Punching above the COVID weight

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CWA # 467, 9 May 2021
Punching above the COVID weight
Learning from Cuba's vaccine development efforts 

  Lokendra Sharma

Cuba has launched an ambitious vaccine development programme, attempting to join the elite club of a few large Western and Asian countries. Is Cuba's health system capable of realizing this ambition?

Two of Cuba's five vaccines under development are in phase three trials; if successful, Cuba will be the smallest country to achieve this feat with positive fallouts for Latin America and beyond. 

According to the Johns Hopkins University COVID-19 tracker, as of 2 May 2021, Cuba has recorded a total of 106,707 confirmed cases and 644 deaths since the pandemic began. Last year, in 2020, Cuba managed to keep the number of Covid-19 infections and deaths down with strict measures and lockdowns, compared to many developed countries around the world. Recently there has been a second wave in Cuba, and it is registering close to 1000 cases every day, but still has one of the lowest rates in the world per capita given its population size of 11 million. 

But Cuba has not restricted itself to just containment measures; it has launched an ambitious vaccine development programme, attempting to join the elite club of a few large Western and Asian countries. Is Cuba's health system capable of realizing this ambition? What is the current status of the vaccines? What would the implications of successful vaccine development be for Cuba, Latin America and the world? Is Cuba' punching above the weight'?

Health sector and vaccine development 

Cuba has been able to keep the pandemic in check due to its strong healthcare system. And, the success of Cuba's health sector is a consequence of decades of state investment in operationalizing universal healthcare. A network of polyclinics spread across the country forms the backbone of Cuba's healthcare system. Life expectancy is among the highest in the world, and with over 8 doctors per 1000 inhabitants, Cuba surpasses all countries of which the WHO keeps a record for this parameter. 

Cuba also exports thousands of medical professionals worldwide, fetching billions of dollars in revenues every year. In 2020, at the height of the pandemic, Cuba sent medical professionals to more than 40 countries spanning all five continents. 

Cuba also has extensive medical research institutes and pharmaceutical facilities. Cuba's biotech industry has more than 30 research institutions and manufacturers and produces several types of vaccines for domestic needs and export purposes. Therefore, Cuba does have the capacity to research, develop and produce vaccines against COVID-19.    

There are five vaccines under development in Cuba at different stages — Soberana 02, Soberana 01, Soberana Plus, Abdala and Mambisa. Of these, Soberana 02, being developed by the Finlay Institute, and Abdala, being developed by the Centre for Genetic Engineering and Biotechnology, are currently in phase three trials. The vaccines have names with symbolic value: Soberana means "sovereignty"; Abdala is named after a poem penned down by a Cuban national hero José Martí; Mambisa refers to the guerrillas who fought Spain. Both Soberana 02 and Abdala are subunit vaccines, that is, they only use a part of the coronavirus spike protein to trigger immune response. Cuba is claiming them to be both economical and storage friendly (can be stored at room temperature). 

Alongside the phase three trials involving tens of thousands of participants, interventional studies are also being conducted on healthcare workers in Havana. About 1.7 million residents of Havana are planned to be vaccinated as part of another interventional study by the end of May 2021. 

Implications: National, regional and beyond

Cuba's development of vaccines against COVID-19 will not just have domestic implications but also for the wider region of Latin America and, indeed the entire world. There will be three primary national implications. First, Cuba would rapidly inoculate its entire population without reliance on offshore suppliers, a dependence that has resulted in slow vaccine rollout in high-burden countries (Mexico, Brazil, Argentina) in the region. And this will help the country tide over the pandemic. Second, Cuba can earn substantial hard cash by selling the vaccines, which its tattered economy badly needs. Third, and one with the most significance, is that, if successful, Cuba will be the smallest country in the world to develop vaccines indigenously. It will thus join the club of large economies of the US, the UK, India, China and Russia, which have developed their own vaccines. This feat will bode well for Cuba's soft power. 

Incidentally, Cuba will also happen to be the first country in Latin America to develop a vaccine. Brazil's Butantan Institute is also developing the ButanVac vaccine but is yet to commence human trials. So far, the region has relied on China and Russia for vaccine needs after the West failure to supply the jabs. Region's vaccination rates remain one of the lowest in the world (barring Chile). According to Our World in Data, only 13.7 per cent of Brazil's population has received at least one dose by 30 April 2021; the corresponding figures for Mexico and Argentina is 9.58 and 15.33 per cent.  

Cuba's vaccines can potentially address the low vaccination rates, and will directly compete with Russia's Sputnik V and China's CoronaVac vaccines. Venezuela, Cuba's ally, has announced that it will produce millions of doses of Abdala vaccine and also take part in the phase-3 trial. Argentina and Mexico have also shown interest in the vaccines. 

Cuba is also reorganizing its vaccine manufacturing system to produce up to 10 million doses each month by the end of this year. In an interview to Nature, Vicente Vérez Bencomo, Director-General of the Finlay Institute, said: "In the face of this emergency, we are reorganizing our manufacturing capacities. We think that sometime this year, we should be able to produce around ten million doses each month". This production capacity, if realized, will outstrip domestic needs of Cuban population and the excess stock would be available for exports to developing countries. Not just Venezuela, but Iran is also conducting trials of Soberana 02 and plans to produce it domestically. Other countries, which either find vaccines costly or cannot accept it from the West due to political reasons, may bet on Cuba's vaccines. 

Is Cuba punching above the weight? 

 While Communist Cuba has been known for human rights violation, suppression of dissent and an authoritarian single-party rule, at the same time, it is also known for its robust education and healthcare system. And Cuban regime's sustained investment in healthcare has paid off well in not just keeping the deaths in check but also enabling it to develop five vaccine candidates. 

Vaccine development is a resource-intensive activity that also requires a chain of research and development institutions as well as production facilities. This barrier is so insurmountable that so far, only a few countries, that too with large economies, populations, research and industrial base, have been able to develop vaccines. For a small developing island country of 11 million people to develop five vaccines in parallel, despite an economy devastated by the pandemic and despite being subjected to decades of sanctions by the US, is no small feat. Given this context, Cuba has already punched above the weight, irrespective of how successful Soberana 02 and Abdala perform in phase three trials. 

About the author

Lokendra Sharma is a PhD scholar in the School of Conflict and Security Studies, National Institute of Advanced Studies (NIAS), Bengaluru. He is currently researching in the field of Technology and International Relations. As part of the Global Politics course at NIAS, he closely follows developments in Latin America. 

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