The Cuban COVID-19 war of 2021
Sovereignty preserved; a comprehensive plan in place
In 2020, Cuba had the coronavirus contained, applying a comprehensive plan formulated by a team of government leaders and scientists; a plan explained to the people. There were two peaks of cases, the first in April, and the second higher peak in August, both low by global standards. Cuba, along with other states constructing socialism and along with some East Asian, African, and Caribbean nations, had one of the lowest rates of contagion and lowest death rates in the world.
The 2021 Third Peak
The opening of international tourism in October 2020 stimulated a third peak of cases, far higher than the two peaks of 2020. The plan of control was theoretically correct. All international travelers, Cuban and foreign, were to be tested upon their arrival in Cuba, and they would be informed of the results in two days. They then would have a second test, to be informed of the results in two days. If negative in these two test results, they would be freed from isolation.
There was a practical flaw in the plan, namely, for travelers returning to their homes, it was to be self-administered. It therefore expected Cubans who had traveled internationally, mainly to purchase goods for informal retail sales or to visit family abroad, to spend five days upon their return to Cuba in a self-imposed isolation. But this did not happen. Cuban international travelers who had been exposed to the virus abroad had frequent contact with Cubans upon their return.
As a result, the number of cases increased in November and December 2020, and it reached 15,536 new cases during the month of January, increasing each month and reaching 50,622 during the month of June. During this time, the government repeatedly called upon the people to exercise more discipline with respect to the health measures. The great majority of people complied with the measures, but many did so in their own form. It was not that there was a sentiment that the measures were unnecessary; the unified and consistent instructions of the leadership, scientists, and journalists had forged an overwhelmingly strong consensus among the people that the measures were necessary. But on many occasions people would be lax in their self-implementation of the measures, believing that they were not at risk in a given situation, a phenomenon that health officials called a “lack of perception of risk.”
Meanwhile, other dynamics were unfolding. More intense variants of the coronavirus were circulating the world. Here Cuba is especially vulnerable, because of the high number of international travelers relative to its population size. The Delta variant, which was first detected in India, entered Cuba and displaced other variants on the island during the first six months of 2021. Delta is more lethal and spreads more rapidly than other variants; it spreads three times more rapidly than the original virus detected in Wuhan and twice as rapidly as other variants. By August 2021, Delta had arrived to 140 countries, supplanting previous variants that had provoked concern, such as the Alfa in the United Kingdom, Beta in South Africa, and Gamma in Japan. In the case of Cuba, Delta was responsible for the increase in cases without precedent in the province of Matanzas during May and June; and it provoked spikes in June in the provinces of Cienfuegos and Holguin.
At the same time, Cuba, developing its own vaccines, arrived to the vaccination of the people a little bit late, after the arrival of Delta, a variant which could only be contained through a vaccine. The combination of the international spread of Delta and the somewhat tardy administration of the vaccine provoked a dramatic spike in cases. Some 200,398 new cases in July, reaching a peak of 265,121 during the month of August, and retreating to 223,013 in September. Given its population size, this was one of the highest rates of infection in the world during that period.
At the height of the peak, the leadership placed its hopes in the effectiveness of the Cuban vaccines and in the health measures. Laboratory studies were showing that the Cuban vaccines had a high level of effectiveness against the Delta variant. The leadership repeatedly maintained that the pandemic would be brought under control as the people were vaccinated, and if the nation continued to observe the health measures (even if with some laxity) following the vaccination of the people. At the height of the battle, with the pandemic raging around them, the Cuban leadership continued to persist in saying that they were on the right road, that they had full confidence in the effectiveness of the Cuban vaccines and in the capacity and willingness of the Cuban people comply sufficiently.
And they were right. There was a dramatic decline in new cases during the month of October, declining to 69,254 during the month, approximately one-quarter of what it had been in August. From September 12 to October 31, there was a steady decline in the number of active cases per week, with 56,048 active cases during the week of September 12 to 6,204 during the week of October 24, a little more than one-tenth the previous number. The decline was predicted by the leadership, and explained as a consequence of the vaccination of the people combined with the continued implementation of some health measures.
In Cuba, there has not been resistance by the people to vaccination. The vaccination program has been well-organized, with vaccination centers set up neighborhood by neighborhood, and local community leaders organizing and reminding the people. People not only complied, but were happy to be vaccinated when their neighborhood’s turn came, believing that it implied greater protection from the virus, as they had been consistently told for months. By October 31, 101.5% of the vaccinable population had received at least one of the three doses; and 74.4% of the vaccinable population had received the full package. (The vaccinable population excludes those not included in the vaccination plan, such as children under two years of age. The first figure is higher than 100% because it is being administered to people were not included in the initial projection of the vaccinable, such has persons who had recovered from an infirmity or had returned from abroad).
As the nation approaches the post-vaccination period, the people are complying, in their own form, with the restrictive health measures that remain in force. There is some easing of restrictions with the decline in cases, such as night curfews and restrictions on travel. But other measures remain in place: masks are obligatory, social distancing, handwashing at the entrance to public places, and restrictions on the number of persons that can enter public places. The Cuban new normality has finally arrived: the people are vaccinated, and yet certain health measures remain in force.
Plans are being made for a booster shot six months following the completion of the initial vaccination program. The booster, Cuban scientists are saying, will extend and strengthen the efficacy of the vaccine. Priority will be given to health workers and researchers, workers in tourism and transportation, teachers and professors, and police and the armed forces. They will be followed by persons older than 60 years, pregnant women, persons with certain infirmities, and finally the rest of the adult population.
With international tourism opening on November 15, the leadership is calling upon the people to continue to comply with the health measures, so as not to lose what has been gained in recent months. Leaders insist that, even though the number of cases has fallen rapidly, the epidemic is not over.
The leaders are confident, because of the high numbers of persons vaccinated and the demonstrated efficacy of the vaccines. But they are cautioning against over-confidence.
Thus, Cuba now retakes the concept of the new normality that was announced on October 8, 2020, which was placed on hold by the unanticipated third peak of January through August, 2021. Limitations on public and private transportation are eliminated. Stores and points of sale are reopened. Schools and universities are gradually reopening, but with health measures. Restaurants are re-opened, but reservations must be made, and the establishment must function at half its previous capacity. Movie theatres and houses of culture are reopening, but with physical distancing and other health measures. Bookstores, libraries, museums, and galleries are reopening, but at 50% capacity and with health measures. Gyms and hair salons are reopening. Beaches and swimming pools are reopening, but avoiding concentrations of persons. Live theatrical and musical events are reopening on a trial basis. International tourism is gradually reopening, with tourists required to have vaccination certification or positive PCR tests results in the last 72 hours; and with restrictions in place in the hotels and rental-room establishments.
Scientific Developments
Thirty years ago, the Center of Genetic Engineering and Biotechnology (CIGB) of Cuba created Heberferon by combining the interferons Alfa and Gamma. It has been evolving and used for the treatment of various infirmities. It is being used in the treatment of persons who test positive for COVID-19, and studies have found that 70% of the infected persons who are treated with Heberferon test negative in four days. Similarly, recent clinical trials indicate that a Cuban anti-SARS-COV-2 Gamma globulin is effective in the treatment of patients in serious condition with COVID-19. The Gamma globulin could become one of the medicines in the first line of treatment of COVID-19.
Even though Cuba is a small country, historically colonized and neocolonized, and currently blockaded, it is one of a handful of countries that has developed vaccines. Studies and trials indicate that the Cuban vaccines are among the most effective that have been developed. And it has the unique characteristic of functioning through the stimulation of the immune reaction system, rather than simulating the contagion; which means that the Cuban vaccines cannot plausibly cause death in a very small number of cases. This is an interesting characteristic, taking into account a certain level of popular resistance to the vaccines globally, in part on the grounds that they cause a very small number of deaths, as historically successful vaccines have done.
The exceptional achievement of the vaccination program has to be credited to the historic leader of the Cuban Revolution, Fidel Castro, who declared on January 15, 1960 before a gathering of Cuban scientists that Cuba has to become a country of men and women of science. And who, since that time, repeatedly channeled funds toward investment in scientific research centers, especially in the areas of health, agriculture, and animal husbandry.
Credit also has to be given to Cuban President Miguel Díaz-Canel. Research scientists who have been participants in this remarkable achievement have given testimony. They report that they, as research scientists with achievements in the development of vaccines during the last decades, were oriented from the beginning to producing an anti-COVID-19 vaccine rapidly. But they were thinking in terms of years. However, Díaz-Canel visited them and called upon them to develop a vaccine in a year. The reason that you must do this, the Cuban president said, is that in the current geopolitical environment, Cuba must have a vaccine in order to protect its sovereignty. And therefore, the Cuban scientists have reported, although it seemed to them impossible at first, they went back to the drawing board to revise their plans and to figure out a way to produce the vaccine in a year, for they were now persuaded by their president that the sovereignty of the nation was at stake. This is the origin of the Cuban unusual strategy of defeating the virus not by attacking the particular virus but by stimulating the immune system, which had been a strategy that they had used with success with respect to some other vaccines. Subsequently, the Cuban president visited the research laboratories, further stimulating the resolve of the researchers. This it why the first vaccines developed were named Soberana, and all subsequent vaccines have patriotic names.
Armed with the vaccine and its experience in the treatment of children, Cuba was the first country in the world to undertake a national campaign to vaccinate the pediatric population against COVID-19. Following the successful results of clinical trials, Cuba began the vaccination of children from three to eighteen years of age, using the vaccine Soberana 02, developed by the Cuban Finlay Institute for Vaccines.
Cuba is poised to export its vaccines. With the recent inauguration of the Biotechnological Complex of the Center of Genetic Engineering and Biotechnology in the Special Zone of Development in Mariel (CIGB Mariel), the Cuban state company BioCubaFarma will have an increased capacity to manufacture and export vaccines and new medicines for the treatment of principal health problems, including cancer; diabetes; autoimmune, infectious and cerebrovascular diseases; and COVID-19. The Complex is financed 100% by the Cuban state. Thus far, Cuba has exported COVID-19 vaccines to Venezuela, Nicaragua, and Vietnam. In addition, a clinical trial in Iran, conducted by the Pasteur Institute of Iran, has verified the high efficiency against the Delta variant of vaccines developed by the Finley Institute of Vaccines in Cuba. Two Cuban vaccines are currently being analyzed by the World Health Organization, which could lead to contracts for distribution to different regions of the world and to poor countries.
The arrival of Cuba to a capacity to produce and export COVID-19 vaccines coincides with a warning issued by the World Health Organization that the pandemic will continue for another year, unless vaccinations are administered in poor countries. A global program that is intended to ensure a just distribution of vaccination has failed to accomplish this objective; Oxfam and UNAids have criticized the countries of high and middle income for acquiring vaccines only for their own populations.
Concluding Reflections
In the Cuban socialist construction, Fidel Castro played a necessary role, guiding the revolutionary process with an exceptional capacity to understand the past and anticipate the future. Inasmuch as everyone understood that this could not be a permanent arrangement, the task of creating a collective leadership to replace leadership by one exceptional person was undertaken. The result was the creation of a new vanguard political party, the Communist Party of Cuba, which today leads the Cuban nation, and which has led the nation in the battle of COVID-19.
When the pandemic was out of control in August, the word in the street was, “This would not have happened if Fidel were here. Fidel would have known what to do.”
It could be said that important errors were made by the leadership in the 2021 battle of COVID-19. It could be said that the opening of international travel in October 2020 was not done correctly. The opening of international travel in late 2020 could have been more gradual, and international travelers could have been placed in isolation centers, like before. The possibility of a more robust strain could have been anticipated, delaying the international opening until the vaccination of the people. So, perhaps errors were made. Perhaps the leadership erred with respect to the easing of the health restrictions because it was anxious to open the economy, which was adversely affected not only by the pandemic but also the increasing impact of the new Trump measures, which including the blocking of transactions with companies and banks of third countries.
If there were errors, does this discredit the current leadership of the Party and the government? I think not. In the first place, exceptional leadership is capable of errors. In 1970, Fidel conceived a ten-million-ton sugar harvest, with the intention of generating income for industrial development. But the harvest did not attain the goal, and the economy was distorted trying to attain it. The ten-million-ton campaign was a failure, and Fidel declared it so as soon as the results were known. There were other issues as well, less dramatic, in which Fidel retrospectively suggests that errors were made. We can conclude that exceptional leadership is capable of errors; this is a teaching of Fidel.
Secondly, if an error was made, it was not a historic error. It was not an error that led to the fall of the revolution, although the counterrevolution located in Miami tried to make it so. If it was an error, it was an error from which the nation has recovered. The nation is now moving forward, with lessons learned.
During 2020 and 2021, the revolutionary leadership demonstrated impressive qualities. Hardworking, committed, explaining with patience, using science, and providing a balance between concern with health and concern for the economy, all of which was observed and appreciated by the people, who were well aware of a completely different situation in the United States.
And the overall results were positive, in spite of the setback of the third spike. As of November 6, 2021, Cuba has had a total of 84,471 cases per one million population, which is behind
China (68 cases per one million population),
Nicaragua (2,481),
Vietnam (9,833),
Japan (13,688),
Venezuela (14, 561),
India (24,571),
Mexico (29,256),
Finland (29,263),
Guatemala (32,986),
Dominican Republic (35,306)
Honduras (37,195),
Norway (39,402),
Canada (45,310);
Germany (56,700);
Russia (60,233);
Peru (65,691),
Denmark (69,172),
Iran (70,490),
and Italy (79,680);
but ahead of
Austria (97,391),
Switzerland (101,450),
Brazil (101,933),
Panama (107,419),
Spain (107,433),
Portugal (108,063),
France (110,244),
Sweden (115,582),
Argentina (116,753),
Belgium (121,334),
Netherlands (128,070),
Luxembourg (129,506),
UK (136,060),
and USA (141,873).
With respect to deaths per one million population, Cuba had 730, which is behind
China (3 deaths per one million population),
Nicaragua (31),
Japan (145),
Norway (168),
Venezuela (175),
Finland (213),
Vietnam (229),
India (330),
Dominican Republic (377),
Denmark (470),
and El Salvador (563);
but ahead of
Canada (763),
Guatemala (841),
Honduras (1,019),
Netherlands (1,080),
Germany (1,153),
Austria (1,267),
Switzerland (1,292),
Sweden (1, 475),
Iran (1,490),
Russia (1,690),
Portugal (1,792),
France (1,801),
Spain (1,871),
Chile (1,958),
UK (2,074),
Italy (2,194),
Mexico (2,215),
Belgium (2,242),
USA (2,324),
Argentina (2,537),
Brazil (2,840),
and Peru (5,966).
Beyond its satisfactory performance with respect to accumulated cases and deaths and its exceptional achievement in the development of vaccines, Cuba, unlike some other nations, emerges from the battle with a coherent, comprehensive and scientific plan, which has the support of the people. In the North, some might criticize the plan for continuing to impose face masks and social distancing in public places. But such health precautions, even if more than necessary, have limited negative impact on the economy; and they are accepted by the people. In Cuba, the people understand and appreciate the notion of restraining individual liberty for the good of the nation and the people as a whole.
Last Saturday night in the early morning hours from my apartment balcony in Central Havana, I could see young people in the street, doing what young Cubans do at that hour. And on Monday morning, I could see school children walking to school, accompanied by a parent or grandparent, dressed in their school uniforms. Cuba has returned to normal, but it is a new normal, a normal with vigilance, a normal with restrictions. The people are aware that another spike could occur; and everyone has a duty to follow the health measures, so as to decrease the possibility of a new peak. For the moment, Cuba is winning the battle of COVID, led by the current generation of revolutionary leaders, who have been formed and prepared by the generation of the revolution.
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