The First National Polio Vaccination Drive was launched in February 1962 among youngsters under 15 years of age.  The two-stage campaign was carried out in one-week periods in February and again in April. We have used the strategy of "national vaccination weeks" for the last 38 years in Cuba, a strategy that has also been applied in other countries.

Decisive is the word that best describes the participation of community organizations--such as the Committees for the Defense of the Revolution (CDRs) and the National Association of Small Farmers (ANAP).  Over 80,000 members of these two organizations have actively worked in national vaccination drives.

In September of 1962, the National Vaccination Drive against Diphtheria, Tetanus and Whooping Cough was initiated among children under 15.  

In the same year, we began to bring neonatal tetanus under control, by using the tetanus toxoid vaccine in pregnant women and increasing the number of institutional births.

In the 1962-63 school year, we began vaccinating children from 6 to 14 years against diphtheria, tetanus, whooping cough and tuberculosis.

In the country's maternity hospitals, the BCG vaccine for newborns has been used widely since 1962.

A National Commission for Infectious Neurological Syndrome was organized in 1963 to investigate suspected cases of polio.

In 1964, the first comprehensive polyclinics were set up--representing the first model of community health care in Cuba.  Each had a special locale for vaccinations, carrying out these activities with the population on a daily basis. 

At about this same time, we established the "cold chain", an essential element for storage, conservation and preservation of vaccines.

Dr. Albert Sabin, who developed the oral polio vaccine, visited Cuba for the first time in 1967.

In 1968, the Ministry of Public Health and UNICEF carried out a joint vaccination drive in the countryside against diphtheria, tetanus, whooping cough, tuberculosis and smallpox among rural young people under 15.

Since 1963 and throughout the sixties, we carried out annual investigations to detect antibodies for the three types of polio circulating among children in the country.

By the end of the sixties, the average coverage with OPV, BCG and DPT did not surpass 70%.

The Seventies...

The decade began with the First National Measles Vaccination Drive in 1971, for the population between six months and five years old.

We launched a strategy to bring diphtheria under control, based on the following actions:

• Increased coverage of DPT and DT in the child population under ten years old.
• Massive testing for C. diphtheriae toxigen by carrying out throat cultures every six months among grade-school teachers and staff;
• Isolation of C. diphtheriae toxigen carriers.
• Epidemiological "clean bill of health" after treatment and proof of negative cultures.

With the rising number of physicians and nurses, the Ministry of Public Health decided to transform the comprehensive polyclinics into community polyclinics as of 1974.  Thus emerged the second model of community medicine in Cuba, which further facilitated vaccination by creating the health sectors, areas which covered some 3,000 residents, who were served by a specific doctor and a nurse at the polyclinic.

In 1975 and 1976, massive national drives took place to vaccinate housewives with tetanus toxoid.  The campaigns relied heavily on participation by another community organization--the Federation of Cuban Women (FMC).

In 1979, a national campaign was launched against meningococcal meningitis A and C in the whole population under 20 years old.

We continued serological studies in the child population to detect antibodies circulating against polio.

For the first time in Cuba, studies were carried out in children's institutions and in sewage ditches to determine the presence of the polio vaccine virus in the environment.

At the end of the decade, average coverage with OPV, BCG, DPT and the meningococcal A-C vaccine had reached over 80%.

The Eighties...

In 1980, a second Immunization Program was developed. Its most novel aspect was to change the vaccination scheme to include the typhoid vaccine in schoolchildren; and to administer DT and TT by school grade, and not by age.

In 1981, the First International Evaluation of Cuba's Vaccination Program was carried out by experts from the Pan American Health Organization (PAHO).

From 1982 to 1986, we applied three classic strategies to prevent the congenital rubella syndrome:

• Rubella vaccination for 12,13 and 14-year-old children in the 1982-83 school year, and subsequent years up to 12, so that by the end of the 1985-86 school year, all teenagers from 12 through 17 had been vaccinated.
• In 1986, all women from 18 through 30 were vaccinated.
• In the same year, all youngsters under 15 received the MMR vaccine.

In 1983, we developed a new method for quantitative evaluation of the program's specific goals.

In 1984, Cuba adopted its third model of community health care with the family doctor-and-nurse program, bringing vaccination services even closer to the population.

In 1984 and 85, two national vaccination drives were organized against tetanus in the over-60 population.  The Federation of University Students (FEU) played an active role in these efforts.

The Third National Tetanus Prevention Drive was carried out in 1985 among housewives.

In 1987, field trials were carried out for the Cuban vaccine against meningococcal meningitis B and C--the world's first vaccine against type B meningitis.

In the two years that followed, the entire Cuban population under 15 was vaccinated against meningitis B and C.

In the eighties, the "cold chain" received a boost with UNICEF's 125,000-dollar donation of refrigerated trucks, freezers, freezer chests, thermoses and thermometers. PAHO also contributed 150,000 dollars for 15 cold chambers and 600 thermoses.

And the Ministry of Public Health itself added some 3,000 refrigerators and 300 electric autoclaves, worth over 2 million pesos.

By the end of the eighties, coverage with BCG, DPT, OPV, MMR and meningitis B and C vaccines was slightly over 90% in the population under two years of age.

During the decade, PAHO carried out eight advisory missions in the field of vaccinations, and by virtue of a resolution from the Cuban Academy of Sciences, the Vaccine Expert Group was created.

Another accomplishment of this and the following decade was the applicaton of three strategies to bring measles under control:

• First--vaccinate the entire populaton under 15 with MMR  (catch- up).
• Second--maintain over 95% coverage with MMR in the one-year-old population (keep-up).
• Third--vaccinate with MMR all unvaccinated or vaccinated but unprotected two-year-old children. This drive took place in 1992, vaccinating all children from two to six years old with MMR (follow-up).

This strategy has been applied in virtually all countries of the Western Hemipshere and has received ample publicity worldwide.

From 1988, we implemented the Program to Eliminate Measles, Mumps and Rubella, as well as a surveillance system for suspicious, probable and confirmed cases of each.  This system was mounted at the Pedro Kouri Tropical Medicine Institute, which was designated as a PAHO-collaborating center for this purpose.

The Nineties...

In 1990, field trials were carried out for the Cuban genetically engineered vaccine against hepatitis B. Thus, Cuba became the world's third country to develop such a vaccine.

The same year, a national campaign was carried out among the Cuban population 15 to 19 years of age against meningococcal meningitis B and C.

In 1990, the medication surveillance system was created to detect adverse reactions, which included adverse reactions to vaccines.

The vaccine against meningococcal meningitis B and C was included in the national vaccination regime in 1991; and at about the same time the National Authority for the Control of Medications and Vaccines was set up.

In 1992, we launched the first national vaccination campaign against hepatitis B in children under one year. To date, several vaccination drives have been carried out against hepatitis B among various risk groups, such as:

• Patients receiving dialysis or who are hemophiliacs.
• Physicians, nurses and medical personnel and patients in psychiatric facilities.
• All health workers subject to risk of hepatitis B.
• All students of medicine, nursing and allied health careers.
• Students at reform schools.
• Family doctors and nurses.
• Sexual contacts or partners of acute cases and carriers of hepatitis B.
• All the Cuban population under 20 years old.
• All insulin-dependent diabetics and those with chronic renal infections.
• Cases and contacts of persons with STDs.

In 1994, the documentation was presented supporting Cuba's candidacy for the "Eradication of Polio Certificate", which was defended before an international commission, which found the report flawless.  All of Cuba's ministers of health from the post-1959 period attended the session.  The same year, the Pan American Health Organization presented the "Eradication of Polio Certificate" to President Fidel Castro.

Figure 1: Percent Coverage with OPV in Cuba

In 1996, field trials began in Holguín Province for the Cuban vaccine against leptospirosis.

Since 1997, residents of homes for the elderly have been vaccinated against influenza.

In 1998, we created the Technical Advisory Group for Immunization Practices within the Ministry of Public Health.

In the eighties and nineties, over 50 post-graduate courses in immunization have been offered throughout the country, each of 40 hours duration.

In this decade, the "cold chain" was once more reinforced, this time in the eastern provinces, by donations from two NGOs:  Doctors without Borders from France, and Doctors of the World from Spain.

In the nineties, the local health sectors received the Program for Controlling Foci of Infectious Diseases, the Third Immunization Program and the Program of Adverse Events Following Immunization.

This year (1999), we initiated the Vaccination Campaign against Haemophilus influenza type B in infants born in 1998, and this vaccine was introduced into the official vaccine regimen for children at two months old.  Thus far, 96% of these infants have been vaccinated.

From 1999, profound changes were instituted in Cuba's national vaccination regime, which includes protection against 12 diseases.

During this decade, coverage in under-two-year-olds with OPV, BCG, DPT, anti-meningococcal B and C, Hepatitis B, MMR and H. influenza surpass 95%.

The Current Situation...

From 1962 through 1998, over 240 million doses of ten different immunobiological substances have been applied in Cuba.

Conservative estimates put at some 300 million pesos Cuba's investment in vaccines, refrigeration equipment, and syringes from 1962 to 1999.

During the same period, Cuba has received slightly over four million dollars in donations from international agencies (PAHO and UNICEF) and non-governmental organizations, such as the Rotarians of Mexico, Doctors Without Borders of France, Doctors of the World of Spain, and the UNICEF Support Group in the Balearic Islands.

Impact of the Program

The above data allows us to conclude that the country has saved 25,000 lives, which would have been lost to diseases preventable by vaccination; 10,000 people have been spared paralysis from poliomyelitis; 2,000 spared from severe heart disease and over 1,000 from blindness or deafness.

As you can readily see, the impact of the National Immunization Program far surpasses its cost.