Cuban Health System Lessons

Saturday, 2 September 2023, 5:52 am
Opinion: Ian Powell

Previously I have published pieces on what Aotearoa New Zealand can learn from Cuba’s health system.

This was largely about the over 11 million population nation’s remarkable progress in high tech vaccine production in response to the Covid-19 pandemic which hit both countries in early 2020.

On 10 June 2021 the Democracy Project published my article on lessons for New Zealand from what the Washington Post suggested was the Cuban “vaccine powerhouse”: Lessons for New Zealand from Covid-19 vaccine powerhouse.

The following month I published an Otaihanga Second Opinion blog (22 July 2021) where I responded to the call of New Zealand doctors for vaccine development here by referring to the successful Cuban experience: Doctors call for vaccine development in New Zealand.

A further blog over a year later (28 August 2022) argued that it was now time for New Zealand to learn from Cuba on vaccination production: Vaccine production learning time for New Zealand.

Instructive whistlestop visit

Now Auckland has had the experience of a whistlestop visit by a Cuban chemical research scientist Marianniz Díaz Hernández to share the experience of her country’s biotech industry and Covid-19 vaccine development. She was accompanied by Cuban international relations expert Iván Barreto López.

The visit was organised by the Auckland Cuban Society and well-reported by New Zealand Doctor journalist Steve Forbes (4 August – paywalled ): Despite US sanctions, Cuba punches above its weight in biotech.

Díaz Hernández works at the Centre for Molecular Immunology in Havana. It is a publicly owned institute that focuses on research and production of new biopharmaceutical products for the treatment of cancer and other diseases.

She was involved in clinical trials for two of the three Covid-19 vaccines developed in Cuba.

Her tour was jam-packed including visiting  Auckland’s Te Whānau o Waipareira Trust as well as meeting officials from the Ministry of Foreign Affairs and Trade and researchers from Auckland University’s Medical School.

Like the rest of the country, Cuba’s health system has been severely affected by vicious economic sanctions (officially called an embargo but more appropriately should be labelled economic warfare) from the United States since 1962.

According to the World Health Organisation, Cuba’s overall performance of its health system is ranked in the top 40 in the world. This includes higher than New Zealand which has not been subjected to American economic warfare.

Joined at the hip

This high rating is because of the focus on public (population) health which has seen Cuba develop an innovative and successful biotech sector. Population health and biotech are joined at the hip.

In response to the arrival of the pandemic Cuba began developing its own Covid-19 vaccines in March 2020. It now has three approved vaccines.

The first vaccine (Abdala) was used to vaccinate around nine of the over 11 million population. The other two (Soberana 2 and Soberana Plus) have been used to vaccinate almost two million children and adolescents between two and 18 years.

Trade restrictions under the very strict sanctions means a constant struggle for Cuba’s health system, including access to vital medical supplies and equipment.

This has led the innovative country to produce 85% of the products needed for Covid-19 vaccines and treatment.

This is a remarkable achievement, especially given that these vaccines have also been exported to other countries in need.

New Zealand medical perspective

Steve Forbes refers favourably to the expertise and experience of Dr Nikki Turner, Medical Director of Auckland University’s Immunisation Advisory Centre. In his (and her) words:

Nikki Turner … says Cuba’s biotech sector has previously played a part in vaccine development in New Zealand.

Dr Turner says in the late 1990s, when New Zealand was looking to stop the spread of meningococcal B, it relied on the work done by Cuban researchers to develop a vaccine.

“They were at the cutting edge of their development at the time,” she says.

The research led to production of the MeNZB meningococcal group B vaccine used in New Zealand between 2004 and 2011 and the Swiss developed Bexsero vaccine rolled out this year.

“That is international cooperation when it works and I hope we can see more of that,” Dr Turner says.

Being fully government funded, Cuba’s biotech sector isn’t compromised by corporate interests and the work researchers undertake isn’t “siloed off”, she says.

“Government funding of vaccine development is a really positive thing and means you can put more of an equity lens on things and look at what the population actually needs. Whereas when you have large multinationals involved, their focus is often on where they can make a profit.”

But there’s even more to learn from Cuba

There is little more that could be added given the succinctness of Dr Turner’s above comments. But there is more for Aotearoa to learn from Cuba’s health system pandemic response.

It is instructive to compare both countries in their public health responses to the Omicron variant of Covid-19, which arrived on our shores in early 2022, and the nature of Cuba’s health system.

Revealing data is provided by the ‘World in Data’ website. It is a trusted collaborative effort between researchers at the University of Oxford, who are the scientific contributors of the content, and the non-profit organization Global Change Data Lab, who owns, publishes and maintains the website: Covid deaths per million population: Cuba and New Zealand.

Below is a table I compiled from this data comparing mortality rates per million people in Cuba and New Zealand from the first year of the pandemic until mid-August this year.

World in Data: Covid-19 Deaths per Million Population

The first standout point is the remarkable performance of both countries throughout 2020. Both adopted successful elimination of community transmission strategies and both were world leaders.

New Zealand had the slightly lower mortality rate but was not subjected to economic warfare from the United States. Both saved of thousands of lives.

By 28 October 2021 New Zealand was impressively unchanged but Cuba had rocketed up by 723 per million. This was a crisis. Every Christmas-New Year thousands of Cubans living abroad return to Cuba to see families and friends.

Overwhelmingly these temporary returnees were from Florida. This particular state was not only one of the laxest American states in their pandemic responses; it also prohibited critical protections in various situations such as vaccine and mask requirements.  

This was a bad error of judgment by Cuban authorities, even given the importance of these returnees to the economy. Had it not been for the economic embargo, this importance would have been much less.

Sadly, the effect was that Covid-19 ran amuck which, by July, was the more deadly Delta variant. Delta hit New Zealand in August.

October 2021 was also when the New Zealand government’s knees wobbled in response to Delta’s arrival. Some poor and confusing decision-making followed. This further deteriorated when Omicron arrived in early 2022.

By 9 June 2022 New Zealand’s mortality rate per million had leapt a big 236 to 241. In contrast, Cuba’s rate only increased by 29 to 761.

By 15 August 2023 there was an even more extraordinary change. Cuba’s mortality rate was unchanged. But New Zealand’s rate had increased by an even larger 386 to 627 per million. This was all under the highly transmissible Omicron.

Cuba’s last Omicron death was in May; New Zealand has been consistently having over 20 deaths per week for over a year. The trend since 2022 suggests a significant narrowing of the mortality rate gap; perhaps even New Zealand’s exceeding Cuba’s.

Explaining the Omicron difference

So why the difference under the Omicron variant? To begin with, fully vaccinated rates. ‘World in Data’ described a fully vaccinated person as someone who has received either a single-dose vaccine or both doses of a two-dose vaccine.

As of March 2023 New Zealand had a fully vaccinated rate of 84% whereas Cuba’s rate was 88%. Not a huge difference to fully explain the sharply contrasting mortality rates under Omicron.

But drilling down further to the rate of doses per 100 people provides more insight. New Zealand’s rate was 244 whereas Cuba’s was a significantly higher 385.

The explanation of the difference is partly that Cuba was able to produce its own quality vaccines. But more than this, Cuba has been much more proactive in encouraging Cubans to continue with vaccine doses.

Compared with Cuba’s proactivity over new vaccines specifically developed for Omicron, New Zealand has been much more laissez-faire. This is reflected in the rate of doses per 100 people difference.

In contrast, whereas in the lead up to the 2020 election the government virtually only talked about Covid and vaccination, since early 2022 it barely talks about it.

Cuba has continued to see the pandemic response as a collective responsibility. New Zealand now sees it as an individual responsibility. Since 2022 this has been the core difference between the two countries.

Community-based health system

Cuba also has a community based health system which is more suitable for ensuring successful public health initiatives. It is much more proactive on immunisation generally. Its vaccination approach originates in this proactivity.

As I have discussed recently in BusinessDesk (29 July), Cuba has a system of polyclinics (primary and lower level hospital care) that helps enable this: Polyclinics are just what the doctor ordered.

Time to talk to Cuba

It is time that New Zealand talked with Cuba more about what our health system can learn from its public health and biotech strategic approaches.

This should also include what we can learn from its community-based polyclinic system that sits below and protects its general and specialist hospitals.

What about beginning this discussion with Cuba’s congenial and accessible ambassador Edgardo Valdes!

© Scoop Media

Ian Powell

Otaihanga Second Opinion is a regular health systems blog in New Zealand.

Ian Powell is the editor of the health systems blog 'Otaihanga Second Opinion.' He is also a columnist for New Zealand Doctor, occasional columnist for the Sunday Star Times, and contributor to the Victoria University hosted Democracy Project. For over 30 years , until December 2019, he was the Executive Director of Salaried Medical Salaried Medical Specialists, the union representing senior doctors and dentists in New Zealand.

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