Cuba Libre, soon Covid-Libre

Marcel Duchamp, The Bride Stripped Bare by Her Bachelors, Even (The Large Glass) (1915–23, Philadelphia Museum of Art).
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By HELEN YAFFE*

The Caribbean island has become a world leader in biotechnology because it has a socialist state.

On March 23, 2021, British Prime Minister Boris Johnson told a group of Conservative Party MPs that “our success with the vaccine is due to capitalism, greed, my friends”. Johnson articulated, in his speech, the dogma that the pursuit of private benefit in the capitalist free market leads to efficient results. The truth, however, is that the UK's achievements in the development of the Oxford-AstraZeneca vaccine and the national vaccination campaign owe more to state investment than to the market mechanism. Government resources subsidized the development of the vaccine at the University of Oxford, and it was the National Health Service (NHS), funded by the state, which ran the vaccination programme. Johnson did not admit that, thanks to capitalism and greed, Britain now has the fifth worst Covid-19 death rate in the world, with over 126.500 deaths (about 1.857 per million) – and that number continues. growing.

The British government, like most neoliberal regimes, has refused to take the necessary steps to slow down and stop community transmission. He was unable, at first, to provide personal protective equipment and other resources to health and social care workers, which could have saved the lives of hundreds of frontline professionals who died as a result. He contracted private companies to perform essential activities, most of them with little or no relevant experience. For example, instead of equipping the NHS's community GP system to handle the 'tracking' of infection, the government allotted £37 billion to Serco to manage part of the system. In terms of public health, the administration was a disaster; but measured by Boris Johnson's celebrated standards of capitalism and greed, she has outdone herself. The biggest beneficiaries of the British response to the pandemic have been private companies, reaping huge profits. Some 2.500 consultants from Accenture, Deloitte and McKinsey earn an average daily fee of £1000, with some earning £6.624 a day.

Johnson has now laid out a roadmap for reopening the economy. As a result, even the most optimistic scenario predicts a third wave between September 2021 and January 2022, resulting in an additional 30.000 deaths in Britain. These deaths are preventable. But precisely because the British government is driven by capitalism and greed, it insists we have to learn to 'live with the virus' so that the business of business can continue.

Contrary to Johnson's assertions, the pandemic has made it clear that public health needs cannot be adequately met in a profit-based system. Incidentally, it is the absence of the capitalist profit motive that is behind the exceptional domestic and international response to Covid-19 by socialist Cuba, which today has five vaccines in clinical trials and will soon be among the first nations to vaccinate. its entire population.

By reacting quickly and decisively, mobilizing its public health system and its internationally renowned biotechnology sector, Cuba kept contagion and deaths at low levels. In 2020, Cuba confirmed a total of 12.225 coronavirus cases and 146 deaths out of a population of 11.2 million, a rate among the lowest in the Western Hemisphere. In November 2020, airports reopened, which led to an outbreak with more infections in January 2021 than in the entire previous year. As of March 24, 2021, Cuba has recorded fewer than 70.000 cases and 408 deaths. The death rate was 35 per million and the mortality was only 0,59% (being 2,2% worldwide and 2,9% in Great Britain). In one year, 57 brigades of specialist doctors from the Cuban Henry Reeve International Contingent treated 1.26 million Covid patients in 40 countries; they joined 28.000 Cuban health professionals already working in 66 countries. Cuba's achievements are even more extraordinary when one considers the fact that, as of 2017, the Trump administration has punitively imposed 240 new sanctions, actions and measures to tighten the sixty-year-old blockade of Cuba, including 50 additional measures during the pandemic that cost , just to the health sector, more than 200 million dollars.

Cuba persisted in the offensive against Covid-19, mobilizing its public health system – focused on prevention and based in communities – to carry out daily visits to homes with the aim of actively detecting and treating cases, in addition to directing the science sector for it to adapt and produce new treatments for patients and specific vaccines for Covid-19. Such advances bring hope not just to Cuba, but to the world.

What's so special about Cuban vaccines?

About 200 vaccines are being developed around the world; As of March 25, 2021, 23 candidates have advanced to Stage 3 of clinical trials. Two of them were Cuban (Sovereign 2 and Abdala). No other Latin American country had a candidate at this stage of development. Cuba still has three more candidates in earlier stages (Soberana 1, Soberana Plus and an intranasal vaccine, without the need for an injection, called Mambisa). How do we explain this feat? The Cuban biotechnology sector is unique; Fully funded and owned by the state, free from private interests, its profits are not sought domestically and its innovations are directed toward meeting public health needs. Dozens of research and development institutions collaborate, sharing resources and knowledge rather than competing, which facilitates the emergence of a fast lane from research and innovation to testing and application. Cuba has the capacity to produce around 60% to 70% of the drugs it consumes domestically, an imperative given the blockade imposed by the US and the cost of drugs on the international market. There is also fluidity between universities, research centers and the public health system. These elements proved vital in the development of Cuban vaccines against Covid-19.

There are five types of vaccines being developed globally:

  • Viral vector vaccines, which inject a harmless, unrelated, modified virus that carries the genetic material of SARS-CoV-2 (Oxford AstraZeneca, Gamaleya and SputnikV);
  • Genetic vaccines containing a segment of the genetic material of the SARS-CoV-2 virus (Pfizer, Moderna);
  • Vaccines containing the deactivated SARS-CoV-2 virus (Sinovac/Butantan, SinoPharm, Bharat Biotec)
  • Attenuated vaccines containing the weakened SARS-CoV-2 virus (Codagenix);
  • Vaccines containing virus proteins that generate an immune response (Novavax, Sanofi/GSK).

The five Cuban vaccines in clinical trials are protein vaccines; they carry the 'spike' protein portion of the virus that binds them to human cells; they generate neutralizing antibodies to block the binding process. Dr. Marlene Ramirez Gonzalez explains what they are: “subunit vaccines, one of the most cost-effective approaches and the type that Cuba has the most knowledge about and for which it has the most infrastructure. Starting from the S protein – the antigen or part of the SARS-CoV2 virus that all Covid vaccines focus on because it leads to the strongest immune response in humans – the Cuban candidates are based only on the part that is involved with contact with the virus. cell receptor: the RBD (receptor-biding domain), which is also the one that induces the greatest amount of neutralizing antibodies. This strategy is not unique to Cuban vaccines, but Soberana 02 stands out from the rest of the world's candidates as the only 'conjugated vaccine'. Currently in phase 3 of clinical trials, it combines RBD with tetanus toxoid, which improves the immune response… Cuba has already developed another vaccine based on this principle. This is Quimi-Hib, 'the first of its kind to be approved in Latin America and the second in the world', against Haemophilus influenzae type b, coccobacilli responsible for diseases such as meningitis, pneumonia and epiglottitis[I].

Idania Caballero, a pharmaceutical scientist at BioCubaFarma points out that vaccines are developed from decades of research and scientific efforts on infectious diseases. 'The mortality rate in Cuba due to infectious diseases, even in times of Covid, is less than 1%. Cuba currently immunizes its population against 13 diseases with 11 vaccines, eight of which are produced in the country. Six diseases were eliminated as a result of vaccination campaigns. Vaccines produced with these technologies have even been administered to children in their first months of life'[ii].

Soberana vaccines are produced by Instituto Finlay in partnership with the Center for Molecular Immunology (CIM) and the Center for Biopreparations. The Sovereign was given this name to reflect its economic and political importance. Without a domestic product, Cuba would find it difficult to access foreign vaccines, either because of the US blockade or the costs involved. Soberana vaccines insert genetic information into higher mammalian cells and Soberana Plus is the world's first vaccine for convalescing Covid-19 patients to reach the clinical trial stage.

The other vaccines, Abdala and Mambisa, names that also pay tribute to the Cuban struggle for independence, are produced by the Center for Genetic Engineering and Biotechnology (CIGB). These vaccines insert genetic information into a less evolved organism, a unicellular microorganism (the yeast Pichia Pastoris). They build on CIGB's extraordinary track record, which includes its vaccines against Hepatitis B, used in Cuba for 25 years.

By developing vaccines from different platforms, these institutions avoid competition for resources. Caballero explains that “Cuba has the capacity to produce two independent chains of vaccines, with more than 90 million vaccines per year, while maintaining the necessary production of other products for the domestic market and for export”. Cuban vaccines require three doses and, as they are stable in temperatures between 2 and 8 degrees, they do not require more expensive refrigeration equipment.

Phase 3 trials and 'interventional studies'

By the end of March, Soberana 2 and Abdala were in phase 3 trials, each incorporating more than 44 volunteers aged over 19 in regions with a high incidence of Covid-19. Soberana 2 is being administered in Havana and Abdala in Santiago de Cuba and Guantánamo. Analyzes and follow-ups of phase 3 trial patients will continue through January 2022 to investigate whether vaccines prevent transmission, how long acquired immunity lasts, and other questions that no vaccine maker is yet able to answer. However, another 150 health workers in Havana are receiving doses of Soberana 2 as part of an 'interventional study', a kind of phase 3. Interventional studies do not involve double-blind trials or placebos. In addition, another 120 health workers in western Cuba will receive Abdala in the coming weeks, and other interventional studies in the capital will seek to ensure that 1.7 million people in Havana, the majority of its adult population, are vaccinated by the end of May 2021, which means that 2 million Cubans will be fully vaccinated.

Assuming satisfactory results, the real national vaccination campaign will start in June, prioritizing groups according to risk factors and starting with people over 60 years of age. By the end of August 2021, six million Cubans, more than half of the population, should be vaccinated and, by the end of the year, Cuba will be among the first countries in the world to fully vaccinate its population.

Cuban medical scientists are confident that they have the capacity and experience to adapt their vaccine formulation, technology and action protocols to attack new variants. The next steps will be the entry of Soberana 1 and Soberana Plus into phase 2 tests and the launch of a new study involving children and adolescents aged 5 to 18 years.

Cuba and China unite to develop Pan-Corona

The Cuban CIGB has teamed up with colleagues in China to work on a new vaccine called Pan-Corona, designed to be effective against different variants of the coronavirus. It will use parts of the virus that are conserved – not exposed to variations – to produce antibodies, in combination with other parts targeted at cellular responses. The Cubans contribute with the experience and the team and the Chinese offer equipment and resources. The research will take place at the Yongzhou Joint Biotechnology Center, in the Chinese province of Hunan, established last year with equipment and laboratories developed by Cuban specialists. Gerardo Guillen, director of biomedical sciences at the CIGB stated that the approach: 'may protect against epidemiological emergencies caused by new variants of the coronavirus that may arise in the future”. The project builds on nearly two decades of medium science collaborations between Cuba and China, including five joint ventures in the biotechnology sector.

A vaccine for the global south

Cuban professionals have received ten gold medals from the World Intellectual Property Organization (WIPO) over the last 26 years; its biotechnology products were exported to 49 countries before the pandemic, including vaccines used in childhood immunization programs in Latin America. Cuba has stated that its Covid-19 vaccines will be exported to other countries. This brings hope to low- and middle-income countries that simply don't have the capacity to immunize their populations with high-cost vaccines (between US$10 and US$30 per dose) offered by large pharmaceutical companies. In February 2021, the Bureau of Investigative Journalism reported that the American company Pfizer practiced 'bullying' with Latin American countries, forcing it to place assets of national sovereignty, such as embassy buildings and military bases, as guarantees against the costs of any legal conflicts related to its vaccines against Covid-19. XNUMX[iii].

Through an agreement with the Pasteur Institute of Iran, 100.000 Iranians will participate in phase 3 clinical trials of Sovereign 2, and another 60.000 people will also participate in Venezuela. Other countries including Mexico, Jamaica, Vietnam, Pakistan and India have shown interest in receiving Cuban vaccines, as has the African Union, which represents all 55 African nations. It is likely that Cuba will apply a variable scale to its exports of vaccines against Covid-19, a practice already adopted in the export of medical professionals. In this way, the amount charged by Cuba will reflect the purchasing country's ability to pay.

What Cuba has accomplished is remarkable, but as Caballero puts it: 'Without the unfair US blockade, Cuba could have achieved even better results'. The Caribbean island has become a world leader in biotechnology because it has a socialist state, with a centralized and planned economy, which has invested in science and technology and which puts human well-being before profits; that is, without capitalism and greed, which the British prime minister so celebrates.

*Helen Yaffe Professor of Economic and Social History at the University of Glasgow.

Translation: Daniel Pavan.

Originally published on the portal counter punch.

Notes


[I]    To see 'rapid response' at the BMJ, 1 March 2021

[ii]   Email Correspondence, March 9, 2021

[iii]  "Held to ransom”: Pfizer demands governments gamble with state assets to secure vaccine deal', Bureau of Investigative Journalism, February 23, 2021.

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