How Cuba Tackled COVID Effectively

A few weeks ago, while visiting the State University of Campinas, Brazil, to sign an agreement with the University of Medical Sciences of Havana, Ileana Morales from the Cuban Ministry of Public Health, gave an interview to Outra Saúde. 

Morales is the director of the Department of Science and Technological Innovation and headed the scientific committee to fight COVID, in addition to supervising Cuba’s vaccination strategy during the pandemic. According to her, Cuba’s exceptional response to the COVID pandemic was only possible thanks to the focus on building public capacities for research and development of medical products, and guaranteeing quality health care, free of charge, to all Cuban people. 

In a conversation with Fabiano Tonaco Borges, Gabriela Leite and Leandro Modolo, Morales reflected on the importance of Primary Health Care in the Cuban health system, the country’s approach to strengthening the health workforce, and technological advances. She also spoke about an approaching end of the hospital-centered era in medicine, and the impact of the US embargo on health in Cuba.

Read the full interview in English below.

Outra Saúde (OS): How did Cuba prepare to face the COVID pandemic?

Ileana Morales (IM): The world is no longer the same after COVID This pushes us, scientists, academics and health professionals, to think a lot, because it is an event that goes beyond a health crisis, it is a social, economic, and environmental fact. We all have to take into account the great complexity that a pandemic brings—and this one was the worst in the last 100 years.

The Cuban model of response to COVID was different from other countries. This has a lot to do with Cuba’s own structure, its socialist model, and the country’s model of public health. 

The pandemic taught the world something that Cuba has learned long ago, because it has always been threatened by cyclones and tropical storms or other natural disasters. Cuba already knew the lesson that the world learned with COVID: plans to face emergencies have to be made in times of peace and tranquility.

Cuba has a broad health surveillance system. It adheres to the same epidemiological school that Brazil follows. The first signs of the COVID crisis came from China, in December 2019. On January 30, a month later, Cuba approved its response plan, which included almost 500 measures and involved all the most important health bodies.

Then we started studying everything that was coming out about COVID. We took training courses to understand what the disease is, what is happening, what China says, what the first reports and publications say. Throughout that process, we were preparing the plan of the Ministry of Public Health, which established the steps to be taken in medical care, in services, in intensive therapies. Then on February 12, 12 days after the plan was approved, we created the Cuban National Science Group for the Prevention of COVID—which is the one I coordinate.

I invited 13 of the scientists who were the most knowledgeable, and we met that very day. Later the group was enlarged and grew to more than a 100 people, of whom 40 to 50 met daily. Of these, approximately 70% were women. In fact, most of the COVID research projects in Cuba were headed by women.

The first case of COVID in Cuba was registered on March 11, 2020—two and a half months after the establishment of the technical and scientific groups. So, when the first patients came in, who were Italian tourists, the system was already prepared. The health workers already knew where to take them, where to do diagnostics, and how to approach hospitalization. A month before that, on February 16, we had already approved the first version of the treatment protocol. 

OS: What about vaccines produced by Cuba?

IM: The decisive factor in controlling the pandemic was vaccines, and this was a huge epidemiological issue. This was also brought to the scientists’ group. There were already proposals for vaccines in May 2020, when we met with the biotechnology groups. They have a long history in producing immunizers—Cuba produced the world’s first meningococcal meningitis vaccine and the first anti-hemophilus vaccine. We have the platforms and knowledge to create this kind of medicine.

The moment the pandemic hit, we decided: we have to create our own vaccines. Cuba knew from the very beginning that we wouldn’t be able to compete with other companies’ prices, that the transnational companies wouldn’t sell us their doses. We wanted to be independent, and in a very short time, at the end of July or so, we already had the first vial in our hands. Then the first clinical trial was approved. In June 2021, we started offering the vaccines to the entire population.

OS: How did Cuba achieve this feat in such a short time?

IM: Because we have had the technology since before. Nobody can invent anything at the moment of crisis. You don’t do science when something happens—you do it before. You don’t make a vaccine platform during a crisis. Cuba was able to develop the vaccines because it has a powerful biotechnology and pharmaceutical industry that responds to the health needs of the people; it has a very fair, large, well-organized and structured health system; and it has sound technological platforms. 

Cuba also has one of the most prestigious regulatory agencies in the Americas, together with Brazil, Mexico and Argentina. I work with the professionals in our agency all the time, because I head the National Center for Clinical Trials. We all had to adjust to the moment quickly—if not, we would still be waiting for the first clinical trial to be approved.

Once the vaccines were approved, immunizing the population was very fast indeed, we were ahead of all the countries even though we started later. Why? Because we also have a national immunization strategy, which I also have the pleasure of directing. [During the pandemic] I made sure that the trucks with the vaccines went out, watched by the police to guarantee safety, and that they arrived as fast as possible in all parts of Cuba. We set up the strategy one day, and the next day, the vaccine was already in the furthest clinic of the furthest mountain in the country. Every night we made reports to keep track of what we had achieved. 

In a year and a half we distributed 40 million doses. We are one of the 11 countries in the world that have vaccinated more than 90% of their population. But if we consider only the population that can receive the vaccines, we have vaccinated 98.7% —this is when we remove from the count people who are outside the country, children under two years of age or people in very fragile health conditions. We were also the first country to vaccinate children, we are reaching 99% of them.

OS: Why hasn’t the WHO approved Cuban COVID vaccines for use yet?

IM: It is not that they did not approve, it is just that the WHO mechanism has its stages. They have their methods, they had to go to Cuba to make technical inspections, and now they are still evaluating the documents in groups of specialists. Soon their approval will come. But we already have the approval of a large agency, which is the Cuban one.

OS: But you have already exported vaccines to some countries, right?

IM: Yes, we have donated vaccines to some countries, and in others like Iran, we are doing joint technical trials of the Soberana vaccine, achieving very good results. I repeat, the UN authorization will come, but it takes some time, it has its own rhythm. The Cuban vaccines are of quality, they are very effective, and they have fulfilled the function that we were expecting, which is to control the disease. They work. 

The interview with Ileana Morales was conducted by Fabiano Tonaco Borges, Gabriela Leite and Leandro Modolo, and published in Portuguese on Outra Saúde.

People’s Health Dispatch is a fortnightly bulletin published by the People’s Health Movement and Peoples Dispatch. For more articles and to subscribe to People’s Health Dispatch, click here.