Vaccines and Public Trust: Containing COVID-19 in Cuba.

As 2021 drew to a close, Cuba struggled to contain the highly transmissible omicron variant of SARS-CoV-2, braced for a new wave of infections and kept a close eye on other variants of concern popping up around the world-a common experience to countries everywhere as we head into the second year of the pandemic. In Cuba, however, there is one marked difference making all the difference: by early January, 87% of the population was fully vaccinated using a three-dose schedule of vaccines developed and produced on the island.[1] This massive vaccination campaign is complemented by a rapid booster rollout-also using Cuban vaccines-that began in December 2021 and was ongoing as we finalized this issue.

In Haiti, Cubans Among First Responders, Again: Luis Orlando Oliveros-Serrano MD Coordinator, Cuban Medical Team in Haiti.

Soaring summer temperatures, systematic urban and political violence, unreliable infrastructure-power outages, water shortages, sporadic transportation and interruption of other basic services-plus the illness, death and economic straits wrought by COVID-19, are what Haitians awake to every day. On the morning of August 14, 2021, they also woke to the earth in the throes of violent, lethal convulsions caused by a 7.2-magnitude earthquake, along the same fault line responsible for the devastating 2010 disaster and stronger still.

Cuba's National Regulatory Authority & COVID-19: Olga Lidia Jacobo-Casanueva MS Director, Center for State Control of Medicines and Medical Devices (CECMED).

At the time of this writing, more than 10 million Cubans (nearly 90% of the country's population), had received at least their first dose of Soberana 02 or Abdala, two of five vaccine candidates for SARS-CoV-2 developed and produced on the island. Late-phase clinical trial data revealed that Abdala is 92.28% effective after the full, three-dose cycle and Soberana 02 is 91.

Monoclonal Antibodies vs COVID-19: Eduardo Ojito-Magaz MS General Director, Molecular Immunology Center.

Cuba has five COVID-19 vaccines in clinical trials and is on track to receive emergency use authorization from the country's regulatory agency to begin mass vaccination with two of those candidates: Abdala and SOBERANA 02. Results from phase 1 and 2 trials of these vaccines, the first developed and produced in Latin America, have been encouraging, both in terms of safety and immunogenicity. The ongoing phase 3 trials will continue to look at safety, together with efficacy; parallel intervention studies involving over a million people in Havana will begin generating data on effectiveness.

COVID-19 Requires Innovation, Regulation and Rigor: Amaylid Arteaga-García MD MS Director, National Clinical Trials Coordinating Center (CENCEC).

The effects and implications of COVID-19 are global, comprehensive and long-term. The pandemic has exposed inequities, the fragility of economic and political systems, and in many cases, skewed priorities. Population health, not to mention planetary health, is suffering as a result.

"Cuba's Medical Team in the European Epicenter of COVID-19: Carlos R. Pérez-Díaz MD MS PhD Director, Joaquín Albarrán Provincial Clinical-Surgical Hospital, Havana Henry Reeve Medical Contingent Leader, Lombardy, Italy".

On March 23, 2020, Cuba's Henry Reeve Emergency Medical Contingent began treating COVID-19 patients at Maggiore Hospital in Crema, Lombardy. Within days, the 52-member contingent comprised of 36 doctors and 15 nurses (plus 1 logistics specialist), together with Italian colleagues, were receiving patients in an adjacent fi eld hospital established and equipped for this purpose. At the time, Lombardy was the epicenter of COVID-19 transmission in Europe.

Early Action, Applied Research & Collaboration to Combat COVID-19: María Guadalupe Guzmán MD PhD DSc.

Virologist Dr María Guadalupe Guzmán is recognized as a global leader in dengue research and heads the Pedro Kourí Tropical Medicine Institute's work as a WHO/PAHO Collaborating Center for the Study of Dengue and Its Vector. The Institute (IPK) was founded in 1937 and is now Cuba's national reference center for the diagnosis, treatment, control and prevention of communicable diseases. Dr Guzmán is also president of the Cuban Society of Microbiology and Parasitology and directs IPK's Scientifi c Council, which is responsible for setting the Institute's research priorities.

SOBERANA, Cuba's COVID-19 Vaccine Candidates: Dagmar García-Rivera PhD.

On August 13, 2020, Cuba's national regulatory agency, the Center for Quality Control of Medicines, Equipment and Medical Devices (CECMED), authorized clinical trials for SOBERANA 01-Cuba's fi rst vaccine candidate and the fi rst from Latin America and the Caribbean. On August 24, parallel Phase I/II double blind, randomized, controlled clinical trials were launched at clinical sites in Havana to evaluate the vaccine's safety and immunogenicity. Analysis of results and development of different formulations are currently under way and Phase III clinical trials are planned for early 2021.

Science as a Social Good: Iramis Alonso-Porro Director, Juventud Técnica.

Science journalism was little known in Cuba when Iramis Alonso wrote her the-sis on the specialized fi eld in 1990. That year, journalism degree from the Uni-versity of Havana in hand, she set off to Cuba's eastern countryside to complete two years of social service reporting for local, regional and national print media. Living in the mountains of Holguín, a typical day for the cub reporter took her to caves, forests and fi elds for stories on the intersection of science, culture and the environment.

Global Collaboration in Times of COVID-19: Cuba's Emergency Medical Contingent.

The days are long and arduous, with end-less patients to attend, often in a foreign language, always on foreign shores. Far from family and the familiar. Sleep is fi tful at best for health profession-als serving in emergency situations-when sickness obeys no clock and patients' pain haunts even the quiet moments.

COVID-19 Case Detection: Cuba's Active Screening Approach.

Meningitis, neuropathy, HIV, dengue-since the 1960s, Cuba has faced its share of epidemics. More recently, Cuban health pro-fessionals tackled domestic outbreaks of H1N1 (2009) and Zika (2016), and worked alongside colleagues from around the world to stem Ebola in West Africa; all three were categorized by WHO as public health emergencies of international concern. In December 2019, China reported its fi rst cluster of pneumo-nia cases, later identifi ed as the novel coronavirus disease COVID-19.

Six Decades of Cuban Global Health Cooperation.

In 1978, the world was put on notice: health inequalities exacerbated by lack of access to essential services was a ticking time bomb threatening social and economic development everywhere. That year, over 100 countries signed on to the Declaration of Alma-Ata, which affirmed that "health . .

Gender & Race in Cuba: An Anthropological Perspective Lourdes Serrano Peralta PhD, Cuban Anthropology Institute.

How does a developing island nation, beleaguered by climatic challenges and 60 years of adverse geo-political pressures become a beacon of scientific innovation, medical services and applied research-all on a shoestring budget? What's more, how does such a country, rooted in a traditional patriarchal paradigm, overcome barriers to create a scientific and medical community where the majority of researchers and professionals are women? These are some of the questions that motivated MEDICC Review to publish this series on Cuba's women in STEM (science, technology and math).

The Power of Persistence: María Amparo Pascual MD MS Founding Director, National Clinical Trials Coordinating Center, Havana.

Throughout the 1980s, Cuban researchers at the country's biotech campus known as the Scientific Pole were making innovative discoveries and began developing unique therapies and vaccines unavailable elsewhere in the world. The pace and level of innovation meant prioritizing the establishment of a dedicated, internationally-certified institute for clinical trials. These and other accomplishments in science and related sectors, coupled with statistics revealing that 53% of all scientists in Cuba are women, prompted MEDICC Review to publish a series of interviews with outstanding Cuban women in science, technology and medicine.

Empowering Cuban Women: Marta Núñez MS PhD, Sociologist & Consulting Professor, University of Havana.

After nearly 60 years of universal education and health, coupled with national policies supporting women's rights and advancement, the results are in: according to recent data, more than half of Cuban scientists and almost 60% of all professionals in Cuba are women. Moreover, women's representation in government is rising, including at the highest levels such as parliament, where they constitute 53.2% of members.

Cuban Youth Promote Healthier Diet through Art.

Art, education, health and nutrition: encouraging healthy eating at an early age is central to the World Food Programme's (WFP) goals. To this end, using art as a learning and communications tool, the program sponsors WFP in Action, a drawing contest open to youngsters 5-18 years old. Cuba has participated in the contest nationally since the 1990s, and since 2002 has sent a selection of drawings annually to the international competition at WFP headquarters in Rome.

Confronting Arboviruses: María Guadalupe Guzmán MD PhD DrSc Director, Reference Center for Research & Diagnosis Pedro Kourí Tropical Medicine Institute, Havana.

The 1980s were a watershed for Cuban research in medicine and health: significant financing and material resources buttressed a strategy to improve population health through enhanced biopharmaceutical innovation and clinical best practices applied to Cuba's universal public health system. Redirecting research priorities and providing substantial public funding to tackle the top population health problems was a radical idea at the time, especially for a developing country like Cuba. Doing so has become a hallmark of Cuba's scientific achievements and approach ever since.

Your Primary Care Doctor May Have an MD from Cuba: Experiences from the Latin American Medical School.

On the 40th anniversary of the Alma Ata Declaration that affirmed health for all a right and primary health care the route to guarantee that right, WHO and PAHO have issued a call to action to convert universal health into reality for the nearly four billion people worldwide lacking full coverage of essential health services. There is some urgency to this movement: WHO estimates the health workforce shortage of nearly 8 million could reach almost 13 million by 2035. And the USA is not exempt: medical associations and special commissions set up to investigate the shortage of primary care physicians, especially "under-represented minority" doctors, have issued report after report on this growing health care emergency.

Dispatches from Haiti, 2010.

In this Retrospective, MEDICC Review reprints excerpts from a blog by Senior Editor Conner Gorry, who, during February and March 2010, was embedded in the disaster-response medical team sent from Cuba after the January 12 earthquake. The team reinforced nearly 500 Cuban health personnel already on the ground long term in 120 communities. Some 700 of the 1300 new arrivals were students or graduates of Cuba's Latin American School of Medicine from 27 countries.

Science at the Service of Public Health: Rafael Pérez Cristiá MD PhD Center for State Control of Medicines and Medical Devices.

Cuba's nascent biotechnology sector began making scientific breakthroughs in the 1980s, including the isolation of human leukocyte interferon alpha (1981) and the development of the world's first safe, effective meningitis BC vaccine (1989). With positive results in hand and a growing R&D pipeline, the island nation established a national regulatory authority (NRA) to implement and oversee best practices for all pharmaceuticals and medical devices, domestically produced and imported, used in the country's universal health system. Founded in 1989, Cuba's Center for State Control of Medicines and Medical Devices (CECMED) is the entity charged with regulating all phases of scientific innovation for health, from clinical trial design to postmarketing surveillance.

Making Travel to Cuba Work for Health and Sustainable Development.

In 2015, a record-breaking 3.5 million visitors-1 million from Canada alone-traveled to Cuba to explore its history, culture, natural splendor, and visit family. That same year, US President Barack Obama relaxed travel restrictions, giving general authorization for a dozen categories of legal travel by US citizens and residents.

Cuba's Family Doctor-and-Nurse Teams: A Day in the Life.

Nurse Sarait Guarat has Felipe's clinical history out of the file cabinet and on Dr Martha Diaz's desk before he's even through the door. Not that Dr Díaz needs it: Having served 26 years at Consultorio (Family Doctor-and-Nurse Office) #17 on a leafy street in Havana's Vedado neighborhood, she knows each of her patients by name and their health status essentially by heart. After greeting 91-year old Felipe with the customary kiss on the cheek, Dr Díaz gets down to business, asking after his family, checking up on his diabetes and inquiring about the reason for his visit.