Times are tough in Cuba. The supply situation has deteriorated dramatically – even basic foods are lacking – currency is losing value, public anger and frustration is turning into street protests, and now Covid-19 numbers are rising also soaring. In just 10 days, the daily number of cases has doubled. With more than 3,500 infections per person, the healthcare system is undergoing a stress test. But at the same time, it is the fight against Covid-19 that is the greatest source of hope. The vaccines developed on the island show high levels of efficacy – not only in clinical studies, but also in practice.

The Havana government has taken a big risk with its May 2020 decision not to import vaccines – neither from Russia nor China, nor by participating in the Covax vaccine platform. Instead, Cubans decided to rely solely on developing their own vaccines. Many were skeptical: why should the Caribbean island succeed where billionaire pharmaceutical companies have failed?

The explanation lies in the biotechnology sector in Cuba, which has systematically built itself since the 1980s as an island of efficiency in the socialist economy. From the outset, emphasis was placed on developing vaccines, not only for domestic consumption, but also for export to countries in the South. It is this established research and production structure that has enabled Cuba in a very short time to manufacture two ready-to-use vaccines.

Cuba’s two highly effective vaccines

Both, ‘Abdala’ and ‘Soberana 02’, are based on the protein-based vaccination method that has been used for decades against polio, tetanus and others. Unlike the new mRNA vaccines from BioNTech and Moderna, this is “old-fashioned” technology. But it has major advantages: Covid-19 vaccines can be produced in existing factories, experience indicates few side effects, and no extreme cooling is needed.

But that’s not all: vaccines are also very effective. Cuban scientists have published the results of phase III studies, according to which, Abdala achieved efficacy against symptomatic diseases of 92.3% after three doses, and. Soberana 02 an equally impressive 91.2 percent.

Vaccination of the country’s medical staff in early March immediately reduced the number of infections among health workers.

Critics have questioned these figures, pointing to a lack of transparency and a lack of documentation in scientific journals. In a real application, these figures can indeed be adjusted. Although the Phase III studies included more than 40,000 people each, the absolute numbers on which the efficacy rates are calculated are not high: For Soberana-02, there were 5 cases of disease in the group vaccinated against 51 in the placebo group.

Cuban vaccines against Delta mutation

But beyond the studies, as for the effectiveness, the vaccination campaign speaks for itself. Vaccination of the country’s medical staff in early March immediately reduced the number of infections among health workers. Since the start of mass vaccinations in May in Havana, this pattern has been repeated in the general population of the Cuban capital.

More than seven million doses have now been administered, the vast majority of them in Havana, which was originally the epicenter of the infections. In all other provinces, the incidence rate is increasing sharply. Meanwhile, in the capital, where more than half of the population has already been vaccinated, the infection rate has fallen to half its peak.

We can see, as in other countries with high vaccination rates, some rebound in infection rates as the aggressive Delta strain spreads rapidly. So far, Cuban vaccines appear to produce good antibody responses also against Delta, but it is too early to say whether – as with other vaccines – the high efficacy rates are also fully valid against the new mutation.

A phase III trial of the Soberana 02 vaccine was also conducted in Iran, with 24,000 participants. As a result, the Cuban vaccine has already been urgently approved there. In Cuba itself, mass vaccinations take place without formal approval; It is only now that Abdala has obtained the emergency clearance, and the clearance for Soberana 02 is still pending. The Cuban regulatory authority will likely only issue this statement once the available data meets all WHO guidelines and protocols.

Export to allies around the world

In addition to beating the pandemic in its own country, Cuba also hopes to export its vaccines. But for now, Cuba faces big hurdles in expanding its vaccine production. The 100 million doses of vaccine announced for production this year will remain a theoretical possibility. The necessary ingredients have become extremely scarce around the world as companies around the world increasingly focus on developing protein-based vaccines – whether Novavax in the US, Sanofi / GlaxoSmithKline in Europe or Anhui in China.

Even though Cuba is “sovereign” in its own vaccine development, as the name “Soberana” suggests, the material to be imported and the ingredients required are not. In addition, as with everything in Cuba, there is the heavy burden of the US embargo. Not only does this limit opportunities to acquire machinery and inputs, Washington’s threats to international banks turn financial transactions with the island into complex and costly maneuvers.

As important as these prospects may be, Cuban vaccines could solve the country’s health crisis, but not the economic crisis.

As a result, Cuba will initially have enough work to do to produce vaccines to inoculate its own population nationwide. However, as a sign of solidarity, a first shipment of 30,000 doses of the ‘Abdala’ vaccine was sent to its ally Venezuela, whose oil shipments to Cuba have declined but remain essential to supply the island. Twelve million more doses have been promised, but no date has been given as to the delivery date.

Cuba will also seek new export opportunities, preferably with advance financing, as well as licensing agreements with countries like Argentina or Vietnam, which have their own production capacities. In the past, the WHO has purchased Cuban vaccines for its health campaigns in countries of the South and may do so again in the context of the current pandemic. In the medium term, protein-based vaccines like Cuban vaccines are also well suited to boosters.

Cuba’s economic crisis continues

As important as these prospects may be, Cuban vaccines could solve the country’s health crisis, but not the economic crisis. This remains the task of a reform program aimed at stimulating the whole economy and not just hoping that the biotech sector becomes a bountiful cash cow.

The fight against the pandemic in Cuba, as elsewhere, is a race against time between the rhythm of vaccinations on the one hand and the spread of the virus and its variants on the other. If things go well, the vaccination campaign will bring relief to hospitals in Cuba, gradually lift the country out of lockdown measures and allow it to open up to international tourism in time for the all-important winter season. Before the pandemic, tourism was the island’s most important industry and its foreign currency income is essential to weather the current crisis.

But also beyond the island, the development of a Cuban vaccine holds a. In this era of global supply chains, all ideas of “self-sufficiency” were quickly dismissed as outmoded. The pandemic has forced even western industrialized countries to learn that globalization cannot be relied on in times of need. Whether it’s masks or vaccines, when the going gets tough, it’s not just “America First”, but every country tends to look for itself first.

The fact that the Cuban biotech industry has managed to develop its own vaccine despite the country’s limited resources is nothing short of sensational. With the recent increase in infection rates, Cuban society faces tense months. But with the pace of the current vaccination campaign, there is good reason to hope that by winter, the country will have reached a level of immunity to make it one of the first in Latin America to reach the “Post-Covid time”.

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