As 2020 draws to a close, the COVID19 pandemic rages on, yet, undoubtedly, we have entered a distinct phase as a number of countries now begin or plan for mass distribution and administration of newly developed vaccines. As of this writing, there are six approved vaccines and over 50 candidates in development (Craven, 2020, WHO 2020). In the UK, the NHS recently started administering the Pfizer BioNTech mRNA vaccine, and the US followed suit one week later. COVID19 vaccine development has reinvigorated a certain type of vaccine nationalism not seen for decades. Each vaccine or candidate gets a particular pedigree, narrative and aura of trustworthiness according to its origins. The vaccines and candidates are a mix of private-sector developed or public/private partnership, with only a few candidates from universities or the public sector (WHO, 2020). In Cuba’s state-run socialist biopharmaceutical system, their new COVID19 vaccine, called Soberana or “The Sovereign,” is effortlessly enfolded into a long-standing national narrative of vaccine prowess.
The narrative of the “vaccine race” as constructed by Western media outlets contains echoes of Cold War-era themes like the space race or the rush of the superpowers to build the first atomic bombs. This narrative has emphasized, for example, a certain “untrustworthiness” of China’s vaccine and vaccine candidates, while the Russian vaccine candidates have been accused of “lack of transparency and poor data” (Cohen, 2020). Meanwhile, in the US and the UK, the multinational and private sector Pfizer and Moderna vaccines face an extra layer of skepticism beyond the expected “anti-vaxxer” sectors, particularly among both political conservatives and communities of color (Gordon and McGrath, 2020; Adam and Booth, 2020), due to the combination of novel vaccine type (mRNA) and the speed of development. Australia recently pulled its vaccine candidate over concerns it was causing false positive HIV test results (Ives, 2020). The global race to develop a COVID19 vaccine represented a virtually unprecedented level of coordination and cooperation in three key domains: scientific, regulatory, and political.
Cuban Vaccine Soberanía
In socialist Cuba, by contrast, state control of those three domains means this type of coordination is business as usual. The history and structure of the Cuban state-run biopharmaceutical system enabled the country, despite a dire economic downturn due to the near evaporation of tourist dollars, to quickly develop not one but two COVID19 vaccines: the Soberana and the Soberana2. A recent article in Granma, the official newspaper of the Communist Party, explained,
[The] challenge, launched by President Miguel Diaz-Canel, to achieve sovereignty with a vaccine of our own and produce it rapidly, mobilized our scientists and technologists. We have worked hard, in unity, with intelligence, and we are going to do our duty, which means fulfilling our duty to the people, to Fidel and Raul (Peláez, 2020).
As a medical anthropologist who studied Cuban cancer vaccines, I could not resist the urge to turn to this new development and consider the vaccine (and the choice of its name) in the context of the history of Cuban vaccine development and production.
On August 24th, Cuba’s equivalent of the FDA, the Center for Quality Control of Medicines, Equipment and Medical Devices (CECMED), authorized clinical trials for the Soberana vaccine, the country’s (and the region’s) first COVID19 vaccine candidate. Phase III clinical trials are planned for early 2021 (Gorry, 2020). The Soberana2 began Phase I clinical trials in late October with 40 participants. The trial is expected to conclude in early January 2021 (Held, 2020). The vaccines have been developed at the Finlay Institute in Havana, Cuba’s oldest vaccine research center. The institute is named for Carlos Finlay, that famed 19th -century Cuban scientist credited there with the discovery of Aedes aegypti mosquito as the vector for Yellow Fever (in the US, the credit goes to Walter Reed). Cuba has long honed its national skills in vaccine production and distribution campaigns, beginning with Dr. Tomás Romay Chacon’s introduction of the smallpox vaccine in 1804 (Gonzalez, 2018). The Finlay Institute began producing vaccines in 1934, beginning with the smallpox, then typhoid, tuberculosis, rabies and tetanus vaccine (PAHO, 2015). Dagmar Garcia, Research Director of the Finlay Institute, recently used her Twitter account to state that “government-health-science integration can do everything when the priority is the health of the people” (Prensa Latina, 2020). The Finlay institute tweeted, “The #CubanVaccineCOVID19 is dedicated to the sower of dreams: Fidel. Our tribute to the one who believed in the strength and future of #CubanScience” (Held, 2020). As anthropologists have long demonstrated, pharmaceuticals in general, and vaccines in particular, do a lot of work in excess of their scientifically-approved indications. Conceptually, vaccines convey protection. Semiotically, they can signal technoscientific knowledge, hygiene, medical authority. They are a tool of population management, politics, privilege, and even coercion. They are a form of insurance against a potential hazard, characterized by a temporal delay. Vaccination is a type of investment, and, like all investments, it has no guaranteed return. Yet this vaccine form of investment exerts large-scale changes on populations, in economic, political, social, and immunological terms.
Across the globe, vaccine production changed significantly with the birth of biotech in the 1970s. Biotechnology brought recombinant vaccines, facilitating rapid scale-up and mass production. Cuba’s biotech industry was jump-started with shared technology from Finnish physician-scientist Kari Cantell, who successfully discovered how to produce and purify interferon from human leukocytes and chose to share rather than patent the process (Feinsilver, 1993; Reid-Henry, 2012). Shortly after the purification of interferon, a dengue outbreak that resulted in the hospitalization of 116,000 patients spurred the first linkage of Cuban biotechnology with public health. Researchers working on interferon approached the Ministry of Public Health (MINSAP) with the idea of using the still largely untested treatment to mitigate the severity of the infection. Preliminary positive results spawned a mass campaign of prophylactic interferon administration. This was the first iteration of what would become the hallmark of Cuba’s socialist biopharmaceutical sector: rapid integration of public health, politics, science and regulation. Interferon generated the stepping-stone on which Cuba’s biopharmaceutical industry has grown, based on immune-modulating molecules, paving the way for the generation of over a thousand patented molecules, called innovadoras. During the first weeks of the pandemic, Cuba shipped interferon to China as an experimental treatment for COVID19.
Cuba’s Center for Genetic Engineering and Biotechnology (CIBG) was the country’s first biotech entity. The US embargo, limiting access to many basic medications, created the major impetus for the early investment in biotech. CIBG began developing the technology to produce both pharmaceuticals and vaccines in the 1980s, using techniques developed during their early work manufacturing interferon. CIBG’s first products included a recombinant Hepatitis B vaccine, interferons, and recombinant epidermal growth factor. The Finlay Institute developed the first vaccine against Neisseria miningiditis type B in 1980, providing the vaccine to Brazil, Argentina, Colombia and Uruguay, helping control a major regional outbreak. (PAHO, 2015).
Cuba’s aptly named Soberana1 and Soberana2 capture some sense of the work done by vaccines beyond simply building herd immunity. Indeed, vaccine historians Christine Holmberg, Stuart Blume and Paul Greenough (2017) argue that the capacity of a government to manufacture its own vaccines sustains national sovereignty and that, for vaccine campaign participants, the success or failure of national vaccine manufacturing impacts their sense of citizenship. Put another way, vaccines can act as a powerful force for cementing national identity.
Vaccines are especially political pharmaceutical entities. As Elena Conis (2016) argues, vaccines afford the enaction of a range of political imaginaries: a healthy populace, a caring state, a state of security. By the same token, among both “anti-vaxxers” or vaccine-hesitant as well as communities of color who have historically been subject to unethical medical experimentation, vaccines represent a politics of violence, perpetrated by the state. Vaccines are a unique category of pharmaceutical. They act through us, not on us. They are active treatments, incapable of working without the active participation of the immune system. Indeed, this very active principle fuels some of the fear and resistance which has emerged among certain sectors. The vaccine is meant to intervene on our reaction to the outside world, helping defend us against would-be assaults from pathogens like the novel coronavirus.
Cuba’s “Sovereign” COVID19 vaccines emerge from the country’s state-run biopharmaceutical “closed ecosystem” of R&D, clinical trials, and distribution to a universal national health system. Fundamental to the system’s design is integration of science and politics in a setting where business interests are not afforded top priority. Cuba’s integration of science and politics contained the virus and generated two vaccine candidates. With the Cuban economy in shambles, the socialist state is leaning into its role as caretaker, and the development of these “sovereign” vaccines is quite important in these dire times. These “Sovereign” COVID19 vaccines might well be read as socialist vaccines.
In the US, by contrast, national vaccine prowess hangs on the ability to secure doses through purchase. The US now faces the very difficult situation of vaccine delivery in the context of a completely fragmented health system with no national leadership or program. In this setting, Walgreens, CVS, and Wal-Mart have emerged as key players in vaccine distribution (Van Gilder, 2020). National health policies in the US frequently turn on questions of individual rights, rather than science and public health. Compared to Cuba, the relationship between science and politics is inverted and at almost every turn, interests and profits are afforded greater importance than health. While the US has secured the lion’s share of the global supply of the major multinational vaccine candidates, the lack of any universal or even regionally coordinated health system, with millions of people lacking health insurance and regular care, means mass vaccination will be a massive challenge, even if a majority of people are willing to be vaccinated, which is still an open question. In Cuba, people receive healthcare from the nurse and doctor in their neighborhood. Medical student brigades roam the streets doing outreach. Elderly and homebound patients get home visits. When the Soberana vaccines are ready for mass distribution, based on the country’s history with vaccinations, nearly everyone can expect to be vaccinated, and administration will be simple: business as usual. In the US, business as usual means people who “believe in science” might possibly be able to get their vaccines at some point, and many will get them from our best substitute for a coordinated national program: our vast network of Walgreens and Walmarts (while supplies last, offer not valid in all 50 states, subject to terms and conditions, may not be combined with other offers).
Naomi Schoenfeld, PhD is a medical anthropologist and public health nurse practitioner specializing in Cuban biotech, post-socialist studies and STS of the Global South. Her new research focuses on novel housing interventions for COVID19 prevention among persons experiencing homelessness in San Francisco.
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