Under US embargoes for decades and blighted by an ageing power infrastructure that is prone to cuts, Cuba may seem an unlikely saviour to parts of the world struggling for Covid-19 vaccines.
But the country of 11.3 million punches well above its weight when it comes to medicine: it has a strong research sector, is a health care tourism destination and sends doctors and nurses to work around the world, including the Gulf region.
It is less surprising, then, that Cuba is in discussions about its locally developed coronavirus vaccines being used in more than a dozen nations – on top of those that have already given them to their people.
Efforts to distribute the shots out more widely came after Cuba achieved one of the highest vaccine coverage figures in the world on home soil.
While the UAE leads the global rankings, Cuba is in the top 10. About 93 per cent of its people have had at least one shot, 87 per cent have had two, and 51 per cent have received a booster.
“I’m not surprised at all that they set out to develop their own vaccine. They have the need, but they also have the capability,” said Dr Helen Yaffe, a senior lecturer in economic and social history at the University of Glasgow in Scotland and author of We Are Cuba! How a Revolutionary People Have Survived in a Post-Soviet World.
“Just because I’m not surprised, it doesn’t mean it’s not incredibly impressive. It’s such a feat for a small Caribbean island.”
Long-term investment in health service pays off
Cuba, with its decades of state-directed investments in healthcare and medical research – an approach championed by the late president Fidel Castro – has long practised self-reliance when it comes to vaccines, producing most of those used in its national immunisation programmes.
Vaccination campaigns have helped Cuba to control or eliminate polio, measles, mumps, rubella and typhoid, among other diseases, something once described in a scientific journal as “remarkable” given the country’s limited resources. The infant mortality rate and average life expectancy have also won praise.
All this meant that when the coronavirus emerged, the country’s research institutes had the expertise to develop their own vaccines.
“They have a pretty good health service given the level of money they have, and part of that was developing their own biopharmaceutical industry, in part a reaction to the Americans blocking them off,” said Prof David Taylor, emeritus professor of pharmaceutical and public health policy at University College London.
Cuba’s constrained finances and the US embargoes would have made obtaining vaccines manufactured overseas harder.
Cuba follows own path on vaccine journey
Also, the country decided not to join the Covax programme, which aims to distribute vaccines to poorer nations but which has struggled for sufficient supplies.
In developing its own vaccines, Cuba did not employ cutting-edge mRNA or viral vector technology of the kind used in the Pfizer-BioNTech, Moderna, Oxford-AstraZeneca and Johnson and Johnson vaccines.
Instead, it turned to a well-established approach of using protein subunits from the pathogen to generate protection against the virus.
The coronavirus proteins can be produced in artificially grown cell lines before they are purified and incorporated into the vaccine.
With a “conjugate” vaccine called Soberana 02 from Cuba’s Finlay Institute of Vaccines, part of the receptor binding domain (RBD) of the spike protein is “conjugated” or linked to a harmless neurotoxin protein, which enhances the immune response.
Two doses of Soberana 02 and a third dose called Soberana Plus containing just the RBD segment has a reported efficacy of more than 92 per cent, although data from Cuban trials has not always been shared as widely as the international scientific community would like.
The Centre for Genetic Engineering and Biotechnology in Cuba’s capital, Havana, has produced a vaccine called Abdala with similar efficacy after three doses.
Another vaccine from the centre, Mambisa, is administered as a nasal spray, and Cuban scientists said it could strengthen the protection in individuals given other vaccines.
Majority of children vaccinated
“They’ve become the first country in the world to vaccinate children from two [years and] up,” said Dr Yaffe. “The Cuban vaccines were developed from the outset to be used in children.”
Government figures indicate that more than 95 per cent of two to 18-year-olds have been inoculated, something that officials have said should reduce transmission.
The country’s vaccine programmes have not been affected by the vaccine hesitancy or scepticism seen in many other nations.
Cuba experienced its main coronavirus peak in July, August and September 2021, and another, much smaller, peak in January this year driven by the Omicron variant, but case numbers have since fallen significantly. There have been just over 1 million cases and around 8,500 deaths.
Just as Cuba has long exported medical personnel, including to the Gulf region to combat the pandemic (like medical tourism to Cuba, this generates much-needed income for the country), so it is expanding overseas use of its vaccines.
There have already been donations to Syria, and exports to Venezuela and Vietnam – some purchased and some donated – while Iran has manufactured Soberana 02.
Last month Progressive International, which ties together left-wing organisations and activists, organised a briefing at which Cuban government officials reportedly said the country was looking to export tens of millions of vaccines to lower-income countries.
The Finlay Institute of Vaccines said it had the capability to produce 120 million doses per year and in a statement released online, Progressive International said Cuban officials had promised “solidarity prices” for low-income countries.
Cuba has said it will transfer technology to allow production abroad and officials have stated they are in discussions with more than 15 countries that could produce Cuban vaccines.
Havana has also offered to provide personnel to assist vaccine campaigns, an echo of how the country sent medical personnel to Africa in 2014 and 2015 to combat Ebola.
Cuba plans to apply for World Health Organisation approval for its vaccines this year, but national regulators in other countries are free to give them approval without this.
“The Cubans are looking for bilateral agreements with other countries to get that vaccine recognition,” Dr Yaffe said.
“The African Union was interested in the Cuban vaccines. It might happen in that collective way … [Cuba’s vaccines] are probably the best chance many populations in the global south have to access a vaccine before 2025.”