Cuba Announces New Cholera Vaccine
At “Health for All” Trade Fair

Havana , April 20 - Scientists at Cuba’s Finlay Institute have announced the successful completion of clinical trials on a vaccine against cholera, after 14 years of research. The vaccine candidate was jointly developed by researchers at the institution, the Pedro Kourí Tropical Medicine Institute and the National Center for Scientific Research (CENIC). The announcement came at the 12 th “Health for All” International Trade Fair in Havana this week, attended by over 330 pharmaceutical, laboratory and medical equipment companies from 29 countries in Asia, Europe and the Americas.

Between five and seven million people are victims of cholera annually, the result of contaminated water supplies. These cases, and the 120,000 deaths they provoke per year, occur almost entirely in developing countries. According to Dr. Concepción Campa, Director of the Finlay Institute, the “10/90 gap” has long been an important factor in determining Cuba’s research priorities. The gap, first described in 1990, refers to the fact that of the US$73 billion invested annually in global health research, “less than 10% is devoted to research into the health problems that account for 90% of the global disease burden (measured in Disability-Adjusted Life Years or DALYs).”[1]

One problem, says Dr. Campa, is that pharmaceutical transnationals do not see their profits linked to developing vaccines against diseases of the poor. “However, our vaccine,” she told MEDICC Review, “is not another version of the tourist vaccine against cholera that has appeared on the market. This vaccine is precisely for the poor, the main ones suffering from the disease.”

According to “The 10/90 Report on Health Research 2003-2004,” published by the Global Forum for Health Research, all but 4% of Cuba’s medical research budget is allocated to priority health topics; and Cuba is one of the few developing countries even close to the percentage of health expenditures the Report recommends be allocated for health research and capacity building.[2]

The clinical trials on the new Cuban cholera vaccine are due to be followed later this year with trials in countries where cholera is endemic, such as South Africa, Mozambique and India.

The “Health for All” Fair

Extending over six exhibition pavilions at Cuba’s “Expocuba,” the Fair (April 18-22) provided Cuban public health authorities, medical professionals and students, the opportunity to examine many of the latest advances in medical products and technologies developed in Cuba and abroad.

Cuba continues to increase its investment in medical products and technologies, making the trade fair an important commercial event for foreign companies already selling to Cuba, as well as those evaluating the Cuban market.

Among several German companies present, Schering has been selling its pharmaceuticals to Cuba for many years and participates regularly in the Fair. The Italian firm R&P Company, which began selling its optometry supplies and equipment to Cuba after the last trade fair in 2003, attracted long lines of visitors eager to try its new mobile equipment for measuring vision. According to its representative, R&P hopes to convince Cuban health authorities to purchase the mobile equipment for use in rural areas and schools.

Asian firms occupied an entire pavilion, where the South Korean company Neneka, took advantage of the Fair to launch its new digital ultrasound equipment, Accudix. Several Japanese companies, including Konica Minolta, Olympus and Shimadzu, demonstrated advanced equipment for medical imaging. Shimadzu participated here four years ago and began selling its equipment to Cuba in 2002.

The Fair is also important to Cuba’s growing pharmaceutical and medical industry, showcasing the country’s growing line of products and services. The 62 Cuban entities represented included Cuban biotechnology leaders such as CIMAB, the originator of cancer vaccines and other advanced biotechnology, the Finlay Institute, producer of many innovative vaccines and antigens for vaccines, and BIOMAT, producer of materials for medical research and diagnosis.

In addition to those mentioned, the countries represented at the fair included Spain, Belgium, Switzerland, Holland, Luxembourg, Canada, Israel, India, China, Argentina, Brazil, Costa Rica, Colombia, El Salvador, Guatemala, Mexico, Panama, Peru, Venezuela, the Virgin Islands and the Dutch Antilles. Two firms from the United States also participated, Medrad and Navarreta Group-Wotham Laboratories. In addition, Ireland was represented at the fair for the first time.

References

1. The 10/90 Report on Health Research 2003-2004, Global Forum for Health Research, Geneva, 2004, p. XV
2. op. cit., pp. 116-117.

By Conner Gorry

An HPIC-facilitated donation of hospital beds is unloaded in Havana.

Ten years of any successful union – whether a marriage, business partnership or championship baseball team – doesn’t happen by chance. The task is doubly tough in the arena of international cooperation, where divergent expectations and cross-cultural differences can derail even the most well intentioned projects. Rising to the challenge is Health Partners International of Canada, (HPIC), celebrating ten years of facilitating over US$32 million worth of medical donations to Cuba.

Although HPIC has worked in over 100 countries in its 15-year history, Cuba accounts for some 25% of the organization’s worldwide donations. The Cuba project began in 1995 after then-Prime Minister Pierre Trudeau returned from a trip to the island determined to lend a humanitarian hand. Rallying the support of key government actors and officers in the Pharmaceutical Manufacturers Association of Canada, the nascent aid project sprang to life when HPIC was enlisted to administer the program and facilitate bilateral Canada-Cuba cooperation in medical materials.

In late 1995, the idea was translated into reality when US$1.8 million of medical aid arrived in Cuba. Over the ten years the two governments have worked together, HPIC has facilitated millions of dollars worth of vaccines, medicines, dialysis machines and other donations. In the wake of Hurricane Mitch in 1998, Cuba advocated redirecting the aid earmarked for the island to Central America. This act of humanitarian philanthropy was underscored by Cuba’s establishment of the Latin American Medical School, which offers full scholarships to students from underserved communities. When Cuba was throttled by its own Hurricane Michele disaster in 2001, HPIC responded with US$815,000 in donations.

More recently, HPIC facilitated the donation of 90 refurbished dialysis machines donated by St Michael’s Hospital in Toronto. Working with the International Society of Nephrology and the Canadian-Cuban Friendship Association, HPIC warehoused and shipped the machines to several hospitals in Cuba, where the donation was expected to increase dialysis capacity by 30%.

HPIC’s Cuba model has a unique design that contributes to its success. Most important, an annual list of urgently needed medicines is submitted by the Cuban Ministry of Health (MINSAP) to HPIC, which then circulates the list to Canada’s top pharmaceutical companies, including Glaxo SmithKline, AstraZeneca and sanofi pasteur, in search of donations. Placing needs assessment and prioritization in the hands of Cuban health officials guarantees that HPIC “is only shipping what [Cuba] really wants and needs,” according to Deborah Collins, HPIC’s Director of International Health Programs.

Another aspect of HPIC’s philosophy is that all medicines and equipment meet strict quality control criteria. Expiration dates are verified – nothing with an expiry date less than a year out is accepted – dosages are checked against MINSAP requirements and packaging is reviewed to ensure the medicines are viable and will arrive in tact. The goods are then shipped to Cuba with support of the Canadian International Development Agency (CIDA, the international aid arm of the Canadian government). Once in Cuba, meticulous distribution logs are kept and sent to HPIC for follow-up; over the ten-year cooperation, HPIC has performed site visits to verify that medicines were indeed received by the intended health installations in Cuba.

Underlying the logistic nuts-and-bolts of the successful cooperation is ten years of relationship building, trust and mutual respect. “It is a pleasure to work with HPIC,” says Dr Gisela Jiménez, Coordinator of Cooperation Projects for the Ministry of Health. “They are marvelous people, very serious and organized and they never put conditions on the donations. Both sides work with incredible transparency.”

“But it’s not only about donations,” avers Lise Filiatrault, Cooperation Counselor for CIDA. “It’s about sustainability.” Indeed, moving from dependency to interdependency is the priority, made evident by the HPIC delegation that visited Havana recently. Comprised of industry leaders from Canadian pharmaceutical companies, the delegates got a close look at the cutting edge of Cuban R&D, manufacturing and educational programs. There is hope that Canadian and Cuban companies can collaborate in several areas in the future, including joint research projects, exchanging best practices, and knowledge-sharing in manufacturing.

According to MINSAP’s Dr Jiménez, “the visit was very important because they saw our capacities and capabilities…I think HPIC can serve as a model for cooperation between the two countries [and] the visit opened doors for future collaborations.” Thanks to ten years of an enviable working relationship among Canada, Cuba and Health Partners International, those doors are opening to a whole new world of possibility.

Las Tunas, Cuba—On March 29th, 34-year-old Hector Despaigne Guillén marked his 19th year with a new heart. He is Latin America’s longest surviving heart transplant patient. In 2001, Cuban surgeons performed heart transplant number 100, when they reported near 90% survival rates for the first year, and 30% after 14 years.

Despaigne was born with a rheumatic cardiopathy that provoked enlargement of the vital organ, and made transplantation his only hope for life. A multidisciplinary team headed by eminent Cuban cardiologist Dr. Noel González, performed the 10-hour surgery in Havana’s Hermanos Ameijeiras Hospital, and the institution’s Transplant Team continues to follow Despaigne’s case with cardiologists in his native Las Tunas.

Despaigne has lived virtually a normal life since the transplant, regularly riding his bicycle, and spending time with his five-year-old daughter Elba Daniela. Dr. Roberto Rabert, one of the Las Tunas team of cardiologists caring for Despaigne, describes his condition as stable, and his chronic hypertension under control.

The number of heart transplants in Cuba dropped during the nineties, a result of the island’s economic crisis, but recovered its rhythm in 2000, according to Dr. González.

By Conner Gorry

At the tender age of 18, Canadian Terry Fox had his right leg amputated above the knee due to bone cancer. While someone else might lament such a fate, struggling against the disease before succumbing, Terry Fox fought against all odds and expectations to challenge cancer. In 1980, outfitted with a prosthetic leg, he kicked off his Marathon of Hope in Newfoundland, Canada, with the goal of running across the country - over 6,000 miles - to raise awareness and money for cancer research. After 143 days of running an average of 26 miles a day, he was hospitalized and died on June 28, 1981.

On March 20th, 25 years after Terry Fox’s heroic effort, nearly one million Cubans across the island set off in the world’s second-largest annual Terry Fox Run Against Cancer. Designed to promote a healthy lifestyle, educate about cancer and raise funds for research, the event is hosted in over 50 countries worldwide; Cubans have embraced the cause with verve, making the island run the biggest outside of Canada.

Launched in Havana in 1998, Cuban athletic and health officials have prioritized the run as a way to encourage healthy practices and raise funds for the national Institute of Oncology and Radiobiology. Cancer is the second most frequent cause of death in Cuba after heart disease; 30% of those deaths are tobacco-related (lung cancer tops the list), and another 30% are due to poor diet. Furthermore, despite ongoing advances in key health indicators including infant mortality and life expectancy, cancer deaths in Cuba increased by 2% between 1990 and 2000.

The Cuban Ministry of Health (MINSAP) wants to change that. Since 2003, the Terry Fox Run Against Cancer has been held in every municipality countrywide to publicize cancer’s causes, effects and the best prevention measures people can take against the disease. Indeed, prevention is the cornerstone not only of the Cuban public health system as a whole, but also in the country’s fight against tobacco-related cancer: in February, Resolution 335/04 took effect, banning smoking on buses and trains, in baseball stadiums, offices, restaurants and all other public spaces.

MINSAP and the Sports Institute work closely with the Canadian Embassy to organize and promote the run, including hosting cultural activities to raise money for the Institute of Oncology and Radiobiology. This year, a gala concert starring Cuban jazz great Chucho Valdés, Canadian trombonist Hugh Fraser and saxophonist-flautist Jane Bunnett lit up Havana’s Teatro Nacional while raising funds for breast and uterine-cervical cancer research. In her welcoming remarks, Canadian ambassador Alexandra Burgailiskis lauded the Cuban people and government for their support in the fight against cancer, citing them as an example of the triumphant will embodied by Canadian hero Terry Fox.