"We joke in Cuba that if we discovered the remedy for the coronavirus, Donald Trump would choose to let all Americans die before buying it”, quipped Ernesto, a young Afro-Cuban waiter at the La Cava restaurant inside the restored Gran Teatro, in the center of Havana.
It was early March. Covid-19 had just arrived in the United States, and Donald Trump was frantically reacting to the incoming pandemic. Meanwhile, Cuba had readied its quarantine strategy, testing program and contact tracing scheme – alerting the cluster of biotechnology institutes in the Scientific Pole to the west of the city.
Eduardo's dry humor made a crucial point. Although some in Florida might dismiss the claim as Castroite propaganda, Cuban biotechnology has indeed developed drugs that have already been effective in fighting the coronavirus in China and other countries. More could come. But the US blockade makes them unavailable in the US.
A chasm separates the philosophy behind biotech in the US and Cuba. Driven by the profits of global pharmaceutical giants, American biotech outfits do not guarantee general access to new drugs, let alone for the more than 30 million Americans who do not have health insurance. In Cuba, biotechnology belongs to the state and constitutes an auxiliary industry to a public and universal health system.
California based Gilead Sciences – owned by the two mega-investment funds Blackrock and Vanguard – helps illustrate the difference. Gilead – chaired between 1997 and 2001 by Donald Rumsfeld, who left the company to direct the US invasion of Iraq in 2003 – manufactures the antiviral Remdesivir, which has driven spectacular gains on the New York Stock Exchange in recent weeks due to its apparent success in treating Covid-19.
But Gilead's business model does not guarantee that those Americans most vulnerable to the virus – those on the lowest incomes – will benefit from the new product. After all, in 2014 the same company marketed a new antiviral drug for the treatment of hepatitis C under the Harvoni brand. The price: $1,000 a pill.
The same thing happened with PrEP4, a retroviral to combat AIDS patented by Gilead. "Gilead's abusive prices have prevented hundreds of thousands of Americans from accessing this drug", said the activist group PrEP4all.
With Remdesivir, the same is likely to happen. As The Intercept has exposed, the decision by Gilead to donate 940,000 vials of Remdesivir to the US federal government, appears to be a marketing strategy. The price of the drug is likely to be hundreds of times greater than its cost of production of $10 for a 10-day course – despite the fact that Remdesivir “does not seem to do much for coronavirus patients", says The Intercept. "A cocktail of generic drugs is proving more efficient."
In Cuba’s universal public health system, everyone has access to drugs made in the Scientific Pole. "In the US a private laboratory develops a formula and sells it to another company for testing, which then probably sells it to a pharmaceutical giant for marketing; and each sale depends on whether there are profits to be made”, said Helen Yaffe, an economist at the University of Glasgow and author of the book We are Cuba. “In Cuba the institutes work in cooperation and not in competition; it is faster because the criterion is the national interest and not the private interest.”
Specializing in preventive medicine, the Cuban health system prioritized immunotherapy to deal with other epidemics, from dengue to meningitis. Because of that experience, Cuba’s response to coronavirus has used dozens of drugs already in the development stage "to improve innate immunity", explained Francisco Durán, director of Epidemiology at the Ministry of Health, in an interview with Spanish news agency EFE.
Among these drugs is Interferon Alpha 2B, which was created in the 1980s in collaboration with other scientists in Helsinki to combat a dengue outbreak. Now it is produced by a joint venture with a Chinese company, while the institutes of the Scientific Pole develop new varieties of Interferon to try and improve its effectiveness against Covid-19.
The Cuban institutes also produce another home manufactured retroviral from the Kaletra range, and have adapted another drug, CIGB 258, which was already under development before the pandemic for the treatment of rheumatoid arthritis. Like Interferon Alpha 2B, CIGB 258 is a product of the Center for Genetic Engineering and Biotechnology (CIGB) in Havana.
These and other drugs, almost all manufactured and patented in Cuba, are components of the island’s anti-Covid-19 cocktail. The results are positive. Cuba has registered a mortality rate of 4.2%, compared to 6% in the US and 12% in Spain, according to Johns Hopkins University. 87% of patients have already recovered from the virus, the highest recovery rate in Latin America
All that being said, the US blockade poses a serious problem for Cuban biotechnology. It makes it hard to import components of the drugs, hinders their commercialization and makes research difficult, since the institutes depend on the cross border exchange of ideas
"The embargo limits us a lot but we are specialized in optimizing scarce resources, working together and we have support from other countries, such as Spain", said Maidalys Bravo Ramírez, a specialist at the National Genetics Center in Havana, who worked in Bolivia as a solidarity doctor.
Likewise, the embargo reduces Cuba's ability to carry out the mass testing necessary to introduce their drugs on the international market and generate the funds required to finance the Cuban health system. "They need to create volume outside of Cuba; you can have a good product but if people don't know they won't buy it”, said Ricardo Torres, an economist at the Center for Economic Studies, during lunch in downtown Havana.
But as Eduardo's joke makes clear, the blockade does not only harm Cubans. During that brief period of rapprochement before and after the historic meeting between Barack Obama and Raúl Castro in 2016, cooperation blossomed between Cuban and US medical researchers. The Roswell Park clinic in New York, for example, signed an agreement with the Cuban state to jointly develop the drug CIMAvax, an effective Cuban-patented vaccine in the prevention of lung cancer.
But Trump's measures that ramp up the embargo in search of votes in Florida threaten to scupper the project. According to the directors of Roswell Park, the Food and Drug Administration (FDA), will require a 10-year trial period for CIMAvax compared to 5 for new drugs from other countries.
For drugs combating Covid-19, such as Interferon Alpha 2B, 10-years is too long. "I’ve received desperate calls from doctors in New York hospitals asking how they can get hold of Interferon Alpha 2B", says Helen Yaffe. It's not going to be possible. Interferon is on trial or in use in 9 countries, including Spain, but the US is not one of them.