Deaths averted, doctors trained, clinics staffed, communities reached, minds changed, lives touched: the metrics for measuring the impact of the late Dr Paul Farmer (1959-2022) are impressive in themselves. As a physician, medical anthropologist, professor, author and public health activist, Dr Farmer’s commitment to advancing health equity is felt from Boston to Peru, Rwanda to […]
As 2021 drew to a close, Cuba struggled to contain the highly transmissible omicron variant of SARS-CoV-2, braced for a new wave of infections and kept a close eye on other variants of concern popping up around the world—a common experience to countries everywhere as we head into the second year of the pandemic. In Cuba, however, there is one marked difference making all the difference: by early January, 87% of the population was fully vaccinated using a three-dose schedule of vaccines developed and produced on the island.[1] This massive vaccination campaign is complemented by a rapid booster rollout—also using Cuban vaccines—that began in December 2021 and was ongoing as we finalized this issue.
The island nation was able to achieve the third highest COVID-19 vaccination rate in the world[2] after decades of scientific investment, research, discovery and innovation; regulatory oversight and compliance; professional training; and increased production capacity. But a vaccine is only as effective as the health system charged with administering it—in a safe and timely manner, to as many people as possible. Here too, Cuba has decades of experience, including a national pediatric immunization program where 98% of children under 5 are immunized against 13 diseases,[3] an annual polio vaccination campaign (both launched in 1962 and uninterrupted since) and campaigns to contain epidemics such as H1N1.
When the first COVID-19 cases were detected on the island in March 2020, Cuba harnessed this vaccine experience, making a hard tack towards developing its own vaccines. Two of the main protagonists in the country’s biotechnology development, the Finlay Vaccine Institute (IFV) and the Genetic Engineering and Biotechnology Center (CIGB), both with several groundbreaking preventive and therapeutic vaccines in their portfolios, led the search for a vaccine. Today, Cuba has three vaccines authorized for emergency use—Soberana 02 and Soberana Plus developed by IFV, and Abdala, developed by CIGB. Schedules with these vaccines have demonstrated more than 90% efficacy in clinical trials,[4] and after regulatory approval for emergency use, became the backbone of Cuban COVID-19 vaccination efforts. A fourth vaccine, Mambisa (CIGB), administered nasally, and a fifth, Soberana 01 (IFV) are still in clinical trials.
For this installment in MEDICC Review’s series spotlighting leading women of Cuban science, we sat down with Dr Verena Muzio, Director of Clinical Research at CIGB. A pioneer of Cuba’s biotechnology sector, she is an immunologist with a doctorate in biological sciences. Her professional trajectory began researching the genetically engineered hepatitis B surface antigen that led to the development of Cuba’s recombinant hepatitis B vaccine in 1989. The same technological platform used in this vaccine was used to develop CIGB’s Abdala vaccine against SARS-CoV-2—part of the reason Cuba was able to secure a vaccine so quickly. A phase 3 clinical trial determined a 92.28% efficacy rate for Abdala, with results to appear in forthcoming publications.
The call came from Calixto García University Hospital: Alfredo shattered his leg in a head-on collision driving from Havana to the beach. After emergency surgery and several weeks of intensive physical rehabilitation, Alfredo is back on two feet. Messages flooded in, my phone vibrating off the table: Manolo and his son were being examined at […]
At the time of this writing, more than 10 million Cubans (nearly 90% of the country’s population), had received at least their first dose of Soberana 02 or Abdala, two of five vaccine candidates for SARS-CoV-2 developed and produced on the island. Late-phase clinical trial data revealed that Abdala is 92.28% effective after the full, […]
Soaring summer temperatures, systematic urban and political violence, unreliable infrastructure—power outages, water shortages, sporadic transportation and interruption of other basic services—plus the illness, death and economic straits wrought by COVID-19, are what Haitians awake to every day. On the morning of August 14, 2021, they also woke to the earth in the throes of violent, […]
Cuba has five COVID-19 vaccines in clinical trials and is on track to receive emergency use authorization from the country’s regulatory agency to begin mass vaccination with two of those candidates: Abdala and SOBERANA 02. Results from phase 1 and 2 trials of these vaccines, the first developed and produced in Latin America, have been […]
The effects and implications of COVID-19 are global, comprehensive and long-term. The pandemic has exposed inequities, the fragility of economic and political systems, and in many cases, skewed priorities. Population health, not to mention planetary health, is suffering as a result. Nevertheless, the global health crisis in which we are embroiled has provided opportunities for […]
On March 23, 2020, Cuba’s Henry Reeve Emergency Medical Contingent began treating COVID-19 patients at Maggiore Hospital in Crema, Lombardy. Within days, the 52-member contingent comprised of 36 doctors and 15 nurses (plus 1 logistics specialist), together with Italian colleagues, were receiving patients in an adjacent field hospital established and equipped for this purpose. At […]
On August 13, 2020, Cuba’s national regulatory agency, the Center for Quality Control of Medicines, Equipment and Medical Devices (CECMED), authorized clinical trials for SOBERANA 01—Cuba’s first vaccine candidate and the first from Latin America and the Caribbean. On August 24, parallel Phase I/II double blind, randomized, controlled clinical trials were launched at clinical sites […]
Virologist Dr María Guadalupe Guzmán is recognized as a global leader in dengue research and heads the Pedro Kourí Tropical Medicine Institute’s work as a WHO/PAHO Collaborating Center for the Study of Dengue and Its Vector. The Institute (IPK) was founded in 1937 and is now Cuba’s national reference center for the diagnosis, treatment, control […]
Science journalism was little known in Cuba when Iramis Alonso wrote her thesis on the specialized field in 1990. That year, journalism degree from the University of Havana in hand, she set off to Cuba’s eastern countryside to complete two years of social service reporting for local, regional and national print media. Living in the […]
Meningitis, neuropathy, HIV, dengue—since the 1960s, Cuba has faced its share of epidemics. More recently, Cuban health professionals tackled domestic outbreaks of H1N1 (2009) and Zika (2016), and worked alongside colleagues from around the world to stem Ebola in West Africa; all three were categorized by WHO as public health emergencies of international concern. In […]
The days are long and arduous, with endless patients to attend, often in a foreign language, always on foreign shores. Far from family and the familiar. Sleep is fitful at best for health professionals serving in emergency situations—when sickness obeys no clock and patients’ pain haunts even the quiet moments. The crisis scenario varies: post-earthquake, […]
In 1978, the world was put on notice: health inequalities exacerbated by lack of access to essential services was a ticking time bomb threatening social and economic development everywhere. That year, over 100 countries signed on to the Declaration of Alma-Ata, which affirmed that “health . . . a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, is a fundamental human right.” To guarantee this right, governments were urged to prioritize the provision of quality, continuous, comprehensive and affordable primary care for their entire populations by the year 2000.[1]
Forty years after Alma-Ata, many countries have failed unequivocally to attain that goal. In 2017, the World Bank and WHO released sobering data that nearly half the world’s population was still without essential health services. Meanwhile, the cost of those services—when accessible—had already pushed nearly 100 million people into extreme poverty.[2]
This dire state of affairs is not limited to developing countries. According to the Association of American Medical Colleges, the USA will be short 21,000–55,000 primary care physicians by 2032[3] and recent data are not encouraging: the percentage of fourth-year medical students filling primary care positions in the 2019 US National Residency Matching program was the lowest on record.[4] Furthermore, access to a primary care physician for US patients has remained flat—76.4% in 2015 compared to 76.8% in 1996—despite evidence that “access to primary care improves health outcomes and lowers health-care costs.”[5]
From astronomical medical school tuition to inconsistent political will, numerous factors contribute to this global human rights crisis. To forge a plan towards ‘building a healthier world,’ experts and governments were invited to share data, analysis and experiences at the 2019 UN General Assembly’s first High-Level Meeting on Universal Health Coverage (UHC). Among the countries presenting findings is Cuba, a small, developing nation whose health system aimed for universal care and coverage as early as 1960, when the rights to health and education were recognized. Through that decade’s Rural Medical Service, doctors fanned out nationwide to extend health services to all Cubans, reaching universal coverage well before the Alma-Ata Declaration was adopted.
It is now widely recognized that UHC contributes to overall social and economic development. Where health care services are not universal, the most vulnerable and poorest patients are either without care altogether, or often shunted to public facilities—making public health care essentially poor people’s health care. Cuba’s global cooperation policy has been to help staff and strengthen public health institutions and systems in coordination with host governments, primarily in developing countries, rather than “setting up shop” on their own. However, early experiences revealed a daunting challenge: many of these countries’ public systems were dysfunctional, poorly run and sometimes in danger of complete collapse, aggravated in cases of natural disasters or war. Often, the health systems where Cubans served were characterized by crumbling infrastructure, health worker shortages and spatial inequality, financial and material resource scarcity, ineffective or insufficient health surveillance mechanisms, and inconsistent national health protocols. This reality begged the question: could long-term improvements in patient outcomes be achieved in such contexts and might Cuba play a larger role?
How does a developing island nation, beleaguered by climatic challenges and 60 years of adverse geo-political pressures become a beacon of scientific innovation, medical services and applied research—all on a shoestring budget? What’s more, how does such a country, rooted in a traditional patriarchal paradigm, overcome barriers to create a scientific and medical community where the majority of researchers and professionals are women? These are some of the questions that motivated MEDICC Review to publish this series on Cuba’s women in STEM (science, technology and math).
Spanning a variety of themes and disciplines exploring the history of women and science; the role of female protagonists in the development of Cuba’s public health and biopharmaceutical sectors; and results produced by women professionals and their colleagues, these interviews illuminate lessons learned and what strategies might be applicable, adapted and replicable in other contexts. This time, we explore the intersection of gender and race in Cuba, a country with the world’s third-highest percentage of female parliamentarians—many of them women of color.
To help us better understand this complex topic, we spoke with Dr Lourdes Serrano, who served as Director of the Cuban Anthropology Institute* (under the aegis of the Ministry of Science, Technology and the Environment and the Cuban Academy of Sciences) from 1991 to 2005.
During her tenure there, Dr Serrano’s research focused almost exclusively on gender and race, including the impact of structural and policy changes since 1959; the manifestations of discrimination and bias in contemporary Cuba; and the role of women in economic, cultural and political life. A lifelong scholar and teacher, Dr Serrano is currently professor at the University of Havana in the Cuban History and Caribbean Studies Departments, and also a coordinator of the Afro-Descendant Caribbean Women’s program in the University’s Caribbean Studies Department.
Art, education, health and nutrition: encouraging healthy eating at an early age is central to the World Food Programme’s (WFP) goals. To this end, using art as a learning and communications tool, the program sponsors WFP in Action, a drawing contest open to youngsters 5–18 years old. Cuba has participated in the contest nationally since […]
