Havana, Cuba – Dr Gustavo Sierra is a storied name in Cuban medicine, with awards and seats on Cuba’s most powerful committees to prove it. He led the team that created a vaccine for meningococcal meningitis, a horrible infection that inflames the membrane of the brain.
That vaccine forms the basis of Soberana-01, one of five vaccines Cuba has been developing against COVID-19 in a move unmatched in Latin America or, in fairness, by any similarly sized country in the world.
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Two of the other vaccine candidates, Soberana-02 and Abdala – are about to be rolled out on a grand scale. María Elena Soto, the director of primary healthcare at Cuba’s Ministry of Health, announced on April 22 that a new trial would see 1.7 million volunteers from Havana immunised.
Cuba’s confidence in its ability to protect itself means it has not signed up to COVAX, the system through which the World Health Organization (WHO) distributes vaccines to poorer countries.
If its vaccines work, it will be a stunning achievement, but not a surprise to those who trained in Cuba’s health service.
“People’s perception of Cuba is music, old cars, rum and beaches,” Dr Miguel Perez-Machado, now a professor of pathology at University College London told Al Jazeera. “But since the beginning of the 1980s, Cuba has made big investments in biotechnology and its scientists.”
Over the years, those scientists have developed vaccines for a whole range of ailments, including hepatitis, tetanus and the meningococcal meningitis Dr Sierra focused on. These are now the “platforms” on which its new COVID vaccines have been developed.
“I was at home on a Saturday early in March when the family doctor knocked on my door,” says Gretel Escalona, mother of a 22 month-old child living in Havana’s Playa neighbourhood. “My block had been selected for the phase three trial of Soberana 02. I met all the requirements – young, healthy, of childbearing age.”
She visited a vaccination site at a clinic not far from the city’s famed Casa de la Musica. “Everyone was very excited and relieved. The desperation for a solution to this pandemic is so great that I think we were happy to be part of the experiment. People trust Cuban scientists a lot.”
Vicente Veréz Bencomo is director-general of the Finlay Institute of Vaccines in Havana that is responsible for the three Soberana “candidates”. In a rare interview last week he told the scientific journal Nature that Cuban president Miguel Díaz-Canel called for vaccines to be developed in May last year: “We had to abandon other projects. It was not possible to continue doing anything else.”
Cuba was caught between a rock and a hard place. Its per-capita income is listed above $4,000, meaning it was not one of the 92 countries eligible for free vaccines through COVAX. But those figures did not take account of a recent economic collapse that has left the centralised state barely able to feed its people.
“Cuba would have had to pay and it doesn’t have the money,” said Amílcar Pérez Riverol, post-doctoral fellow at São Paulo State University in Brazil and a veteran of Cuba’s laboratories. There was another problem, according to Veréz Bencomo: “What we’re seeing across the world is that vaccine supplies are being hoarded by rich countries.”
And so, using the infrastructure built up from the 1980s, Cuba’s scientists set to work repurposing previously created vaccines.
The move has been a source of pride for the put-upon population. It has led to headlines such as “Against the odds, Cuba could become a coronavirus vaccine powerhouse” in the Washington Post. Some think the “could” in that sentence is doing too much work. “If it doesn’t work they’ll blame the variants,” muttered one foreign Cuba watcher.
Such scepticism is not hard to fathom. Access to basic medicines – and food – currently requires hours of queueing, if it is possible at all. Residents use heart-rending WhatsApp messages to search for heart-healing medicines and antibiotics.
“Tetraciclina anyone?” read one recently. “It is for a child who has had surgery recently. He has a serious infection in his eye.”
Meanwhile, there is an outbreak of scabies, and no benzyl benzoate to treat it. The authorities blame the 60-year-old US embargo, tightened to strangulation by Donald Trump, and yet to be relieved by Joe Biden.
But such shortages have led to questions about the focus on COVID; so much so that Veréz Bencomo felt the need to tell Nature: “I can assure you that not one penny of the money used to make medicines or buy food – both of which are scarce at the moment – has been diverted for the manufacturing of COVID vaccines.”
To roll the vaccines out, Cuba will turn to its impressive network of family doctors and nurses. Medical students have been repeatedly visiting every home in the country to check for symptoms and take names for the immunisation programme. The vaccines, which are reportedly storable at 46.4 degrees Fahrenheit (8 degrees Celsius), will be administered from the clinics that are on every corner, and from state workplaces.
With the virus having caused a full-scale collapse of the tourism industry, there are hopes that the vaccines could prove a financial fillip (although Cuba has said it will supply poorer countries for free).
Veréz Bencomo said they were looking for countries to offer money up front so Cuba can “invest the resources we do not have in production”. There has also been talk of “vaccine tourism,” where visitors coming for the beaches and culture are offered the option of buying a jab.
Cuba is particularly susceptible to the virus. It is a nation of abuelos, or grandparents, with the median age an astonishingly high 42.2 years (in Britain it is 40, Haiti next door is 22.7).
And so Soberana-02, and possibly Abdala, will be rolled out before testing is complete, in this vast trial with its 1.7 million “volunteers”. “That is something that only particular countries – China maybe – can do,” says Perez-Machado in London. “It would be illegal elsewhere, people would be able to sue. It’s not an example to follow, I don’t think.”
But the pressure is mounting. While Cuba was heroic in keeping COVID beyond the borders for much of 2020, new daily cases have now climbed above 1,000. Deaths have also been creeping up (although still far below the numbers in other places). As of Sunday 664 people have died in total. Among them, last week, Dr Gustavo Sierra, the creator of the meningitis vaccine at the heart of Soberana-01.
Despite concerns, public support remains rock solid. There will be no US-style problems with take-up.
Rolando Berrio lives in Santa Clara, the crossroads town where Che Guevara won his greatest battle and ushered in the revolution that would dream of Cuba competing intellectually with the world like this. Santa Clara has a long history of great musicians, of romantic singers, and Berrio is among the best of them.
“These have not been good days for those of us in music, theatre and dance, for those of us who need public spaces,” he says. “COVID-19 has erased the most important part of any work of art: the public. These vaccines represent the return of life.
“That the island that I love is working miracles – in a confluence of history, dreams, sacrifices, of mistakes – many mistakes – and most definitely of successes – well, it brings back my soul.”