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Cuban heals

A propitious new book goes some way to explaining how the modest Caribbean island of Cuba is contributing to helping the world fight coronavirus

24 March, 2020 — By Dan Carrier

Dr Helen Waffe with Dr Agustin Lage Davila, director of the Center of Molecular Immunology in Havana

“THE future of Cuba will be a future of men of science,” Fidel Castro told the Cuban Academy of Sciences in 1960, a year after his army had taken Havana and established a revolutionary government.

And 60 years later, Cuba – a small Caribbean country that since 1959 has suffered from a swingeing economic blockade – has become a beacon of publicly funded, ground-breaking, life-saving biotechnology.

In a new book, We Are Cuba!, by economic historian Dr Helen Yaffe, who grew up in Tufnell Park, went to Acland Burghley School and teaches at the London School of Economics, the extraordinary work of Cuban doctors fighting the coronavirus is laid bare.

Cuban health bosses announced last week they were dramatically increasing the production of a drug called Interferon B, one of the medicines China has been using effectively to combat the illness.

They have also sent a team of doctors to Italy armed with the drug to help slow the pandemic, while Eduardo Martinez, the head of the state-run Cuban pharmaceutical industry has described the drug as “the flagship product of a set of Cuban medicines”.

He added the drug would be exported to other countries to be used to help stop the spread of coronavirus, saying: “We are capable of satisfying not only the possible demand in Cuba but also the requests that we are getting from other countries, and that are increasing day by day.”

That Cuba should be able to play a leading role in global public health is, as Dr Yaffe’s book explains, no accident – but the result of decades of national investment and that Cuba’s biotechnology success builds on their “long history of really good infectious disease vaccination”.

Pre-1959 Cuba was not a good place to be poor, writes Dr Yaffe.

Under the dictatorship of Fulgencio Batista, there were three ways to access healthcare: a contributory system, used by the middle classes and trade unions, which relied on regular payments deducted from pay rolls; there was a private sector used by the wealthy; and then a public sector, offering hard-to-access facilities for unskilled and rural workers.

Barriers came in the form of geography, racism and corruption: 62 per cent of doctors lived in the capital, Havana, which limited access, while some mutual health schemes were for whites only. The Cuban government allocated around 7.5 per cent of its annual budget to health – but it was misused through graft and corruption.

For example, in rural areas political parties channelled medical services in return for votes.

There was one respected medical school in the country, but it demanded such high entry grades only those educated at the best colleges could get in.

The effect on the ground was Cuba had the second highest infant and maternal death rates in Latin America. Public health issues were, of course, interlinked with poverty, wide-scale unemployment or seasonal employment in sugar cane fields. Poor sanitation – 98 per cent of people lived without any running water in wooden shacks – contributed to misery, hunger and death.

It meant when the revolutionaries won, a key aim was to improve public health. Tackling illiteracy was a starting point and from there came the establishment of the National Commission for the Academy of Sciences in 1962.

“Thousands of Cuban students studied in Socialist bloc countries, while others received scholarships from institutions in the West,” writes Dr Yaffe.

The need was urgent: after the dictatorship was overthrown, 12 of 250 teachers at Havana’s medical school stayed in their posts, while half of the country’s 6,000 doctors left.

Stopgap measures were introduced, including asking women earning a living through prostitution to retrain as nurses and work in rural health centres.

There was also an urgent need to wean the country off relying on US drug products – leading the new government to expropriate the production and distribution of medicines, writes Dr Yaffe.

Che Guevara, Castro’s right-hand man who had a medical background, set up nine different research and development institutes and commandeered an abandoned farm for socio-productive and botanical experiments, adds Dr Yaffe.

From here sprung the state-run pharmaceutical industry, helped by the training of thousands of scientists and engineers in the 1960s and 1970s.

By the 1980s polyclinics and primary care gave Cuba the “health profile of a highly developed country”, writes Dr Yaffe, “[and] having eliminated most infectious and poverty-related diseases, ailments such as cancer, diabetes and heart disease became priorities, on a par with the developed capitalist world”.

And today, Cuba’s biotech sector is on a par with any of the best in capitalist countries.

“Driven by public health demand, it has been characterised by the fast track from research and innovation to trials and applications,” writes Dr Yaffe.

Landmarks include developing the world’s first vaccine against Meningitis B, furthering research into immunology as a way of fighting cancer, working on new ways to detect tumours, preventing organ rejection in transplants, and even eliminating mother-to-child HIV infection by 2005.

Cuba’s success is, as American research body chief Bill Heseltine, explains: “How can such a poor, communist system produce such a success? From the earliest days the government placed health and health technology, along with education, at the centre of its efforts. Cuba’s success makes the point that state-run enterprises can be successful and meet demanding goals.”

It means this small island in the Caribbean, so long made to suffer under stringent sanctions, is today at the forefront of saving all humans from a devastating pandemic.

We Are Cuba! By Helen Yaffe,Yale University Press, £15

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