cuba) is behind the other candidate vaccines. Abdala and Mambisa, a nasal spray, entered phase 1/2 trials late last year.
Soberana means sovereign in Spanish. Abdala is the title of a poem by a Cuban revolutionary, and Mambisa is named after the guerrillas who fought against the Spanish colonialists in the 19th century. All of which indicates that the vaccine campaign is a source of national pride. President Miguel Díaz-Canel has visited the Finlay Institute on three occasions during the course of the COVID-19 pandemic. At home and abroad, the post-revolutionary Cuban identity has always been linked to health. In 1960, Cuba joined the relief effort after the Chile earthquake. In 1963, he sent health workers to help the newly independent state of Algeria.
The Henry Reeve Brigade of Cuba was established in 2005. It has sent cadres of health professionals around the world to combat disasters and epidemics. Cuban doctors were on the scene in Haiti during the cholera outbreak that followed the 2010 earthquake; arrived in West Africa during the 2013-16 Ebola crisis. And when COVID-19 spread to Europe, two teams from Henry Reeve landed in Italy. By the end of April 2020, more than 1,000 Cuban health workers were helping foreign countries respond to COVID-19.
“The international health program is about solidarity; Cuba believes that healthy populations are the foundation of global society and they want to support that in any way they can, ”said Clare Wenham, assistant professor of global health policy at the London School of Economics and Political Science (London, UK). Malaria, poliomyelitis, tetanus and measles have been eradicated in Cuba. The island’s successful response to COVID-19 was largely the result of years of investment in primary care and assiduous health care for the population. The country has comprehensive universal health care and one of the highest doctor-to-patient ratios in the world.
Teams of doctors and nurses are integrated into the local community. “Everyone has a yearly routine checkup, and if you don’t go, the doctor will come get you,” Wenham told The Lancet Infectious Diseases. “It means that doctors proactively identify problems; there is a real emphasis on prevention ”. Disease outbreaks can be detected more or less immediately. Under a model known as CARE, patients are stratified into four categories: apparently healthy, at risk of illness, unwell, and in rehabilitation or recovery. Those at risk for disease include people who are overweight, have diabetes, or hypertension. When Cuba registered its first case of COVID-19 on March 11, 2020, it already knew the whereabouts of its most vulnerable citizens.
In an interview with MEDICC Review, the family doctor Marta Gálvez highlighted the advantages of the Cuban system: “The first thing any self-respecting doctor should know is the health situation of the population they serve,” she explained. “The main objective of a primary care doctor is the promotion of health and the prevention of diseases, that is why you have to know your community to design a strategy that adapts to your needs. CARE is a vital tool: that is why I know that I have 658 older adults in a total population of 1,093 people, and 42 of the elderly live alone ”.
About one in five cubanos is over 60 years old.
“The public health network is very strong in Cuba, but at the cost of civil liberties,” Wenham said. “Cuba is a very specific context; not many countries are going to accept that kind of close medical surveillance, and most governments don’t have such strict control over their citizens. ” After SARS-CoV-2 entered the island, more than 28,000 medical students led an active research program that in a few weeks reached 9 million Cubans. Cuba had started preparing long before its first case of COVID-19. It quickly closed its borders and established isolation centers and an efficient test and trace system. But shortly after Cuba was opened at the end of last year, the cases began to increase.
The pandemic has been extremely expensive. Gross domestic product fell 11% in 2020. Instead of the usual 4 million tourists, Cuba welcomed just 80,000. The long-standing economic blockade imposed by the United States has taken a heavy toll. “Health centers and clinics face regular shortages of basic medicines, such as acetaminophen, and other equipment such as bandages,” says Fiona Samuels, Principal Investigator and Honorary Associate Professor at the London School of Hygiene & Tropical Medicine (London, UK). United) . “The staff are very well trained, but the health infrastructure is in disrepair and they often lack the basic elements to enable them to do their jobs effectively.”
Cuba’s biotechnology industry emerged in response to the US blockade. It is made up of more than 30 research institutions and manufacturers, under the aegis of the state conglomerate BioCubaFarma. In the late 1980s, Cuba developed the world’s first meningococcal B vaccine. It produces eight of the ten vaccines commonly used in the country and ships hundreds of millions of doses abroad. But obtaining raw materials is a constant struggle, especially after the tightening of US sanctions during the presidency of Donald Trump. “There are situations in which suppliers of components important to our industry for several decades have been forced to stop suddenly; it makes everything more expensive and complicated, and it’s a real concern, ”Verez-Bencomo said.
Tourism brings a much-needed flow of currency, especially since Cuban-Americans have been banned from sending remittances, but with tourists comes the virus. The Cuban government recognizes that more than 70% of current COVID-19 cases are linked to newcomers to the country. If Soberana 02 is successful, Cuba plans to export it cheaply once national vaccination efforts have ended. The centralized health care system means that national deployment is unlikely to be problematic, although parts of the island are difficult to access. Verez-Bencomo estimates that by the end of the summer the country will have the capacity to produce 10 million doses of vaccine per month. Cubans are excited about the effort. “When we call in volunteers for clinical trials, we always have two to three times more people than we need,” Verez-Bencomo said. “On the street, wherever I go, everyone asks about the vaccine.”
Behind Cuba’s successful pandemic response Burki, Talha The Lancet Infectious Diseases, Volume 21, Issue 4, 465 – 466.