Open brief aan Biden

Open Letter to President Biden on Cuban vaccines against COVID-19
August 11, 2021
We share with our readers the Open Letter regarding the Cuban vaccine and vaccine candidates and President Biden’s interfering statements.
President Biden:
You recently referred to Cuba at the White House saying: “I would be willing to administer significant quantities of vaccines if … an international organization would administer those vaccines and do so in a way that average citizens would have access to those vaccines.”  You also called Cuba a “failed state.”
These statements surprised many, including Americans who have had direct contact with the Cuban health care system.  It also outraged frontline Cuban health workers who risk their lives to contain the COVID epidemic in our country.  This does not reflect the Cuban reality and we regret that misinformation by malicious actors is influencing your political decisions.  As scientists, physicians and concerned citizens, we believe it is worthwhile to verify the reality of three assumptions implicit in your words.
Assumption one: International intervention is needed to ensure that all Cubans receive vaccines.
Assumption two: Cuba’s response to the pandemic has been dismal, symptomatic of a “failed state.”
Assumption three: U.S.-supplied vaccines are the only way to guarantee immunization against COVID-19 for Cuba’s 11 million inhabitants.
Assumption one: Need for external intervention to ensure access to vaccines
Let’s look at these assumptions one by one: the first assumption – that foreign intervention is needed to guarantee access to vaccines for all Cubans – suggests that Cuba’s deployment of vaccination campaigns is inefficient and discriminatory.
The facts do not support this assumption. In fact, as both UNICEF and the World Health Organization have confirmed, child vaccination rates in Cuba exceed 99%.  Immunization is part of our country’s universal public health system, free for all Cubans regardless of socioeconomic status, politics, religion, sex or race.
The national immunization program, created in 1962, covers the entire country.  Since 1999, all Cubans have been protected against 13 life-threatening diseases, including diphtheria, tetanus and pertussis.  Eight of these vaccines are manufactured in Cuba.
As a result of high vaccination rates, we have not had a single case of measles in recent decades.  On the contrary, the CDC confirmed 1,282 cases of measles in the United States in 2019, and only 74% of children received all of the CDC-recommended vaccines.
The Finlay Vaccine Institute in Havana developed the world’s first effective vaccine against meningitis B (meningococcal disease) in 1989.  The annual incidence of this disease in Cuba dropped from 14.4 / 100,000 inhabitants to less than 0.1 / 100,000 since 2008, eliminating the disease as a public health problem in the country.
Several factors explain the success of Cuba’s national vaccination program: people trust easily accessible family doctors and nurses and health professionals at community polyclinics, making vaccine refusal very rare.  At the same time, the organizational capacities of the health system make the implementation of vaccination campaigns fast and reliable.  Finally, Cuban biotechnology research and production centers are well integrated with the needs of the public health system.
Cuba collaborates closely on vaccinations with the World Health Organization and UNICEF.  But neither of these agencies has ever suggested the need to intervene to administer vaccines in Cuba.  Rather, Cuban vaccine experts have been asked to assist in global efforts to eliminate polio, and WHO has called on our production facilities to export urgently needed vaccines to the “meningitis belt” in sub-Saharan Africa.
Assumption two: Cuba’s “failed” pandemic response.
It is puzzling why, with so many real COVID catastrophes in the Western Hemisphere, only Cuba is labeled a “failed state.”  In fact, Cuba has experienced a recent surge in cases that threatens to overwhelm the healthcare system in some parts of the country.  However, its response has been more effective than that of many other nations that have not received this harsh criticism from the United States.
All countries now face the challenge of new variants of COVID, such as the Delta variant, which is generating sharp increases in the number of cases.  Cuba is no exception in this regard.  What makes Cuba unique is the need to manage the epidemic under a crippling financial, trade and economic embargo imposed by the U.S. government for the past six decades.  The 243 additional restrictions imposed by the Trump administration, all of which are still in place under your presidency, were intended to close the few remaining loopholes in the embargo and thereby cut off revenue to Cuba.  This reduces the cash available to buy medical supplies and food, and delays the arrival of materials into the country.
Assumption three: The only route to immunity against COVID in Cuba is through U.S.-supplied vaccines.
This ignores the fact that more than two million Cubans, or nearly 30.2% of the population, have already been fully vaccinated, with vaccines developed in Cuba.
The Abdala vaccine received emergency use authorization from the Cuban regulatory authority on July 9, becoming the first vaccine to achieve this status in Latin America.  Abdala achieved 92% efficacy in Phase III clinical trials, while the Soberana vaccine reached 91% and is also close to emergency use authorization.  At the current rate of vaccination, the entire population could be reached by October or November.  The difficulties in this campaign, including imports of vital ingredients for vaccine production, are mainly due to the financial constraints imposed by U.S. sanctions.
If the U.S. government really wanted to help the Cuban people, it could reverse the 243 Trump-era measures, possibly with just a signature from the President.  Congress could also lift the sanctions altogether, as demanded every year by the overwhelming votes of the world’s nations at the UN General Assembly.
During the pandemic, science reiterates that (aside from politics) we are all in this situation together.  We are all threatened not only by disease, but also by the unprecedented challenge of climate change.  In this context, health systems in all countries must be supported, not undermined; and collaboration must be the order of the day.  All the more so, given the alarming shortage of vaccines worldwide, especially dangerous for low- and middle-income countries.  Several of them have already shown interest in acquiring Cuban vaccines, and we would argue that such a Cuban contribution to vaccine equity should be applauded by the Biden administration, not repressed.  The Cuban Democracy Act of 1992 (Part II.6) explicitly prohibits exports to Cuba from the United States in cases where: “the product to be exported could be used in obtaining any biotechnological result,” which includes vaccines.
We were able to get a glimpse of what the two countries could do together during the Ebola virus epidemic in West Africa (2013-2016), when both countries struggled to contain the disease and save lives.  Obviously, the U.S. and Cuban governments differ on fundamental issues.  However, the world is full of such discrepancies.  The essential question, not only for Cuba and the United States, but also for human civilization, is whether nations can respect each other enough to exist side by side and cooperate.
President Biden, you can do a lot of good if you move in the right direction and take into consideration what the majority of Cubans living in Cuba want.  This does not include ignoring and undermining their public health care system, but it does include respect for the nation’s achievements.  Let’s hope that the shared threats posed by the COVID pandemic will lead to more collaboration, not more confrontation.  History will be the judge.
Signed by scientists, physicians and concerned citizens of Cuba and the world.
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