Minister of Health: “The best responses to combat COVID-19 have been born from science”
“Covid-19 has represented the greatest challenge for science in recent decades. Never before have so many scientists, professionals, and experts investigated the same topic so intensely and in such a short period of time,” said the Minister of Health, José Angel Portal Miranda, in a keynote address during BioHabana 2022.
“Cuba has not been the exception. The best responses to combat the virus have been born from science and, despite the uncertainty due to its accelerated spread, knowledge has been developed in an unprecedented way in the country”, Portal Miranda highlighted in his speech, which opened the second day of the congress that is in session until Friday at the Havana Convention Center.
The government management system assumed by Cuba -he stressed- has allowed, among other elements, to set priorities, distribute resources and promote expert knowledge in decision-making, support monitoring and promote public policies, eliminate barriers, promote institutionality and extend science to all areas of society.
As a result, very useful tools have been found that reaffirm the value of science and innovation to face dissimilar challenges, he added.
The minister recalled the words of President Miguel Díaz-Canel Bermúdez at the XIII Congress of Higher University Education on the role of science in the country’s development: “It is not just about having more science and more scientists, with more publications and patents . It is about these capacities allowing us to promote prosperous, sustainable, fair development, and ensuring the independence and sovereignty for which we Cubans have fought for centuries.”
“Working from science and innovation to solve the main problems is not a new path for our sector”, said Portal Miranda, who highlighted that innovation has been a priority in the last six decades.
He maintained that the last two years have been extremely complex for the health system and for Cuba in general. “The development of science and the biotechnological industry promoted by Fidel has been an essential element to advance as we have done in these months,” he said.
The government’s management and the participation of all agencies made it possible to create the covid-19 prevention and control plan approved very early in 2020, before positive cases were detected in Cuba.
“This plan has been constantly updated based on the experiences provided by science. It has been essential to anticipate the risks of the disease and act without improvisation. The central axis of all actions has been the political will of our Party and our Government to put the people’s health first,” said Portal Miranda.
Lessons from an unprecedented crisis: Science saves
When the World Health Organization declared the pandemic nature of covid on March 11, 2020, no one could imagine the crisis that was coming and from which no nation has escaped, Portal Miranda pointed out.
“Experts say that crises expose shortcomings and bad practices, and in them innovative alternatives emerge for the benefit of the majority,” he said.
With the pressure of the virus – the minister pointed out – not only did socioeconomic indicators deteriorate in the nations, but old fissures appeared and other more recent ones that slow down the development of peoples became visible.
“Health systems have been deeply affected as a result of the health emergency and the levels of inequality that characterize the world have become more noticeable, as well as the limited access of millions of people to quality medical care.
“Derived social conditions such as poverty, injustice and environmental deterioration led to the rapid spread of the virus. Together with this, non-communicable diseases that exacerbate the burden of disease in vulnerable groups have led to an increase in mortality,” said the Cuban Minister of Public Health.
According to Portal Miranda, understanding the implications of the pandemic was imperative two years ago and continues to be so today, despite the advances made by science to understand the virus.
“Because it is not only about the virus and the disease it causes. It is also about profound alterations in the biological, psychological and environmental order that go beyond the individual and impact communities and countries”, he pointed out.
Taking stock, the Cuban minister affirmed that these more than two years of the pandemic have made it clear how unequal the responses of nations have been, conditioned by an increasingly globalized and neoliberal world.
“The pandemic has affected all people equally, but not all people have had the same chance to protect themselves. It is therefore necessary that we work together, health professionals, scientists and governments, to change this attitude in the world and achieve coordination between the health sector and others, especially the economy”, he said.
Science vs. covid
In Cuba, the emergence of covid-19 did not take the government by surprise, Portal Miranda said.
“The plan designed to combat the virus has allowed us to anticipate the risks of the disease without improvisation and make the necessary decisions.
Among its strengths, its comprehensive and intersectoral nature stands out, which together with the capacities created in the health structure and the Cuban biotechnological and pharmaceutical industry, allowed the timely implementation of the measures contained therein, ”he emphasized.
He asserted that the human, health and scientific capital, formed for more than 60 years in the country, has been essential to implement the more than 500 measures contained in the plan, based fundamentally on the organization, coverage and resolution of the Cuban health system, with a potential of 9.2 doctors per thousand inhabitants.
Another distinctive element of the Cuban strategy has been the creation of the temporary work group to confront covid, created at the government level and headed by the President of the Republic and the Prime Minister. “The management and correct conduct of the plan at the government level, as well as the constant monitoring, marked the difference of what was done in Cuba. This monitoring has allowed both the central government and the territories to take immediate action in the face of the change in the epidemiological context.”
Since the covid began to represent a threat to the world, the Cuban health system adopted the principle of trying to ensure that people do not get sick, that if they did they would not get worse and if they entered a serious condition they would not die. The intention was also that the patients were left with the fewest sequelae possible, Portal Miranda explained.
The constant search for cases, attention to vulnerable groups, innovative solutions to avoid the collapse of services, especially in intensive care units, and the organized participation of the community in each of the implemented actions were also key.
He mentioned the effort made to increase diagnostic capacity as a health response to the epidemic. In March 2020, there were four laboratories in the country with the capacity to perform 100 tests per day; Currently, there are 27 molecular biology laboratories in all the country’s provinces, expanding the daily diagnostic capacity to more than 25,000 tests.
He recognized the role of the Pedro Kourí Institute of Tropical Medicine (IPK) in the creation of this network of laboratories in the country and the training of personnel for its use. He explained that the technological deployment achieved in this network of laboratories, with innovative technology, will allow conducting research on infectious diseases and others such as cancer.
“The design, implementation and validation of our disease management model represent the country’s first results in confronting covid-19. They are the result of the integration of science and health. The way of conceiving this confrontation has constituted an organizational innovation”, he referred.
The minister explained that the investigations carried out since the detection of the first cases of covid in Cuba made it possible to establish the circulating variants of SARS-CoV-2.
“It has been possible to isolate them in cell cultures. This has made it possible to develop research to determine the immune response of neutralizing antibodies in people to whom the Soberana 02 and Abdala vaccines have been applied, as well as in convalescents and those who received booster doses of our vaccines”, he specified.
According to Portal Miranda, these studies have been essential to show the effectiveness of Cuban vaccines against the variants that have circulated in the national territory.
He recalled that although during 2020 it was possible to minimize the impact of the epidemic in the country and contain the disease in a few months, the emergence of new variants of the virus and its behavior in the world caused a dizzying rise in infections in 2021, which which strained the health system for most of that year.
“The circulation of the beta and delta variants made the situation more complex, causing the infection of thousands of people. August 2021 marked the worst figures of the entire epidemic and on the 23rd more than 9,000 new cases were reported. Sadly, 98 people died in one day,” he said.
This reality led the authorities to create new hospitalization capacities and the challenges multiplied, “and although a more favorable situation began to be experienced in 2021, the entry of the omicron variant shortly before the end of the year meant new challenges due to its high transmissibility”.
However, despite the increase in infections in 2022, the peak that Cuba had to face was ten times lower than that experienced in most nations due to the circulation of the omicron variant. “This had to do with the set of measures applied, together with the successful immunization campaign that we were already developing,” said the Minister of Public Health.
He considered that the innumerable lessons that covid-19 has left will help to face other health problems in better conditions, thanks to the tools designed, evaluated, assimilated and introduced during this period.
“Even in the midst of enormous challenges such as the tightening of the economic, commercial and financial blockade, Cuba’s response to the pandemic has been commendable and much has been done with limited resources, in the face of a hostile blockade and the consequences of a deep global crisis.
“The integrated work of all sectors, mass organizations and agencies and the active participation of young people have been indisputable strengths, and the role of science and the important link between scientific centers, universities and the workers of the education system cannot be ignored. Health.
“In a short time, it was shown that doing science in Cuba is not a consequence of the market, but of the socialist economic system that integrates, manages and introduces its results with priority always on people,” said the minister, who stressed that today 99% of people infected with the virus have recovered from the disease.
Products, equipment and supplies of the biotechnology industry have become strengths to guarantee comprehensive care for patients in the country.
This – highlighted Portal Miranda in his conference at BioHabana 2022 – “has not only allowed a more agile response to the risks of the epidemic, but has also provided us with technological sovereignty through the development, introduction, substitution and production of various medicines, equipment and medical devices.
He added that most of the products used in the national therapeutic preventive scheme for the care of covid-19 have emerged from the actions carried out in that sector, from which he highlighted the impact of Cuban interferons in the treatment of people suspected of being infected and those confirmed as positive.
The minister reported that in the period of the pandemic, more than 1,100 investigations and innovations dedicated to confronting covid-19 have been approved and launched.
In record time, 52 clinical trials have been approved and carried out, 24 of them corresponding to the development of Cuban vaccines against this disease.
Likewise, basic applied studies related to the molecular diagnosis of covid-19, advances in the molecular characterization of SARS-CoV-2 and phylogenetic analyzes of the virus were carried out.
Other epidemiological, genetic and epigenetic investigations of the virus have made it possible to arrive at an early marker that predicts the severity of covid-19 patients. The epidemiology of asymptomatic infection has also been studied.
Likewise, the forecast models have been of vital contribution to the decisions adopted by the national temporary working group. In this regard, Portal Miranda mentioned the computer tools that have supported epidemiological management and sociodemographic research carried out during the pandemic.
The investigation of associated genetic risks made it possible to identify the clinical severity of those confirmed and their relatives through a clinical-epidemiological characterization, said the minister.
According to Portal Miranda, one of the most significant contributions has been the design and execution of a Cuban protocol in the management of covid-19, which since its first version in February 2020 (when no cases had yet been diagnosed in the country) has been in constant improvement, and of which six versions have already been approved.
“Its conception takes into account both the preventive and therapeutic scenarios and its actions begin and end in the community.
“Family doctors and nurses, intensive care specialists, clinicians, paediatricians, epidemiologists, microbiologists, among many other health professionals, students of Medical Sciences and health workers and others, have been vital in its implementation. sectors have given a hard battle for life”.
As part of the Cuban strategy, immunomodulatory products such as Nasalferon or Biomodulin T have been implemented with a preventive approach in an isolated or combined manner in the elderly, also achievements of Cuban biotechnology.
The minister gave special connotation to the intervention carried out in all the country’s nursing homes, where three cycles of Biomodulin T have been applied, which have allowed the incidence of the disease to be very low in these institutions.
Likewise, with the purpose of minimizing the evolution of patients towards critical illness, the use of innovative products from the Cuban biotechnology industry has been implemented as part of clinical management, among which the peptide Juzvinza and the monoclonal antibodies Nimotuzumab stand out. and Itolizumab, which obtained authorization for use in emergencies during the epidemic stage.
“The skills demonstrated by the professionals and technicians of the intensive care units, together with the effectiveness of the new Cuban medicines and the use of plasma from convalescent people, as well as other medicines whose effectiveness was thoroughly verified through clinical trials and studies, have allowed the survival rate of critically ill patients in Cuba to exceed 75%”, Portal Miranda highlighted.
The minister attached particular importance to the protocol implemented for the care of convalescent patients, which includes rehabilitation and psychological support.
He reported that at this stage a folder has been created with 27 products developed by the BioCubaFarma companies: four immunomodulators, three antivirals, three anti-inflammatory drugs, three vaccines approved for use in emergencies and two vaccine candidates in phase III clinical trials. four serological diagnosticians, molecular diagnosticians and other medical equipment.
Of the 27 products, 18 have the authorization for use in emergencies granted by the Cuban regulatory authority, nine are in the process of development and 22 are in production scale-up.
The minister added that Cuban swabs and culture media are also available, which has enabled a wide diagnostic coverage. More than 200 pulmonary ventilators produced by the Cuban industry have been used in health care centers, which have been key in the care of seriously ill patients.
He highlighted that nanotechnological inputs used by molecular biology laboratories are added to the contributions of the national industry at this stage, while companies in the sector advance in the development of equipment and supplies that will allow the diagnosis by PCR of this and other diseases.
Portal Miranda affirmed that the national regulatory authority, the Center for the State Control of Medicines, Equipment and Medical Devices (Cecmed), has guaranteed support for the strategies developed, whose mechanism of action has represented a therapeutic and/or prophylactic alternative to face the virus outside the approved conditions of use.
“This has been possible from simplified and accelerated regulatory mechanisms, always under strict regulatory requirements. The early interaction of the regulatory authority with the industry and the processes of research and development of innovative products, has allowed the establishment of regulatory support and a procedure for the gradual evaluation of products, enabling early access to patients”, he said. .
This early interaction was also important in the activity of clinical trials, in the monitoring of these and other studies related to the disease.
Own vaccines, a decisive contribution
As a result of the development of science, since 2021 Cuba has three vaccines aimed at fighting covid-19, Portal Miranda highlighted.
He recalled that the Abdala vaccine was the first approved in Latin America to combat the virus, and highlighted that Cuban immunogens and vaccine candidates are designed on technological bases previously worked on in the country, which guarantees greater safety in their application.
He said that the high efficacy achieved by the Sovereign 02 and Abdala vaccines, with 92.28% and 91.2%, places them among the first of their kind in the world.
“The national vaccination strategy has been one of the most comprehensive actions taken in the country. Its implementation has allowed, using our own immunogens, to stop the course of the epidemic and reach indicators that demonstrate control of the disease”, he stated.
From its advance, Cuba has remained in the first places at the international level according to the high percentage of the population with the vaccination scheme initiated.
“We are the nation that in the shortest time has managed to make the most progress in vaccinating its population and in the total doses applied per 100 inhabitants,” said Portal Miranda.
“Our strategy not only meant a future reference for Cuba, but it has become an unprecedented lesson due to its magnitude and complexity,” he added.
According to the MINSAP, a few days after reaching a year of starting vaccination, at the end of April 23, 2022, 35,672,949 anticovid doses had been applied in Cuba.
“This impressive figure constitutes the equivalent of 15 years of work of the national immunization program for other diseases, which includes 11 vaccines, eight of them nationally produced,” stressed the Cuban Minister of Health.
“With infinite pride I can say that we are the only nation in the world that has been able to massively vaccinate its little ones from the age of two. We will soon begin two clinical trials in children under one year of age and an intervention study in children between the ages of one and two.
“Cuban children safely attend their schools and recreational places. So far, more than 1,905,000 infants have been immunized, 97.5% of the Cuban vaccinable pediatric population”, highlighted the Minister of Public Health.
Currently, 95.9% of the vaccinable Cuban population has already completed their immunization schedule, and more than 6,525,000 Cubans have received booster doses, reported Portal Miranda, and said that the immunization campaign has required significant efforts and resources, with the participation of many people and organizations.
“This small country has shown how much can be done when talent, intelligence and accumulated knowledge come together. The successes that today distinguish the way in which we have faced covid-19, despite the economic shortcomings, are unquestionable proof of this”, he affirmed, and dedicated special words to the contribution of the members of the 58 brigades of the Henry Reeve contingent who they fought the virus in 41 countries.
“Much remains to be done on the way to contain the epidemic and protect health, but the knowledge generated by this crisis will have an impact and continuity beyond the pandemic, both in the management of infectious diseases and chronic non-communicable diseases.
“We will continue to advance in the search for new evidence as a daily way of managing science and health.
“Covid-19 highlighted how necessary it is to prioritize health systems, promote science, achieve technological sovereignty and have prepared, competent and dedicated human resources, as well as a political system that supports these purposes.
“Taking advantage of the benefits that science and innovation leave us is a challenge and a permanent need for all health systems in the world. In Cuba, that path is already defined and the meritorious response given by the country to the pandemic is based on it,” Portal Miranda concluded.
