Much of the press coverage of Cuba last week focused on the anti-government protests that didn’t eventuate. Less covered has been something of potentially greater global significance: its vaccination drive.
After a dire twelve months, when a too hasty reopening sent the pandemic surging, deaths peaking, and the country back into a crippling shutdown, a successful vaccination program has turned the pandemic around in the country. Cuba is now one of the few lower-income countries to have not only vaccinated a majority of its population, but the only one to have done so with a vaccine it developed on its own.
The saga suggests a path forward for the developing world as it continues struggling with the pandemic in the face of ongoing corporate-driven vaccine apartheid, and points more broadly to what’s possible when medical science is decoupled from private profit.
The Safer Gamble
According to Johns Hopkins University, as of the time of writing, Cuba has fully vaccinated 78 percent of its people, putting it ninth in the world, above wealthy countries like Denmark, China, and Australia (the United States, with a little below 60 percent of its population vaccinated, is ranked fifty-sixth). The turnaround since the vaccination campaign began in May has revived the country’s fortunes in the face of the twin shocks of the pandemic and an intensifying US blockade.
After a peak of nearly ten thousand infections and close to one hundred deaths each day, both figures have now plummeted. With 100 percent of the country having taken at least one vaccine dose by the end of last month, the country reopened its borders on November 15 to tourism, roughly a tenth of its economy, and has reopened schools. This makes Cuba an outlier among low-income countries, which have vaccinated only 2.8 percent of their combined populations. This is owed largely to vaccine hoarding by the developed world and their jealous guarding of patent monopolies, which bar poorer countries from developing generic versions of the vaccines that were produced through public funding in the first place.
Key to this outcome was Cuba’s decision to develop its own vaccines, two of which — Abdala, named for a poem penned by an independence hero, and Soberana 2, Spanish for “sovereign” — were finally given official regulatory approval in July and August. In the words of Vicente Vérez Bencomo, the internationally acclaimed head of the country’s Finlay Vaccine Institute, the country was “betting it safe” by waiting longer to manufacture its own vaccines. This way, it would avoid dependence on bigger allies like Russia and China while adding a new commercial export at a time of ongoing economic hardship.
These efforts are already underway. Vietnam, with only 39 percent of its population fully vaccinated, inked a deal to buy 5 million vaccine doses, with Cuba recently shipping more than 1 million of them to its communist ally, 150,000 of which were donated. Venezuela (32 percent fully vaccinated) also agreed to buy $12 million worth of the three-dose vaccine and has already started administering it, while Iran (51 percent) and Nigeria (1.6 percent) have agreed to partner with the country to develop their own homegrown vaccines. Syria (4.2 percent) has recently discussed with Cuban officials the prospect of doing the same.
The two vaccines are part of a suite of five COVID vaccines Cuba is developing. That includes a vaccine delivered nasally that’s progressed to Phase II of clinical studies, one of only five vaccines in the entire world that have a nasal application, according to one of its top scientists, that could be particularly useful if proven to be safe and effective, given the virus’s entry through the nasal cavity. It also includes a booster shot specially designed to work for those already inoculated with other vaccines, and which was recently trialed on Italian tourists. Since September, Cuba’s been in the process of getting World Health Organization approval for its vaccines, which would open the door to its widespread adoption.
A Different Vaccine
Several aspects make Cuba’s vaccines unique besides their country of origin, according to Helen Yaffe, senior lecturer in economic and social history at the University of Glasgow. At the heart of it is Cuba’s decision to pursue a more traditional protein vaccine rather than the more experimental mRNA technology used for the COVID vaccines we’ve become familiar with, which had been in development for decades before the onset of the pandemic led to a breakthrough.
Because of this, Cuba’s vaccine can be kept in a fridge or even at room temperature, as opposed to the subpolar temperatures the Pfizer vaccine has to be stored at or the freezer temperatures Moderna’s vaccine requires. “In the Global South, where huge amounts of the population have no access to electricity, it’s just another technological obstacle,” says Yaffe.
And while the mRNA technology, which has never been used on kids before, has meant a lag between adult and child vaccination in the developed world — and means vaccines for kids under five are still being developed — Cuba aimed from the outset to create a vaccine that kids could take. As of this month, it’s fully vaccinated more than four-fifths of all kids aged two to eighteen.
While roughly two-thirds of all kids were shut out from school in Latin America and the Caribbean as of September, Cuba has now reopened its classrooms. Gloria La Riva, an activist and independent reporter who has been visiting Cuba throughout the year and has been in Havana since mid-October, described the scene at the Ciudad Escolar 26 de Julio as parents and grandparents turned out for the school’s reopening.
“It’s a very big thing for the families,” she says. “Everyone feels this enormous pride.”
The Power of Nonprofit
There’s one more factor that sets the Cuban vaccine apart. “The Cuban vaccine is 100 percent entirely a product of a public biotech sector,” says Yaffe.
While in the United States and other developed countries, lifesaving medicines are developed thanks largely to public funding before their profits and distribution are ruthlessly privatized for corporate enrichment, Cuba’s biotech sector is wholly publicly owned and funded. That means Cuba has de-commodified a vital human resource — the exact opposite policy direction that we’ve seen in these last four decades of neoliberalism.
Cuba has poured billions of dollars into creating a domestic biotech industry since the 1980s, when a combination of an outbreak of dengue fever and new economic sanctions from then president Ronald Reagan forced its hand. Despite a crushing blockade by the United States, responsible for a third of the world’s pharmaceutical production, Cuba’s biotech sector has thrived: it makes nearly 70 percent of the roughly eight hundred medicines that Cubans consume and eight of the eleven vaccines in the country’s national immunization program, and it exports hundreds of millions of vaccines a year. The revenues are then reinvested into the sector.
“All these vaccines that have a very large impact on science are very expensive vaccines, economically inaccessible to the country,” Vérez Bencomo said recently about Cuba’s decision to develop its own vaccines.
The sector is internationally acclaimed. Cuba has won ten Gold Medals from the United Nations’ World Intellectual Property Organization (WIPO) for, among other things, developing the world’s first meningitis B vaccine in 1989. In 2015, Cuba became the first country to eliminate mother-to-child transmission of HIV and syphilis, a result of both the retroviral drugs it had produced and its robust public health care system.
In this way, Cuba has been able to do the unthinkable, developing its own vaccine and outdoing much of the developed world in overcoming the pandemic, despite its size and level of wealth, and despite a policy of concerted economic strangulation from a hostile government off its shores. International solidarity efforts have been vital, too. When the US blockade meant a shortage of syringes on the island, jeopardizing its vaccination campaign, solidarity groups from the United States alone sent 6 million syringes to Cuba, with the Mexican government sending eight hundred thousand more, and more than one hundred thousand on top of that coming from Cubans in China.
A Source of Hope
Even so, there is some uncertainty around Cuba’s vaccines. Their use in Venezuela has met objection from the country’s pediatric physicians unions and medical and scientific academies, on the same basis as other critics, who say the vaccine trial results haven’t been peer-reviewed and published in international scientific journals. The Pan American Health Organization has called on Cuba to make the results public.
For his part, Vérez Bencomo blames an international community hostile to Cuba. In a September interview, he charged that Cuba’s scientists were being discriminated against by major journals, who he said had a history of rejecting submissions from Cubans while later publishing similar research from other countries, and act as “a barrier that tends to marginalize scientific results that come from poor countries.”
These are pretty serious charges from a globally respected scientist. A winner of the Cuban National Chemistry Award and a 2005 WIPO Gold Medal, Vérez Bencomo led the team that worked with a Canadian scientist to develop the world’s first semisynthetic vaccine, creating a more affordable shot to protect against Haemophilus influenzae type B. Upon helping develop the low-cost vaccine against meningitis, he was barred in 2005 from traveling to California to accept an award for it, with the George W. Bush State Department deeming his visit “detrimental to the interests of the United States.” In 2015, he was made a Knight of the Legion of Honor by France’s then minister of social affairs and health, who commended him for his work and called him a “friend of France.” (Vérez Bencomo did not respond to a request for an interview).
While Cuba’s rebound from the pandemic suggests his and the Cuban government’s confidence in the vaccines isn’t misplaced, it may take some more time for them to get the international scientific community’s official imprimatur. Should it come, it would prove a powerful refutation of the corporate-driven vaccine model that has so far dominated, which holds that, in line with the talking points of Big Pharma, only profit-driven competition can produce the kind of lifesaving innovation the world is desperate for.
Perhaps more importantly, it may be a way for the developing world to finally crawl out of the pandemic-shaped hole it looks no nearer to escaping now, months after vaccines have been rolled out in wealthy countries. Western governments have continued to oppose calls from the Global South to waive vaccine patents and allow them to manufacture or buy cheaper generic versions, leaving the vast majority of the world’s people still vulnerable to the virus — and, ironically, endangering us all, should new, vaccine-resistant strains mutate in the country-sized petri dishes this unbalanced policy has created. In that sense, we should all hope that Cuba’s vaccines are proven as successful as its scientists are sure they are.