“Sometimes people think because it’s Cuba, they’re just making these drugs in their garage and giving them to people, and that’s not true. They’re very much practicing with exactly the same high standards that every other country does producing these drugs.” - Candace Johnson, President of Roswell Park Comprehensive Cancer Center, USA, President.  
 

“I need to be blunt: the world is on the brink of a catastrophic moral failure – and the price of this failure will be paid with lives and livelihoods in the world’s poorest countries. Vaccine equity is not just a moral imperative, it is a strategic and economic imperative.” – Dr. Tedros Adhanom Ghebreyesus, WHO, Executive Director

Dear friends,
 
It has been nearly a year since WHO declared a worldwide pandemic. On the global scale, infections are dropping, and more than 227.5 million people have been vaccinated (3 doses for every 100 people). Yet thousands of lives are still being lost each day and equitable vaccine distribution is slowed by myriad logistical, political and infrastructural challenges. Meanwhile, the Cuban government says it is “on the brink of an extraordinary scientific achievement: the mass production of a coronavirus vaccine invented on the island.” But will the country have enough material resources to capitalize on its innovation and public health infrastructure before the surge in infections spirals? 
 
This month, we provide an update on COVID and vaccine innovations on the island, and consider what it all means for vaccine sovereignty and equity. 
 
*And one special note. The Caring in Crisis newsletter is scheduled to go out for only four more months, before concluding in June 2021. Are there special topics you would like to see covered before then? Let us know: platform@cubaplatform.org  
 
Take Care – Sarah, Justine, Mariakarla 
 
Cuba and COVID 19 – recent numbers
 
For much of the last year, Cuba experienced only one tenth of the global average for daily infections per capita. But since the government loosened restrictions and reopened its borders in November (just in time for holiday travel) cases have surged. The situation in Cuba is now much worse than at any other point during the pandemic, and is edging closer to the world average. Cuba has reported more infections from COVID-19 in February than in all of 2020. As of February 25, the 7-day average is 708.14, up 60.47% since our January report. Ninety-eight lives have been lost already this month. Beginning February 6, the government has been implementing new international sanitary control measures, which include reductions in flights and quarantine for returning Cubans/arriving foreigners. Havana has been back in lockdown since mid-January.

 
Photo: AP/Ramon Espinosa. A resident shows his ID to a police officer who is limiting access to the neighborhood as a way to curb spread of the disease while nurses stand behind.

The Cuban COVID19 Vaccines
 
Cuba has a celebrated and rich history in the development and production of vaccines, dating back to the 1980s. The country manufacturers eight of the 11 vaccines included in the national immunization program, which boasts vaccination rates of almost 100% thanks to what medical anthropologists have described as “rapid integration of public health, politics, science and regulation.” 
 
At the outset of the pandemic, Cuba immediately activated its scientists and biopharmaceutical institutions to begin developing a national vaccine. Now, the island has not one but four vaccines under development:

• Soberana 01, at the Finlay Institute for Vaccines
• Soberana 02, at the Finlay Institute for Vaccines, which is a conjugate vaccine - meaning an antigen is fused to a carrier molecule to bolster the vaccine's stability and effectiveness
• Abdala, at the Center for Genetic Engineering and Biotechnology; and
• Mambisa, at the Center for Genetic Engineering and Biotechnology, which would be administered nasally. 

Soberana 02 will enter a final phase of testing next month, with volunteers in Cuba, Iran and – possibly – Mexico. Already, the island has successfully produced a first batch of 150,000 doses, and officials have said that they expect to produce 100 million doses, inoculate the entire Cuban population (11.3 million) and begin exporting to other countries before the end of the year. The island is even considering vaccinating visiting tourists, a measure that would bring together its two biggest economic engines (health care and tourism).
 
Situating Soberana in the Global Context
 
In recent months, many equity advocates around the world have grown concerned about a rise in “vaccine sovereignty” – in which wealth and power, rather than need, determine vaccine distribution. As the head of WHO pointed out in January, while more than 39 million vaccine doses had been administered in at least 49 higher-income countries, only 25 doses were administered in one of the lowest-income countries. WHO is leading the COVAX initiative to bring vaccines to low-income countries, but may not be able to secure vaccines if high income countries continue to buy up large volumes of vaccines and producers do not honor their deals with COVAX.  
 
Cuba’s Soberana 02, in contrast, has been designed with the explicit purpose of avoiding dependence on zones of wealth and power. As Vincente Vérez, one of the scientists involved in its development, described, “We are not a multinational where return on investment is our No. 1 priority. Our first priority is to create health, and return on investment is a consequence of that.” Cuban officials have said that the country will give away some doses as part of its historical south-to-south diplomacy, and Cuba is also expected to sell doses to other countries in the global south. Jamaica, Venezuela, Vietnam, Pakistan, India, the African Union (representing all 55 nations in Africa) and various Latin American countries are all expected to request the Soberana 02 vaccine if trials conclude successfully.
 
Cuba also provides a counterpoint to the challenges of efficient and equitable distribution found in the U.S.. Despite ability to manufacture the vaccine, distribution in the U.S. has been extremely chaotic, due to poor health infrastructure, conservative “anti-vaxx” narratives, and a failure to rebuild trust in public health systems among communities of color. Meanwhile in Cuba, “people receive healthcare from the nurse and doctor in their neighborhood. Medical student brigades roam the streets doing outreach. Elderly and homebound patients get home visits. When the Soberana vaccines are ready for mass distribution,” writes medical anthropologist Naomi Schoenfeld, “based on the country’s history with vaccinations, nearly everyone can expect to be vaccinated, and administration will be simple: business as usual.” 
 

Nurse Yosian Diago checks door-to-door for people with symptoms of covid-19 in Havana, Cuba, in June. Alexandre Meneghini/Reuters/PA Image

Material Challenges and International Relations
 
Despite all this, Cuba – still under embargo from the U.S. and mired in a deep internal economic crisis - could face serious challenges in securing the material resources needed to bring manufacture to scale. As the former WHO representative to Cuba points out, it could become difficult to even purchase enough vials for the vaccine, or to repair manufacturing equipment if it breaks. Cuba will need collaborators.
 
As Dr.Vérez explains, there has been no U.S. participation in the vaccine development. Although the Biden administration is expected to review U.S. policy on Cuba, the Trump administration’s harsh sanctions are still in place. Vérez notes that contacts from Europe and Canada have been involved. The Pan-American Health Organization (PAHO) has also been supportive. According to the organization’s representative in Cuba: “We’re very optimistic. We’ve been kept informed since the pilot phase of Soberana 2 and during the experimental trials, and we’ve known that Cuba has been investigating the viability of several vaccines since August last year.”