Solidarity is priority of Cuba’s health care system

By Rémy Herrera

From a speech by Rémy Herrera of the National Center of Scientific Research (CNRS) in Paris given at the South South Forum (SSF Hong Kong) on July 3, 2024. Workers World publishes it with the author’s permission on the occasion of the 71st anniversary of the attack on the Moncada Barracks, considered the start of the Cuban Revolution.  This article was slightly edited.

My thanks — first of all, for the initiative of this new South South Forum and the honor of participating in it. I’ll talk about Cuba and the exceptional health system it built, inside and outside its borders. If we look at the latest statistical data from the World Bank for 2020, published in 2023, we see that life expectancy was slightly higher in Cuba than in the United States, the infant mortality rate was lower in Cuba than in the USA, and the risk of dying between the ages of 20 and 24 was three times lower in Cuba than in the USA. In 2020, there was the pandemic.

But something special is happening in Cuba, which is called a Socialist Revolution led by a Communist Party. And these results were obtained under an embargo imposed by the USA in 1962.

• It must first be said that the health situation before 1959 was catastrophic: few doctors (one per thousand inhabitants, two out of three being in Havana, the consultation worth a fifth of the median monthly salary or a third of the monthly food budget). The poor were excluded from care. Infant and maternal mortality rates were terribly high, diseases were widespread among rural workers (a third had intestinal parasites or malaria, a sixth had tuberculosis or typhoid).  Before 1959, Cuba’s health budget was sacrificed in the face of that internal security.

Revolution brought health care system 

• It was only with the 1959 Revolution that a health system was finally set up. Since then, progress has been rapid, although training medical personnel takes time. Everything had to be rebuilt, because many doctors from the old regime fled socialism. The revolution implemented social justice measures in favor of the people, including the establishment of social security, ensuring universal coverage, free health care and a pension system. … 

A big success has been made in scientific research, the excellence of which is recognized worldwide. The foundations of this success were laid, beginning in 1961, by building a free, quality education system, both egalitarian and elite, without social, sexist and racial discrimination. In 1966, the National Center for Scientific Research was created whose teams made great discoveries linking research and production. 

Internationalism a priority

From the start, internationalism was present: Doctors were sent to Chile during the 1961 earthquake, when its government was hostile to Cuba. In 1962, Algerian war wounded were treated in Cuba. In 1963, African medical students from Guinea came to train in Cuba, etc.

• Progress was noticeable starting in the 1960s, then amplified in the 1970s. At the end of the 1980s, Cuba was at the top of the socialist countries in health indicators, comparable to those of the German Democratic Republic (GDR). The pharmaceutical industry satisfied 85% of domestic demand for medicines. More than 200 products, from vaccines to equipment, which were designed on the island were marketed around the world in 1990 and even purchased by the World Health Organization. 

During the special period, the health system, integrated into the communist project, resisted, was not privatized, and was even developed. Cuba has not stopped investing in science. I compiled around a hundred human development indicators, taken from statistical databases of international institutions. 

And we can see that, at the worst moment of the post-USSR crisis from 1992-1996, Cuba still ranked among the top three countries in Latin America for share of health budgets, social security coverage, life expectancy, deliveries of babies in hospitals, infant mortality rates, child vaccinations, number of inhabitants per doctor or nurse, access to the health system in rural areas and more. 

The same goes for research (budget as a percentage of gross domestic product,  number of full-time researchers or in proportion in the active population), education and the status of women and the environment. Despite problems and shortcomings, the health system, shaken, remained standing and free.

U.S. use of biological warfare

• And all this happened, despite attacks from the USA, including biological warfare organized from U.S. territory and aimed at infecting the population, livestock and crops in Cuba. For example, in 1981, the dengue hemorrhagic fever epidemic: It was proven that this type of dengue, unknown then, had been created in a laboratory in the United States for its intentional spread to Cuba. 

After vaccinating the soldiers at the Guantánamo base, Washington banned its companies from supplying mosquito repellent pesticides and spray planes to stop the epidemic, which killed 158 people in Cuba, especially children. 

Other similar operations have been revealed. One could believe these cases were fabricated by the Cubans, but it’s difficult to believe that when the diseases were detected for the first time on the island — like the Shigella 1 bacteria of dysentery in 1982; in America, hemorrhagic conjunctivitis in 1981 and acaro steneo syndrome in 1997; or even in the world, with dengue serotype 2 in New Guinea in 1924. Or even when members of anti-Cuban criminal organizations in the USA publicly admitted having participated in these terrorist actions — as with the modified swine fever virus in 1979 or the Trèsza virus in 1992.

Cuba puts morality before profits

• Faced with these attacks, what was the response of the Cuban government and people? They award hundreds of scholarships to underprivileged U.S. students each year. The ethics that drive the internationalism of the government and the generosity of the Cuban people — who accept that morality goes before profits — can be illustrated by an example. In 1990, Cuba welcomed 25,000 Ukrainian children aged 5 to 15, victims of the Chernobyl nuclear disaster who were suffering from cancer or malformations. 

When the USSR fell, Ukraine’s leaders submitted to Washington and voted in favor of the U.S. embargo, but Cuba continued to treat these sick children free of charge. In 2005, after Hurricane Katrina, Cuba offered the USA more than 1,000 doctors and several tons of medicine, but then-President George W. Bush refused this aid.

• Progress in medical research is impressive. Cuba holds patents to and exports to around 50 countries via the BioCubaFarma group numerous original, or even unique, pharmaceutical or biotechnological products: vaccines against meningitis, hepatitis, pneumonia, cholera, leptospirosis and Haemophilus influenzae.

Also, this includes successful development of protein INF interferon, epidemic growth factor against burns, monoclonal antibodies against cancers, PPG against cholesterol, heberprot P against diabetes recombinant erythropoietin against renal failure, Suma technology against congenital pathologies, treatment of heart attacks, embolisms and hypertension, vitiligo and tropical medicine.

The World Psychiatric Association praises Cuba’s treatment of mental illness. During clinical trials for AIDS care, doctors volunteered to inoculate themselves with the HIV virus and test the drugs they developed on themselves. Agreements have been signed with China to manufacture Cuban products or export complex services and specialized software.

U.S. embargo limits goods, health care, research

• The embargo is obviously a big problem for health care, production and exports.  It threatens food security, nutritional balance, the state of health of the population, and it reduces the availability of goods not manufactured in Cuba, thus exacerbating the shortages of medicines for pregnant women, radiology or surgical equipment, anesthetics, epidurals, artificial respirators, pediatric intensive care unit equipment and food for infants.

Water purification centers are also affected by the embargo. A humanitarian tragedy — which is the objective of this embargo — was only avoided by the will of the Cuban state to maintain its socialist model, which reaffirms the priority given to human development, despite budgetary constraints. 

Washington is also undermining the circulation of researchers and scientific knowledge, which is prohibited by law. It’s criminal and damaging, including for people in the U.S. For example: In 1985, the team of Dra. Concepción Campa from the Finlay Institute in Havana discovered the vaccine against meningitis B, the first effective vaccine against this disease, and the first designed by a country of the South and administered in countries of the North.

Doses have been sold worldwide. Brazil ordered them during an epidemic in the Nordeste (Northeast), Washington broke the contract, so Cuba sent them for free. For two years, negotiations for marketing were blocked. It took pressure from scientists and also from U.S. parliamentarians and citizens to authorize importation into the USA. Unfortunately, in the meantime, more than 500 U.S. citizens had died from group B meningococcal meningitis, mostly children.

Life-saving health care teams sent abroad

• At the same time, millions of lives have been saved, thanks to internationalist missions. Before the COVID-19 pandemic, there were more than 50,000 Cuban health workers in 66 countries, half doctors, two-thirds of them women, often working in extremely difficult conditions — from the forests of Guatemala to remote villages in Eritrea via Soweto. These doctors were being sent to places where there was no health care structure. This is more than the medical personnel sent by the six richest countries on the planet. 

The results from 1961-2020: Cuba carried out more than 600,000 medical missions in 158 countries, mobilizing 326,000 professionals who performed nearly 2 billion consultations, 4.3 million deliveries of babies, 14.5 million surgical operations, 12 million child vaccinations. How many lives were saved? Some 66 countries from the four Southern continents have signed a medical cooperation agreement with Cuba; 25 of them are for a comprehensive health program, a system launched after Hurricane Mitch. Cubans stay on site for two years in medical deserts, so as not to compete with local doctors.

• Cuba opened the Latin American School of Medicine in Havana (ELAM) in 1999 to train disadvantaged and discriminated against foreign students willing to return as doctors to their countries. To date, more than 40,000 students from 140 countries have graduated from it, especially doctors, with all costs covered by scholarships from the Cuban state. Thousands of others are studying at other medical schools in Cuba. 

Medical mobilization in Venezuela

At the Millennium Summit in 2000, Cuba declared that it had — at the disposal of the United Nations, the WHO and African states — the personnel necessary for a plan to combat AIDS — to train doctors in Africa and open specialized units. A solidarity program began in 2003 in Venezuela (Barrio Adentro, inside the neighborhood), which mobilizes tens of thousands of Cuban health professionals throughout the territory to help the poorest people benefit from the opening of hospitals city by city. And they set up dispensaries district by district for emergencies, with dental practices, optician centers, analysis and diagnostic laboratories, and medicines are being distributed by a network of pharmacies managed by the state. 

Since 2004, the Miracle mission has also welcomed in Cuba disadvantaged patients who have undergone surgery for cataract or eye diseases (4 million from 35 Southern countries, including from Africa and Asia.) In 2005, Cuba established the Henry Reeve Contingent, made up of health personnel specialized to deal with natural disasters and epidemics. 

Since then, 39 Henry Reeve brigades, bringing together more than 10,000 doctors, have worked in around 20 countries. After the earthquake in Pakistan in 2005, 2,564 Cuban doctors arrived within 48 hours to help victims. They treated 2 million patients in eight months in 32 field hospitals built by the Cubans, then offered to the country. 

The Cubans did the same thing in Indonesia in 2006 and in Haiti in 2010 to fight the cholera epidemic. In 2014, Cuba carried out a malaria vaccination campaign in 15 African countries, and responded to the WHO’s call declaring a state of health emergency against the Ebola epidemic. In Cuba, more than 15,000 health professionals volunteered for the mission; 165 were selected and went to Guinea, Sierra Leone and Liberia, and another 91 joined the effort, (Granma, Dec. 11, 2015). That Cuba was among the first countries to respond with one of the largest human contingents, was widely-acknowledged.  

• The Cuban health system is a structured, efficient, generous one. I witnessed it when I was sick and treated there, without being asked for my identity or nationality, or for payment. Cuban doctors have received job offers from the USA, but remain in Cuba, even if life under the embargo is hard. 

Is all this irrational? No, it’s an anti-capitalist vision: Cuba trains surplus doctors to treat its population, export them through its missions abroad and develop medical tourism. At the start of the revolution, the missions were completely free. For some time, they have remained free, comparable to donations to poor countries, but a contribution in the form of sharing the costs of these missions is requested from rich, intermediate countries. 

Cuba today generates valuable revenue from medical cooperation — which can correspond to transfers from the diaspora, nickel exports or tourism income. And high-tech industries and exports with scientific and intellectual content are having  their share increase in the trade balance. 

World-renowned leader in health care

Cuba has become a major medical tourism destination. The world-renowned health system, with affordable prices and which is time-saving, convinces patients to come under tourist visas to get treatment for cancers, get fitted for prostheses, have ophthalmological operations, plastic or cosmetic surgery and undergo detoxification. The services are around 75% cheaper than in the USA for comparable quality. Thus, tens of thousands of patients have already traveled to Cuba for their care.

• For all this, the scientific community has expressed its gratitude to Cuba: The American Public Health Association welcomes the absence of racial barriers to access to health. The New England Journal of Medicine praises the free, quality care. The Lancet medical journal cites the Cuban system as a model. Science Magazine praises the work of anti-Ebola brigades. Nobel Prize winners say this system is an example for the world. The WHO awarded the Henry Reeve Brigade.

• The level of the Cuban health system stood out to the world in 2020. The COVID-19 pandemic remained under control in Cuba, while it raged in Latin America and the USA. The response provided by Cuba was based on the principles of the national health system: prevention and the key roe of the family doctor and a mobilization of the people. 

Achievements during pandemic at home and abroad

Despite the embargo and the global chaos, Cuban researchers quickly managed to find effective vaccines against COVID-19: Abdalá or CIGB-66, designed by the Center for Genetic Engineering and Biotechnology and authorized for use by the regulatory authority Cecmed in July 2021 and Soberana 2 or Finlay-FR-2, from the Finlay Institute, authorized for use in August 2021. 

National vaccination campaigns began in April 2021. Before that, Cuba had helped foreign countries, including those in the North, by sending doctors free of charge to Italy — to Lombardy in March 2020, then in Sicily and Calabria. This was the first time that Cubans provided treatment in Western Europe. In mid-2020, Cuba accepted France’s request for aid in its overseas departments and sent 2,579 health professionals to 24 countries.

Fifty countries have purchased recombinant interferon alfa 2B, the preventive anti-COVID-19 drug manufactured in Cuba, which has produced millions of doses for Southern countries. In Cuba, the campaign against the pandemic starting in January 2020 mobilized 28,000 medical students who visited 4 million people per day.

• Despite all the difficulties, social progress has never stopped, and the quality of care offered to the population by its free health system has held up. A societal choice is made — cooperation and solidarity in an egalitarian and peaceful society rather than individualism and competition in an unequal and violent society. And this health system is integrated into a vision of harmony between humankind and nature — because the protection of the environment is real, with reforestation, organic farming and more measures. 

Cuban researchers have therefore risen to the forefront in the world and, by remaining in the country, choose to serve their people — and often other peoples with their missions abroad. So we say: Gracias a Cuba.