BULLETIN OF PAHO/WHO IN CUBA Vol. 25 No.1 JANUARY-MARCH 2021 CUBA: ONE YEAR INTO THE PANDEMIC

04 43 46 50 OUR NEWS: NOTEWORTHY: OVER A STORY A CUP OF TO TELL: Interview Benefits with Cuba's of a Cúrcumal onga COFFEE Dr. Ricardo Minister pdroject uring WITH… Pereda González: of Public Health, thep andemic Coordinator of Dr. José Angel Concepción the COVID-19 Clinical Portal Miranda Campa Experts Commission Huergo Pathways to Health is a bulletin prepared by the office of the Pan American Health Organization/World Health Organization EDITORIAL (PAHO/WHO) in Cuba. Its main aim is to share the most important aspects of the On March 11, 2020, the Director-General of the World Health Representation's technical cooperation with Organization (WHO) declared the novel coronavirus a pandemic, the country's Ministry of Public Health which at the time already affected 114 nations. Coincidentally, (MINSAP) and other institutions. that same day, the Pedro Kourí Tropical Medicine Institute (IPK) in Havana confirmed the first COVID-19 cases in Cuba. At the one-year anniversary of the pandemic in Cuba, this issue is dedicated to One year into the pandemic, more than 115 million cases and close to 2.6 million deaths have been reported from the disease systematically review key aspects of the worldwide. About half of both these cases and deaths have been national response over the last months. In registered in the Americas, with results differing according to how particular, it includes an interview with the well the response has been organized, how robust the healthcare Minister of Public Health, Dr. JoséA ngel delivery systems and how great the magnitude of social Portal Miranda, who reflects on the range of inequalities. work and milestones achieved in confronting the novel coronavirus in the island nation. During this first year, we have witnessed the exponential rise in disease transmission rates, as first and second waves, forcing It also carries articles related to the massive confinement of children, young people and adults, in turn epidemiological situation, treatment affecting mental health. Just as it appeared that case numbers were declining and countries had begun to progressively resume protocol, Cuban vaccine development, economic activities, new variants appear that have provoked work carried out under the National epidemic waves greater than the first, more highly contagious, Maternal–Child Health Program, and with shorter incubation times and new deaths to mourn. contributions by the country's PAHO/WHO Collaborating Centers, among others. In this grave context created by the pandemic, we underscore the historically unprecedented efforts by hundreds of research centers As an exception, we publish this special issue the world over, dedicated to the search for COVID-19 vaccines. in English. The bulletin is usually published There are already 250 vaccine candidates, 67 of which are in in Spanish. clinical stages, and a dozen have presented final phase-3 clinical trial results. With emergency use authorization by national regulatory agencies, many countries have begun the complex task March, 2021 of immunizing their populations, not without problems related to limited vaccine availability, given the concentration of supplies in the high-income countries. Editorial coordination: Tania del Pino PhD General revision: Dr. José Moya In April, 2020, precisely in order to assure equitable vaccine To subscribe, write to: [email protected] distribution worldwide, the COVAX mechanism was launched, led Website: www.paho.org/cu by the Global Alliance for Vaccines and Immunizations (GAVI), Facebook: @opsomscuba WHO/PAHO and the Coalition for Epidemic Preparedness Innovations (CEPI). This mechanism allows 20% of each country's Twitter: @opscuba population access to vaccines, including health workers and older adults. PAHO/WHO Offices in Cuba, Calle 4 No. 407 e/ 17 y 19, Vedado, Havana, Cuba. Some countries that have signed COVAX agreements will receive Telephone.: (53) 831-0245 Ext. 40613 the vaccines as donations, while others will purchase them, according to price accords previously reached with pharmaceutical OUR NEWS laboratories. One condition is that the vaccines must be prequalified by WHO, which happens only after detailed review by 04 ADVANCES AND MILESTONES IN the organization's experts once the vaccines have completed phased clinical trials and published their results. CUBA'S RESPONSE TO COVID-19: INTERVIEW WITH CUBA'S MINISTER COVAX vaccine distribution began in February and will continue OFP UBLIC HEALTH, progressively throughout this year, thus contributing to the DR. JOSÉA NGEL PORTAL MIRANDA protection of health personnel, especially those on the front lines: doctors, nurses, biologists, aides and all those working in health care delivery in hospitals and communities. 12 COVID-19 SITUATION IN CUBA: ONE YEAR INTO THE PANDEMIC Nonetheless, control of transmission and thus of the pandemic will only be achieved when at least 70% of the population is 19 CUBA'S NATIONAL COVID-19 vaccinated, thus reaching herd immunity and enabling protection of the most vulnerable people while reducing the threat to global TREATMENT PROTOCOL: public health from new strains or variants. AN UPDATE

Cuba reaches the one-year anniversary of the pandemic informed 24 PROGRESS IN CLINICAL STUDIES by accumulated knowledge that has allowed it to maintain FOR THE FOUR CUBAN COVID-19 epidemiological surveillance as well as active case finding and contact tracing at the community level, with follow-up in health VACCINE CANDIDATES services organized throughout the country. Laboratory molecular diagnosis has been maintained and considerably expanded for 30 CONFRONTING COVID-19 precise case management and transmission chain containment. IN CUBA: A VIEW FROM THE NATIONAL MATERNAL–CHILD Noteworthy in Cuba is also the experience accumulated in patient management, with the treatment protocol applied in all health PROGRAM services now in its sixth edition. Various specialists review and assess evolution of cases; adjust medication doses; and define 32 CUBA'S INTERNATIONAL new prevention, treatment and recovery strategies. The premises COOPERATION: EXPANDING rely on timely diagnosis, clinical observation, and early application SOLIDARITY TO CONFRONT of medications according to risk levels and disease stage (whether viremic, pulmonary or inflammatory). Each phase requires certain COVID-19 medications—most domestically produced—that, on the basis of ongoing clinical trials, continue to improve case management as 37 PAHO/WHO COLLABORATING demonstrated by the low overall case fatality rate. CENTERS' CONTRIBUTIONS TO CUBA'S COVID-19 Of course the most important achievement for Cuba is the fact that it has four vaccine candidates in development, as a result of RESPONSE the experience and knowledge amassed over decades by its scientific institutions dedicated to vaccine research and 40 PAHO/WHO COVID-19 RESPONSE: production. The Finlay Vaccine Institute (IFV) has proposed CRISIS COMMUNICATION Soberana 01, Soberana 02 and even Soberana Plus, the latter for convalescing patients. The Genetic Engineering and Biotechnology Center (CIGB) has advanced its Mambisa and NOTEWORTHY Abdala vaccine candidates, heading for phase 3 clinical trials. Once results are presented and the vaccine candidates are 43 BENEFITS OF A CÚRCUMA LONGA approved for population use by the Center for State Control of PROJECT DURING THE PANDEMIC Medicines and Medical Devices (CECMED), this will enable millions of Cubans to be vaccinated, reaching the collective immunity desired. OVER A CUP OF COFFEE WITH…

Nevertheless, in the remaining months ahead, as Cuba has 46 CONCEPCIÓN CAMPA HUERGO experienced an increase in COVID-19 transmission since the reopening of international flights last November, it is important to maintain the preventive measures introduced very early by the A STORY TO TELL Ministry of Public Health (MINSAP): mask use, social distancing, crowd avoidance, proper ventilation and frequent handwashing. 50 DR. RICARDO PEREDA GONZÁLEZ:

Dr. José Moya Medina COORDINATOR OF THE COVID-19 Permanent PAHO/WHO Representative in Cuba CLINICAL EXPERTS COMMISSION March, 2021 OUR NEWS

ADVANCES AND MILESTONES IN CUBA'S RESPONSE TO COVID-19: INTERVIEW WITH CUBA'S MINISTER OF PUBLIC HEALTH, DR. JOSÉA NGEL PORTAL MIRANDA

One year after the first cases of carried out during these last 12 It's been a year of intense work COVID-19 were diagnosed in months, comments on to control COVID-19, Cuba, the country and its milestones, lessons learned, demanding constant learning health system have good practices and future and dynamic decision-making, accumulated an array of perspectives. Undoubtedly, his based on results from science experiences and results words provide shape and form and innovation. emerging from the pandemic to the battle waged by the response implemented by the island nation against COVID-19. This has meant adopting Ministry of Public Health measures throughout the (MINSAP), accompanied by WHAT ARE THE MOST country that respond to health other sectors of government IMPORTANT MILESTONES and social needs at each stage and society. IN THE PANDEMIC'S of the epidemic's evolution. EVOLUTION IN CUBA OVER Every decision corresponds to From young students and THESE LAST MONTHS? a strategy, based on health professionals to integrating epidemiological accomplished specialists with If I had to characterize the elements with those of patient long track records in various context in which we have care and the potential of disciplines—all have come addressed the COVID-19 Cuban science, as we aim for together to face down the pandemic in our country, I the essential goals of pandemic, dedicating long would have to say that it is a prevention and clinical hours of work and multiplying complex one, but also management of infection. their efforts in research and enriching. Two fundamental innovation. premises have guided our Thus, guided by a approach to this comprehensive pandemic Cuba's Minister of Public epidemiological situation in approach, our national Health, Dr. JoséA ngel Portal Cuba: first, deliberate political response to the health Miranda, reflects on the work will that defines people's emergency was structured health as a priority, and from primary health care second, risk anticipation and through the rest of the health prevention. care delivery levels in the health system. Virus Cuba's Minister of Public Health, Dr. José Angel Portal Miranda. Photo: MINSAP containment actions begin in In this sense, it is noteworthy discipline have all contributed the community and also that in January 2020, well to the results obtained to date. finalize there, through before the first cases were surveillance and other detected in Cuba, actions had Government validated a system preventive measures, as well already been designed to for managing the epidemic as attention to the recovery contain the disease, contained based on science and and rehabilitation phases once in a broad National innovation, that linked patients have been Coronavirus Prevention and government activities as well as discharged. Control Plan that was production and service sectors approved by the Communist with the knowledge and The health response is also Party of Cuba's Political learning sector. grounded in a statistical Bureau, the full Council of information system and Ministers and its Executive By February 3, the national health surveillance. This Committee. Government health system had initiated the includes an integrated, agencies and civil-society first phase of capacity building comprehensive surveillance mass organizations were on biosafety issues for our system for all involved in drawing up the health professionals and epidemiological phases; an Plan, which has been employees in the Central State intersectoral approach in all continually updated since Administration agencies. And actions; transdisciplinary then, specifying indicators on February 12, 2020, the interventions; agile decision- that determine changes in the Scientific Group to Address making; and personalized different phases established, COVID-19 was created. care with no exclusions. This according to the epidemic's conception incorporates evolution. The COVID-19 Health Cuba's biotechnology and Observatory was established pharmaceutical industry. On a daily basis, the President on February 17, and the and Prime Minister monitor the Innovation Committee on Thus, as we have sought to National Plan, in coordination February 26. On the 28th, the address and control the with the main agencies first five COVID-19 research COVID-19 epidemic in Cuba, involved. projects were approved, and we can refer to several by early June, 460 studies milestones—from handling of This Plan, together with were under way, 85 of these epidemiology, patient care and infrastructure, organization and directed by the Scientific health care services human resources capacities; Group of the National organization to scientific our public health system's Technical Group. Today, this activity. strengths; and our population's number has grown to over 900

Medical sciences students participating in active community-based screening.

06 OUR NEWS President of the Republic of Cuba, Miguel Diaz-Canel Bermudez, meets with the Temporary COVID-19 Working Group.

projects, including studies and and enabled us to maintain to increased timeliness of clinical trials, health patient care. decision-making and interventions and innovations, strengthened health among others. Primary health care surveillance at the level of professionals and medical community polyclinics and Particularly important over the sciences students also carried their corresponding health last year have been the out active community areas. meetings held by the President screening to detect, isolate of the Republic, Miguel Díaz- and provide timely treatment Also noteworthy over the last Canel Bermúdez, with this for people with respiratory few months is the launch of group of scientists and experts, symptoms. More than 28,000 molecular biology laboratories which number over 40 since students joined this important across the country: we had only they began on April 1, 2020. effort and their contribution to 4 at the start of the epidemic, These exchanges have our communities was essential but by the close of February facilitated an intense and for early case detection, which 2021, the number had grown systematic dialog between translated into breaking the to 22. All the labs were duly government and experts. virus's chain of transmission. equipped and had the requisite biosafety conditions The first SARS-CoV-2 infections Just as important was the as well as the necessary in Cuba were detected on launch of an innovative personnel to process RT-PCR March 11, 2020, marking the technology application for self- tests for viral detection. By beginning of the epidemic in screening, developed by the enhancing our diagnostic the country. Informatics Sciences University capabilities, we were able to in cooperation with the continually increase the Rapid organization by the Ministry of Public Health numbers of RT-PCR tests, so public health system was (MINSAP) and Ministry of that from a daily capacity of decisive, creating and Communications (MINCOM). 100 tests in March, 2020, by outfitting the capacities This virtual screener is a February 2021, we were able needed to ensure medical care personal tool for online to process some 18,000 throughout the country. As a surveys, available free, and is samples daily, or 185 times our result, COVID-19 patient care built into the Cuban initial number. was gradually extended Telecommunications Company regionally in hospitals and (ETECSA) infrastructure, Today, we are moving ahead in other centers exclusively for permitting real-time the computerization of these those whose infection was identification by people who diagnostic results, to provide confirmed or suspected, or recognize their respiratory more immediate information to who were their contacts, as symptoms and whose infection patients online using well as necessary intensive care may be suspected. As a technological monitoring unit (ICU) capacities for serious reflection of individual platforms and systems. At the and critical patients. All this responsibility for health, not as same time, these systems will prevented collapse of our a substitute for active help us improve management health care delivery facilities screening, this tool contributed of capacities in hospitals and

OUR NEWS 07 Cuban IgM antibody test developed for SARS-CoV-2.

isolation centers, since beds Engineering and Biotechnology Each stage we have passed can be made available much Center (CIGB). These are in through has contributed to earlier, right after test results various phases of clinical trials, consolidating Cuba's model are posted. and thus far have shown for addressing COVID-19, evidence of safety and efficacy. whose principles applied Also decisive was approval of during each epidemic the Clinical Management Our reference laboratories are resurgence have prioritized Protocol, conceived in both paying particular attention to adequate isolation of cases, preventive and therapeutic monitoring entrance into the timely diagnosis, contexts, with a scale of country of the virus's new individualized care and follow- services depending on genetic variants. To date, up of convalescent patients. complexity. The protocol is in genetic sequencing reveals its sixth edition, its actions that 99.3% of the samples Always, the most important refined and improved over studied belong to the D614G thing is to keep our people time in accordance with the mutation of the G strain, from getting sick, and if they scientific evidence and best present in the country since the get sick, to keep them from experiences internationally. epidemic's beginning. becoming seriously ill, and if The first edition was approved they do become seriously ill, to on February 16, 2020; the WHAT ARE ASPECTS prevent them from dying. To second in March, the third in COMMON TO CUBA'S accomplish this, we continue to April, the fourth in May and RESPONSE TO THE apply innovative medications the fifth in June, 2020. The PANDEMIC OVER TIME, developed by Cuban sixth was published in AND WHAT ASPECTS ARE biotechnology, use preventive February, 2021. DIFFERENT, SPECIFIC TO and therapeutic Amidst the pandemic, one of THE VARIOUS WAVES OF pharmaceuticals in vulnerable the milestones for Cuban DISEASE RESURGENCE? groups, and implement science is that it has placed interventions in populations at Cuba in the small group of Our handling has been risk. countries that have managed constant, ordered and based to develop vaccines specific to on science. Epidemiological Differences in managing the SARS-CoV-2. The country has management, organization of pandemic's various waves or four vaccine candidates: patient care, and scientific moments of epidemic Soberana 01 and Soberana 02 evidence provide the premises resurgence are summarized in of the Finlay Vaccine Institute for our approach to the the modifications made to the (IFV); as well as Abdala and pandemic over these long Clinical Management Protocol Mambisa of the Genetics months here in Cuba. over its six editions, as well as

08 OUR NEWS changes related to Leading this effort have been safety and already accrued epidemiological management, the Finlay Vaccine Institute (IFV) evidence of the candidates' in particular in the diagnostic and the Genetics Engineering immunogenicity, which makes algorithm and in case and Biotechnology Center us expect that they can prove isolation. (CIGB), as well as other their efficacy in the new scientific institutions, such as clinical trial phases. Each of these stages has been the Molecular Immunology accompanied by changes, Center (CIM). WHAT HAS BEEN such as those related to the INCORPORATED INTO THE isolation protocol, and Today Cuba has four vaccine DAY-TO-DAY FUNCTIONING particularly the decision in candidates that use the same OF THE NATIONAL HEALTH October 2020 to make it more type of antigen: the receptor SYSTEM AS A RESULT OF flexible, permitting persons binding domain (RBD), the LESSONS LEARNED DURING who were contacts of means by which the virus THIS PANDEMIC? confirmed and suspected penetrates cells. Soberana 01 cases to self-quarantine at has gone through three phase 1 Cuba itself provides an home, and for international clinical trials, one of these in example of one of the most travelers to do the same. convalescing patients with low noteworthy lessons learned antibody titers who are thus at over the last few months: that The Clinical Management risk of re-infection. Soberana 02 it is no luxury for countries to Protocol contains is now in a phase 2 trial, and is guarantee access to universal modifications as to when best expected to enter phase 3 in health of their citizens, by to administer innovative March. The Genetic strengthening health systems medications that prevent the Engineering and Biotechnology that place people at the center so-called cytokine storm. Center's Abdala and Mambisa of their priorities. Cuba has These changes have been candidates are both in phase done this, and it is the essence made in the various Protocol 1/2 trials. One of these with of a universal public health revisions and in the latest Mambisa uses essentially system, accessible, free and edition, we have also included intranasal administration. humanistic. the concept of high-risk patients and the need to The regulatory strategy Nonetheless, there are a hospitalize them in units approved for these studies has number of lessons learned that permitting intensive permitted overlap of clinical we'll need to incorporate into monitoring. trial phases for each of the the post-COVID functioning of vaccine candidates, in an effort the national health system. I In summary: one of to shorten running times would summarize them along COVID-19's biggest lessons without affecting the trials' these strategic lines: has been to demonstrate that quality. Decisive for this process we have the capacity to adopt has been constant 1. Organization and measures according to a accompaniment by the regionalization of services changing context, and it's regulatory agency, the Center possible to do this quickly and for State Control of Medicines 2. Use of molecular based on scientific evidence. and Medical Devices diagnostics on a national (CECMED). Another advantage scale WHAT IS YOUR of having several SARS-CoV-2 ASSESSMENT OF CUBA'S vaccine candidates is that we 3. Preventive approaches to FOUR VACCINE can contemplate each one's acute respiratory infections CANDIDATES AND WHAT use for specific population ARE YOUR EXPECTATIONS groups, according to the 4. Individualized care for FOR THEIR RESULTS? candidate's characteristics. seriously ill patients using innovative Cuban medications From the very start of the Thanks to rigorous application epidemic in Cuba, a priority protocols for our country's 5. Strengthening hygiene and set for Cuban science was to biotechnology pharmaceuticals sanitary measures in health move ahead on research and and the vaccines in institutions development of our own development, Cuba has gained vaccine, one that would important independence in this 6. New forms of management prevent transmission of the complex epidemiological for science and technology SARS-CoV-2 coronavirus and context. give the country technological 7. Linking students more sovereignty in terms of its Results thus far are promising, closely to problem-solving in production and availability. particularly when it comes to health at the community level

OUR NEWS 09 The inclusion of registered, innovative Cuban pharmaceuticals—those used for COVID-19 patients and others in development—will undoubtedly facilitate individualized care for seriously ill patients.

At the same time, a new management style adopted in science and innovation has allowed us to streamline mechanisms for approval and implementation of high- impact clinical studies. This relies on the creation of an Innovation Committee, integrating actions by MINSAP, the BioCubaFarma corporate group and the regulatory agency (CECMED).

The Cuban population Linking many academic and in times of pandemic. scientific institutions to the health sector—as we searched for the best solutions to address the epidemic—also A number of things can also studying cancers, opening a shed light on contributions by help optimize the system's field for personalized the different fields of science functioning. Among the medicine and high-impact on improvements in the noteworthy are improvements research to address one of the population's health status. Of in medical care patient flow, main causes of morbidity and course, work by many of these restricting companions to those mortality in the Cuban makes and impact on the hospitalized patients who population. various determinants of require it and suspending health. companion visits. The epidemiological context also prompted accelerated Especially deserving of Making maximum use of the design and testing of new mention is the active molecular biology medications and active participation by thousands of laboratories' installed screening tools for preventively medical sciences students who, capacities will be especially approaching acute respiratory with their pertinent, committed important, particularly for infections. and active involvement,

1. National Coronavirus Prevention 5. First edition of Clinical and Control Plan approved Management Protocol approved (January 28, 2020) (February 16, 2020)

2. Technical Group constituted to direct the Plan 6. COVID-19 Health Observatory (January 28, 2020) established (February 17, 2020)

3. First phase initiated of capacity building 7. Virtual Screener presented, an app for workers in health and public administration for self-screening (February 17, 2020) sectors (February 3, 2020) 8. Innovation Committee established (February 26, 2020) 4. Scientific Group to Address COVID-19 created (February 12, 2020) 9. First five COVID-19 research projects approved (February 28, 2020) 2020 3 4 5 1 2 6 7 8 9 10 11 12 JAN. FEB.MAR. APR. MAY. JUN. JUL. AUG. Young Cuban scientists at the Immunoassay Center (CIE).

demonstrated the new expressing the political will with the health measures generation's capacity to carry to put every resource into oriented, the willingness of out timely actions directed at the health of our people, thousands of our citizens to solving health problems at the since nothing is more be admitted to isolation community level. This precious than life centers, their sincere dovetails with the essential itself—more than a lesson appreciation for the work of premises of Cuban medicine, learned constitutes a our health professionals who focused as they are on health ratification of the have labored ceaselessly in promotion and disease importance of approaching red zones for nearly a year prevention. health from an intersectoral and in every one of the perspective. essential health services that Bringing together all the have never stopped. This has country's sectors and actors No less important has been been everyone's battle, and to confront this dangerous public participation in the in the lead have been the disease—in doing so, virus's control, complying Cuban people.

10. First cases of SARS-CoV-2 infection 15. Soberana 02 phase 2 clinical trials begun detected in Cuba (March 11, 2020). (December 22, 2020)

11. Meetings initiated between Cuba's 16. Abdala phase 2 clinical trials begun President groups of scientists and experts (February 1, 2021) (April 1, 2020) 17. Sixth edition of Clinical Management 12. Soberana 01 clinical trials announced Protocol approved (February 12, 2021) (August 13, 2020) 18. Twenty-second molecular biology 13. Start of Soberana 02 clinical trials laboratory inaugurated to process RT-PCRs approved (October 29, 2020) (February 21, 2021)

14. Mambisa y Abdala clinical trials begun 19. Phase 3 clinical trials authorized for (December 7, 2020) Soberana 02 (March 3, 2021). 2021 13 14 15 16 17 18 19 SEP.OCT. NOV. DEC. JAN.FEB. MAR. COVID-19 SITUATION IN CUBA: ONE YEAR INTO THE PANDEMIC

When the first cases of multisector public health November 15, 2020. This COVID-19 were reported in measures, successful measure included an initial Cuba on March 11, 2020, the epidemiological surveillance, RT-PCR test upon arrival in COVID-19 Prevention and and a broad communications Cuba and a second test on the Control Plan, drafted at the end program promoting key fifth day. During those first of January that same year, was information in all media. days, incoming travelers had to already being implemented. isolate in a residence, attended From that moment on, the Good transmission control in by their local family doctor- Temporary COVID-19 Working the country made it possible and-nurse team, or in a hotel Group at the highest level of for Cuba to apply a new plan with on-site medical staff. government had begun putting of measures in October 2020, the plan into action. aimed at reestablishing social However, failure to comply and economic activities, with these indications, In the first months of response marking different phases by relaxation of preventive to the epidemic, a series of province and municipality, and measures, and family and preventive measures and a final “new normal” phase, social gatherings at New progressive restrictions on thereby encouraging Year's combined to detonate a population mobility were responsible reopening while sustained increase in case established. These included involving the public in numbers. The initial increase mandatory use of face masks maintaining broadly in this latest wave was due throughout the country, disseminated preventive fundamentally to travelers, but cancelling international flights, measures. the infection spread widely, curtailing urban and and in both January and interprovincial public One group of provinces February 2021, local transportation, and suspending (Santiago de Cuba, transmission occurred in most in-person classes in schools and Guantánamo, Holguín, provincial capitals, as well as universities. Restrictions on Granma, Camagüey, Las Tunas in all Havana municipalities. activities in different provinces and Cienfuegos) remained in and municipalities were applied the “new normal” phase, with Guantánamo and Santiago de in line with the epidemic phase no cases of local transmission Cuba Provinces, which in each territory, according to for more than five months. reported no cases of local previously defined transmission for many months, epidemiological indicators. Considering that the country have had widespread had managed to maintain low outbreaks and very high Throughout 2020, all incidence of disease, it was incidence rates. In February outbreaks that emerged in the decided to resume 2021, transmission also provinces were controlled by international flights on increased in Mayabeque and

NEW NORMAL

INDICATORS

RT-PCR positivity last 15 days ≤0.35% Rate x 100,000 population last 15 days ≤5

DEFINITO I N

Production and service activities resumed with strengthened epidemiological surveillance, compliance and control of health and safety measures.

Implementation of other health protection measures with responsible participation of individuals, by adopting a new code and lifestyle.

12 OUR NEWS CUBA: EVOLUTION OF CONFIRMED COVID-19 CASES, BY SYMPTOM STATUS (APRIL 2020–FEBRUARY 2021)

No. CONFIRMED CASES

Jul Jul

Jan Jan

Jun Jun

Apr Apr

Oct Oct

Sep Sep

Feb Feb

Dec Dec

Aug Aug

Nov Nov

May May

8- .

4- .

8- .

9- .

6- .

6- .

3- .

5- .

7- .

5- .

23- .

9- .

19- .

23- .

24- .

21- .

21- .

18- .

20- .

22- .

20- .

24- .

SYMPTOMATIC ASYMPTOMATIC

CUBA: EVOLUTION OF CONFIRMED COVID-19 CASES, BY INFECTION SOURCE (MARCH 11, 2020–FEBRUARY 28, 2021)

No. CONFIRMED CASES

Jul Jul Jul

Jan Jan

Jun Jun

Apr Apr

Oct Oct

Sep Sep

Feb Feb

Dec Dec Dec

Aug Aug

Nov Nov

May May

1- .

3- .

8- .

7- .

9- .

2- .

4- .

15- . 29- .

6- .

13- . 27- .

17- .

22- .

11-Mar. 25-Mar. 21- .

23- .

10- . 24- .

16- . 30- .

12- . 26- .

18- .

20- .

IMPORTED LOCAL TRANSMISSION

OUR NEWS 13 Artemisa, the Isle of Youth LA HAV ANA MAYABEQUE MA Special Municipality, and the provincial capitals of Pinar del Río, Camagüey, Granma and ARTEMISA Holguín. PINAR DEL RÍO Thus, since December 2020 and during the first two months of 2021, Cuba has faced a new epidemic scenario with higher transmission rates. In January of this year alone, 15,536 cases were registered, 3480 more than the total detected during CIENFUEGOS 2020. Numbers in February were even higher, with 22,998 positive cases. The progressive increase in active cases during January and February, reaching ISLE OF YOUTH a record 38,534 nationally, called for increased hospital capacity to meet the growing demand for medical care. Rate X 100,000 pop. (March–December, 2020) It is important to note that these outbreaks were 200–240.0 (3) managed with the experience 100–199.9 (3) acquired in the first months of 23.2–99.9 (10) the pandemic. Currently, Cuba has more diagnostic, medical and preventive tools available, taking into account local scientific advances, including MA increased SARS-CoV-2RT- PCR LA HAV ANA MAYABEQUE diagnostic capacities with the 12 inauguration of new molecular ARTEMISA biology laboratories (MBL). PINAR DEL RÍO In fact, the first tests were conducted in February 2020 in the National Reference Laboratory at the Pedro Kourí Tropical Medicine Institute (IPK). Between March and May 2020, four more laboratories were opened in Havana and two in other provinces (Villa CIENFUEGOS Clara and Santiago de Cuba). In the third trimester of last year, six more labs were added in the capital, the territory with ISLE OF YOUTH the largest population and the most affected by the epidemic. Between October and Rate X 100,000 pop December, MBL were (January–February, 2021) inaugurated in four more provinces (Matanzas, Ciego de 400– (478.4–823.4) (3) Ávila, Holguín and Artemisa), 300–399.9 (2) and during January and 200–299.9 (3) February 2021, new MBL 100–199.9 (4) International opened in four other provinces 44.8–99.9 (4) Airport (Camagüey, Pinar del Río,

14 OUR NEWS ATANZAS CUBA: CUMULATIVE INCIDENCE

VILLA CLARA RATES BY PROVINCE (MARCH–DECEMBER, 2020)

CIEGO DE ÁVILA

CAMAGÜEY

S LAS TUNAS

HOLGUÍN SANCTI SPÍRITUS

Molecular Biology Laboratories in March, 2020

GRANMA SANTIAGO DE CUBA GUANTÁNAMO

ATANZAS CUBA: CUMULATIVE INCIDENCE

VILLA CLARA RATES BY PROVINCE (JANUARY–FEBRUARY, 2021)

CIEGO DE ÁVILA

CAMAGÜEY

S LAS TUNAS

HOLGUÍN SANCTI SPÍRITUS

Molecular Biology Laboratories in February, 2021 GRANMA SANTIAGO DE CUBA GUANTÁNAMO CUBA: CONFIRMED CASES AND CUMULATIVE INCIDENCE RATES BY PROVINCE (JANUARY–FEBRUARY, 2021)

No. CASES

RATE X 100,000 Pop.

La Havana IYsle of outh

CASES RATE X 100,000 Pop.

CUBA: COVID-19 CASES, DEATHS AND CASE FATALITY RATES (MARCH 11, 2020–FEBRUARY 28, 2021)

CASE FATALITY %

No. CASES AND DEATHS

July

May

June

April

March

August

January

October

February

December

November

September

CASES DEATHS CASE FATALITY %

16 OUR NEWS Guantánamo and Cienfuegos), high risk of developing serious January and February 2021, the plus one more in Havana. forms of the disease. months with highest transmission, the proportion of symptomatic There are currently 22 In terms of indicators observed cases rose along with intensified laboratories, 12 in the capital in one year of the COVID-19 surveillance. and 10 in the same number of epidemic in Cuba, from March provinces. Another five are 2020 to February 2021, 50,590 Following the reopening of under construction to give all positive cases were reported, international flights last provinces MBL testing with a cumulative incidence November, a high proportion of capacities. rate of 449.5 per 100,000 imported cases was noticed at population. The highest rates first, followed by a progressive In response to the new wave, occurred in Havana, increase in locally transmitted flights have been restricted Guantánamo, Santiago de cases. again to reduce the entry of Cuba and Ciego de Ávila. imported cases and the There were 322 deaths, with The incidence rate has risen possible introduction of new 0.6% overall case fatality. Villa notably during the first months of variants or strains of the virus. Clara Province reported the 2021, reaching 344.5 per 100,000 By the end of January, hospital highest rate, 0.9%, whereas the population, a 68.8% increase with monitoring of all positive cases capital, Havana, accumulated respect to the cumulative rate in had been reinforced, 44.6% of cases in the country March–December 2020. Sancti regardless of clinical status. All and 52.2% of deaths. Granma Spíritus was the only province in contacts of positive cases, as is the only province reporting which the rate declined, and the well as international travelers, no deaths from COVID-19. greatest increases occurred in are also isolated in centers Guantánamo (94.6%), Santiago de equipped to for their medical Between March and December Cuba (89.1%), Camagüey (79.7%), monitoring. 2020, the majority of detected Mayabeque (79.5%) and the Isle of cases were asymptomatic at Youth Special Municipality Intensified surveillance is diagnosis, having been (79.3%). currently provided in discovered through contact designated health facilities tracing and traveler Conversely, the case fatality rate, prepared to care for people at surveillance. However, in which reached 4.4% in April 2020,

CUBA: SERIOUS AND CRITICAL CASES, AS TOTALS AND AS PERCENT OF TOTAL ACTIVE CASES (MARCH 11, 2020–FEBRUARY 28, 2021)

No. CASES SERIOUS AND CRITICAL

Jul Jul

Jan Jan

Jun Jun

Apr Apr

Oct Oct

Sep Sep

Feb Feb

Dec Dec

Aug Aug

Nov Nov

May May

9- .

5- .

9- .

7- .

7- .

4- .

6- .

8- .

6- .

24- .

20- .

24- .

10- . 25- .

11-Mar. 22- . 26-Mar.

22- .

19- .

21- .

23- .

21- .

10- . 25- .

SERIOUS + CRITICAL CASES AS % OF ACTIVE CASES CRITICAL SERIOUS % SERIOUS + CRITICAL

OUR NEWS 17 gradually declined during the in cases nationally, including March–November that can be year as effective treatments patients with underlying defined as very good response, were applied based on comorbidities at higher risk of with controlled transmission experience acquired in severe disease and death. and very low incidence in the managing critically ill patients. population. The second Nevertheless, as cases In March–December 2020, scenario, characterized by increased in December, January 1308 COVID-19 pediatric higher transmission, began in and February, so did the patients were reported. In November, increased steadily number of severe cases and January–February 2021, that in December and January, and deaths, although mortality number rose to 4240, including maintained a high plateau in remained low, between 0.3% 212 children aged <1 year February with daily averages of and 0.5%. By February 28, (5%). Pregnant and postpartum about 900 cases. 2021, 324 deaths had been women accounted for 401 reported for an overall mortality patients, and 291 of these Despite this increase, however, of 0.6%. There were 178 deaths (72.6%) were reported in the health system continues to in the first two months of 2021, January–February 2021. provide a timely response 32 more than in However, no infant or maternal through surveillance and case March–December 2020. deaths have been reported. In management, and is hopeful general, the numbers of cases that results of the final The proportion of severe cases and deaths in Cuba are much community trials of Cuba's four (serious and critical) has lower than those reported by vaccine candidates will enable remained at about 1% with the majority of countries in the the country to control the respect to total active cases Americas and the world. pandemic and return to the between November 2020 and normality desired. January 2021. In February, In Cuba, the pandemic has however, this proportion rose to presented two epidemiological By: Susana Borroto 1.3% as a result of the increase scenarios, one in Gutiérrez PhD

TOTAL CASES AND DEATHS, CASE FATALITY AND CUMULATIVE INCIDENCE BY CUBAN PROVINCE (March 11, 2020–February 28, 2021) PROVINCE CASES RATE DEATHS CASE FATALITY No. %X 100 000 pop. No. % % PINAR DEL RÍO 2 897 5,7 493,9 21 6,5 0,7

ARTEMISA 1 702 3,4 331,6 4 1,2 0,2

LA HAV ANA 22 545 44,6 1 060,8 1 685 2,2 0,7

MAYABEQUE 1 756 3,5 457,9 3 0,9 0,2

MATANZAS 2 390 4,7 333,0 17 5,3 0,7

VILLA CLARA 1 809 3,6 437,4 16 5,0 0,9

CIENFUEGOS 729 1,4 93,3 4 1,2 0,5

SANCTI SPÍRITUS 1 043 2,1 223,1 7 2,2 0,7

CIEGO DE ÁVILA 2 252 4,5 514,7 19 5,9 0,8

CAMAGÜEY 1 588 3,1 208,2 10 3,1 0,6

LAS TUNAS 3 93 0,8 72,7 2 0,6 0,5

HOLGUÍN 1 164 2,3 112,4 8 2,5 0,7

GRANMA 766 1,5 91,5 0 0,0 0,0

SANTIAGO DE CUBA 5 544 11,0 527,2 31 9,6 0,6

GUANTÁNAMO 3 668 7,3 712,9 10 3,1 0,3

ISLE OF YOUTH 344 0,7 408,0 2 0,6 0,6

TOTAL 50590 100,0 449,5 322 100,0 0,6 Photo: José M. Correa. Granma

CUBA'S NATIONAL COVID-19 TREATMENT PROTOCOL: AN UPDATE

As soon as the National specialists and researchers guides procedures for Coronavirus Prevention and from various scientific managing both asymptomatic Control Plan was formulated institutions, has reviewed and and symptomatic patients with in January 2020, a Scientific periodically updated the confirmed infections; their Group of experts was national Clinical Management evolution according to established to develop a Protocol, whose sixth edition severity; rehabilitation of treatment protocol for the was released in February, recovering patients; and new country, which would be 2021. measures for international continually revisited and health controls. updated according to new The Protocol is a tool for case evidence gleaned from management based on the The Protocol prescribes how national and international country's strategic actions for to ensure strict fulfillment of research. epidemic control, including biosafety norms for physician, care for pediatric, pregnant dental and nursing care in all Thus, this Scientific Group, and older-adult patients as healthcare delivery services, comprised of medical well vulnerable groups. It also including family doctor-and-

In suspected or confirmed COVID-19 cases, a high-risk patient is defined as one who presents as clinically stable, but who has comorbidities, risk factors, morbid obesity or advanced age, thus requiring intensive monitoring.

OUR NEWS 19 ALGORITHM FOR CLASSIFICATION OF COVID-19–CONFIRMED PERSONS AT HIGH RISK: CASE MANAGEMENT PROTOCOL, Edition 1.6

Asymptomatic Symptomatic Low risk Low risk Mild High risk

High risk Moderate Low risk NATIONAL COMMISSION Severe Intensive (serious Care or critical) Units (ICU) Source: MINSAP PROVINCIAL HEALTH INTENSIVE MONITORING UNIT DEPARTMENT nurse offices, community and follow-up of second- polyclinics, hospitals and degree contacts. other health institutions, emphasizing those caring for If the contact of a laboratory- MUNICIPAL vulnerable populations, such confirmed COVID-19 patient COMMISSION as people in nursing homes, is a person with a psychopedagocial centers, or decompensated chronic without permanent housing. illness, is socially vulnerable or due to distance is difficult Important since the Protocol's to monitor daily, then they first edition has been the may be transferred to a concept of community-based healthcare institution FAMILY active screening for the entire equipped for medical DOCTOR- population, involving the observation and follow-up. NURSE OFFICE primary health care level, which has proven successful Another aspect included in for early identification of this latest edition of the cases. Thus, each family Protocol is identification and doctor-and-nurse team makes classification of cases (whether weekly visits to the families in suspected or confirmed, Source: MINSAP the geographic area under asymptomatic or symptomatic) their care, or daily when it into risk categories: low, cancer, all associated with comes to vulnerable people at moderate and high, as well by severe COVID-19—led to higher risk. severity of symptoms. This inclusion of a definition of information is used to prompt high-risk patient, aimed at The Protocol's 1.6 edition timely response to avoid avoiding progression to adopts stay-at-home isolation complications and progression serious or critical stages. for contacts of confirmed to severe forms of the Suspected, low-risk patients cases, with daily monitoring disease. are remitted to isolation for first-degree contacts and centers, while moderate- and RT-PCR on the fifth day. If the Identification and timely high-risk patients are remitted RT-PCR is positive, they are treatment of possible to intensive-monitoring hospitalized, and if negative, complications—along with hospital units. they remain at home during a control of comorbidities such total of 14 days. The Protocol as diabetes, hypertension, These units were created for also provides for identification obesity, heart disease and high-risk COVID-19 patients

20 OUR NEWS PRIMARY HEALTH CARE TREATMENT ALGORITHM FOR CONVALESCENT COVID-19 PATIENTS

MINISTRY OF PUBLIC HEALTH Republic of Cuba

Composed of National Formulates guide Identifies and Updates protocols and Expert Groups and for COVID-19 assesses feasibility algorithms, provides Scientific Societies convalescent of therapies methodological of specialists patient care proposed guides to provinces

Ensures Designates Selects Establishes and Ensures follow-up municipal specialists who coordinates treatment and by medical commissions comprise them their functioning necessary specialties studies

Family medicine Internal Pediatrics Psychology Orients, medicine OB-GYN assesses, coordinates and Physical medicine Epidemiology Geriatrics determines and rehabilitation interconsultation frequencies Other specialties as needed

Records patient Re-evaluates At 72 hours, Doctor-and-nurse Within 24 hours, Collects data history, does CARE (Continuous interconsults with team receives visits homes for from hospital comprehensive complete Assessment & polyclinic's Basic

patients discharge OBSERVATIONAL STUDY patient evaluation physical exam Risk Evaluation) Work Group

Provides Provides follow-up Provides Identifies risk factors Classifies at-risk Refers hospital referral, during 14-day continued follow-up and previous patients (CARE to Municipal includingRT- PCR stay-at-home period and care illnesses groups III or IV) Commission

as part of the health The post-acute phase of frequently in patients who system's reorganization in COVID-19 leads to a have experienced severe response to the pandemic, convalescent phase that can forms of the disease. in an effort to begin early be complex and prolonged, Asymptomatic patients have treatment and monitor every depending on how aggressive also developed pulmonary detail of their evolution. the disease was and the lesions. The program They are staffed by immune system's capacity for designed to care for internists, critical care response. recovering patients includes specialists and other health research to identify sequelae, personnel specially trained Given the short time that as well as psychological for COVID-19 clinical case COVID-19 has existed, it has support and therapy by a management, and conditions not been possible to define multidisciplinary team in the have been created to carry either the duration or severity health area served by out daily laboratory and of sequelae, although they patients' community-based other complementary tests. are appearing more polyclinic.

OUR NEWS 21 DOMESTICALLY PRODUCED MEDICATIONS IN THE NATIONAL

INTERFERONS

Cuba's biotechnology properties, justifying their hematological diseases, industry took off during the inclusion in the national among others. In Cuba, it has 1980s. In 1981, it produced Clinical Management been approved for emergency the first human-origin Protocol for COVID-19 since use against COVID-19, in vials interferon and in 1986, its first edition. Scientists of 3000 units, via human recombinant agree that, while interferons intramuscular administration. interferon alfa-2b, which do not represent a cure, they Its use is recommended for generated introduction of could be effective when used adults who are suspected or various interferon types and early in the disease's viremic confirmed with COVID-19, as formulas by the recently phase. well as pregnant women, inaugurated Genetic asymptomatic high-risk Engineering and Recombinant alfa-2b patients, and pediatric Biotechnology Center (CIGB) interferon (Heberón Alfa R), patients in early stages of the in Havana. registered since 2003, has disease. been used for viral infections To date, these interferons such as HIV/AIDS, papilloma Another interferon therapy have demonstrated antiviral (HPV), viral hepatitis, dengue, option is human interferon and immunomodulatory some neoplasms and alfa-2b combined with

ITOLIZUMAB

This anti-CD6 monoclonal effects.[1] In SARS-CoV-2 deterioration, decreasing the antibody (MAB) was infections, Itolizumab rate of patients requiring developed by the Molecular inhibits over activation of mechanical ventilation or Immunology Center (CIM), effector T cells, and reducing their time on a and recognizes domain 1 of prevents or diminishes ventilator. the human CD6 glycoprotein. secretion of multiple CD6 is expressed on the inflammatory cytokines. Itolizumab has resulted in surface of mature T cells, in recovery of 89% of all patients B-1 lymphocytes and Given all this, the Cuban receiving the treatment, immature B cells and, along regulatory authority, particularly moderate and with CD166, plays an CECMED (Center for State serious cases, including 97% of important role in cell Control of Medicines and moderately ill high-risk proliferation and Medical Devices), authorized patients. Studies to date[2] proinflammatory cytokine emergency use of Itolizumab indicate early application is secretions. in July 2020, incorporating it preferable, for which use of into the national Clinical biomarkers is recommended, Due to its immunomodulatory Management Protocol permitting better prediction of properties,Itolizumab has (beginning with the 1.2 onset of the disease's been used in Cuba to treat edition) to treat serious and inflammatory phase. Results autoimmune diseases such as critical patients with are encouraging: case fatality psoriasis and rheumatoid pneumonia provoked by rates have declined and arthritis, with proven safety SARS-CoV-2. The aim is to clinical trials continue to better and no evidence of adverse reduce pulmonary function assess use of this medication.

1Saavedra D et al. An anti-CD6 monoclonal antibody (itolizumab) reduces circulating IL-6 in severe COVID-19 elderly patients. Immunity & Ageing [Internet]. 2020 [cited 3 Mar 2021]; 17(34). Available at: https://immunityageing.biomedcentral.com/articles/10.1186/s12979-020-00207-8

2Caballero A et al. An anti-CD6 antibody for the treatment of COVID-19 patients with cytokine-release syndrome: report of three cases. Clinical & Translational Immunology [Internet]. 2020 [cited 3 Mar 2021]; 9. Available at: https://onlinelibrary.wiley.com/doi/full/10.1002/cti2.1218

22 OUR NEWS CLINICAL MANAGEMENT PROTOCOL FOR COVID-19

human interferon gamma and effectiveness of response, thus reinforcing the (Heberferón), registered in Heberferón against Heberón body's defenses against 2016 and indicated for local Alfa R in patients infected COVID-19. It has been treatment of basal cell with SARS-CoV-2. It is approved for emergency use carcinoma. It has been expected that patients will as a preventive medication, authorized for emergency use reachRT- PCR negativity and has been used in health against COVID-19, in vials sooner and in general, will workers, contacts of lyophilized for intramuscular have a more favorable confirmed COVID-19 patients injection, and has evolution. Preliminary results and persons in risk groups. demonstrated high levels of are encouraging, since only Studies reveal that just 1.5% antiviral and 4% of patients treated with of persons who have received immunomodulatory activity, interferons have evolved to this medication have keeping patients from severe forms of COVID-19. contracted COVID-19. While progressing to serious or scientists agree that it is not critical stages of disease. Nasalferón is administered a cure, they think the intranasally, with high levels medication could be effective CIGB is directing a phase 2 of absorption and when used early in the clinical trial evaluating safety immunological and antiviral viremic phase of the disease.

JUSVINZA

This is a peptide with At the start of the pandemic, it reported in Cuba, with a case immunomodulatory effects was approved for fatality of 4.8%. Over the that was initially called CIGB compassionate use in this type next months, the technical 258, nowJusvinza . The of patient, and later CECMED group reviewed other molecule was first designed to gave authorization for experiences, adapting and treat autoimmune diseases, emergency use aimed at improving treatment mainly rheumatoid arthritis, reducing COVID-19 case protocols, with good results. and was approved by CIGB fatality, the time patients spent In January, 2021, 15,536 early in 2000. Jusvinza's on ventilators and pulmonary cases were registered, but expected effect on COVID-19 damage. First trial results have case fatality had declined to is to curb the exaggerated been quite encouraging, 0.45%. This clearly responds inflammatory reaction demonstrating survival of 76% to the experience produced by the immune for critical patients and 87% for accumulated in case system, known as the cytokine serious patients. management, reflected in the storm—responsible for nearly national Clinical Management 70% of fatalities in serious and In April, 2020, a total of 1325 Protocol, which is continually critical COVID-19 patients.[3] COVID-19 cases were reviewed and updated.

3Venegas R et al. Péptido inmunomodulador CIGB-258 para el tratamiento de pacientes graves y críticos con la COVID-19. Revista Cubana de Medicina Militar [Internet]. 2020 [cited 3 Mar 2021]; 49(4). Available at: http://www.revmedmilitar.sld.cu/index.php/mil/article/view/926/625#:~:text=El%20CIGGB% 2D258%20es%20capaz,de%2060%20kDa%20(HSP60).

By: Dra. Lizette Pérez Perea and Tania Crombet Ramos PhD OUR NEWS 23 Photo: Cubadebate

PROGRESS IN CLINICAL STUDIES FOR THE FOUR CUBAN COVID-19 VACCINE CANDIDATES

August 13, 2020 is a date to vaccine candidates: two from then on, it accumulated remember since that day, the IFV and two more from the extensive experience Finlay Vaccine Institute (IFV) Genetic Engineering and formulating important announced the start of its Biotechnology Center (CIGB), vaccines for such diseases as phase 1 clinical trial for its first both highly regarded leptospirosis, tetanus and COVID-19 vaccine candidate, institutions nationally and diphtheria. It has developed Soberana 01. That also meant internationally. a tetanus and diphtheria that Cuba entered the select toxoid vaccine (in single and list of 30 countries—and as IFV was officially founded in combination presentations), the first in Latin America—with 1991, although initially called and a triple vaccine adding their own vaccine candidates the National Center for inactivated Bordetella in human clinical trials, Meningococcal Vaccine pertussis cells, commonly according to the World Health Development in the 1980s, called DTwP. In addition, the Organization (WHO) registry. since at the time it was Institute's current director, dedicated to research and Vicente Vérez BencomoPhD , That began the step-by-step development of the world's also led the team that progress that has led to first vaccine for B-group obtained the world's first Cuba's development of four meningococcal disease. From synthetic vaccine for

24 OUR NEWS BASIC CONCEPTS CONCERNING VACCINES

SAFETY: Process involving production, storage and manipulation of vaccines that ensures greatest vaccine efficacy with a minimum of adverse reactions. Vaccine safety is essential for immunization programs.[1]

REACTOGENICITY: A vaccine's capacity to provoke adverse reactions. Reactogenicity studies evaluate adverse events following immunization, and if these are directly related to the vaccine or are coincidental.

INMUNOGENICITY: A vaccine's capacity to induce an immune response, whether measured by antibodies (humoral immunity) or y T cells (cellular immunity). Clinical studies on immunogenicity measure the immune response induced by a vaccine.

EFFICACY: The direct effect of a vaccine measured in randomized clinical trials prior to licensing (that is, under optimal conditions). Vaccine efficacy is the percentage reduction of disease in a vaccinated group of people compared to an unvaccinated group, and is the measure used to describe how well a vaccine prevents disease.[2]

EFFECTIVENESS: The probability that a vaccine, when used in the field under routine vaccination circumstances (real-world as opposed to optimal conditions) confers immunity in a population. A vaccine's capacity to prevent disease, expressed as a percent.[3]

Haemophilus influenzae type biotechnology. One of its Soberana 01 and Soberana 02 b (Hib) in 2003. main achievements was are the vaccine candidates obtaining a recombinant developed by IFV, while CIGB All this has made it possible hepatitis B (HBV) vaccine, has its Abdala (CIGB 66) and for IFV to assume included in Cuba's National Mambisa (CIGB 669) in clinical development of synthetic Immunization Program since trials. vaccines, such as the one for 1991. Both HBV and Hib pneumococcal disease, which vaccines are single vaccines. FINLAY VACCINE is in advanced phases of INSTITUTE (IFV) clinical evaluation. Thanks to these two institutions' accumulated Soberana 01 began phase 1 IFV also provides an example experience, 8 of the 12 clinical trials in August, 2020. of collaboration among vaccines now included in the Based on the novel coronavirus Cuba's scientific institutions: it National Immunization RBD antigen, it is produced with supplies purified, Program are domestically mammalian cells and its formula concentrated antigens of produced. also contains meningococcal B diphtheria toxoid, tetanus, outer membrane vesicles plus and inactivated suspensions of The four Cuban vaccine aluminum hydroxide as an Bordetella pertussis for CICB's candidates for COVID-19 use adjuvant. About 130 volunteers production of its pentavalent the protein involved in the participated in phases 1 and 2, vaccine, incorporating two receptor-binding domain which tested five different more antigens (for hepatitis B (RBD). They use antigen formulations of the vaccine. and Hib).[4] subunits recognized by the human immune system, and All received 2 doses on days 0 CIGB, inaugurated in 1986, is are thus known as subunit and 28. The vaccine candidate the flagship of Cuban vaccines.[5] was shown to be safe, and the

OUR NEWS 25 Vicente Vérez BencomoPhD , Director of the Finlay Vaccine Institute, with Soberana 02. Photo: Alejandro Ascuy, Cubadebate

only adverse events were for those who had already volunteers between the reported were those common been affected by this novel aged 19–59 years, divided to any vaccine administration. coronavirus. With the results into 2 groups, which The first results observed in hand, IFV recently received different during the trial led to a announced a fifth vaccine formulations of the vaccine modification that involved candidate, Soberana Plus, for candidate (high- and low- application of a third dose as COVID-19 convalescent dose). Preliminary results a booster to one of the three patients. showed the high-dose groups included in the study. formula provoked a strong With this additional dose, Researchers are now immune response, just one improved response in preparing the dossier of week after first application. antibody titers was achieved, Soberana 01 phase 1 results This permitted overlapping a finding that prompted for submission to the national of trial phases, leading application of the booster to regulatory agency, the Center researchers to propose the other two groups in the for State Control of Medicines phases 2a and 2b. trial. and Medical Devices (CECMED). If results are This second period of In November 2020, a new favorable, a phase 2 study is clinical trials began on clinical trial was registered, expected to begin in December 22, 2020, and called Soberana 01B, to Cienfuegos Province in the meant that Soberana 02 was evaluate safety and coming weeks in 700 the first Latin American reactogenicity, as well as to volunteers. vaccine candidate to reach explore immunogenicity of this stage of development. this vaccine candidate in Soberana 02 is a conjugate Phase 2a included some 100 persons who had already vaccine that combines the participants, with an suffered mild or same SARS-CoV-2 RBD expanded age range that asymptomatic COVID-19, that antigen with tetanus toxoid. included male and female is, in convalescent patients. A After successfully completing volunteers up to 80 years of single dose was administered preclinical studies, CECMED age. On January 18, 2021, to 60 persons, aimed at authorized a phase 1 trial on phase 2b was begun at 2 generating a good antibody October 29, 2020. The trial Havana clinical sites, with response and thus protection included 40 healthy some 800 volunteers (100 of

26 OUR NEWS A specialist at the Genetic Engineering and Biotechnology Center (CIGB) with Abdala and Mambisa. Photo: CECMED

whom received a placebo). On February 10, the candidates, based on the On March 3, 2021, CECMED biopharmaceutical industry RBD protein, both authorized a phase 3 clinical announced production of the recombinant vaccines in yeast trial for the Soberana 02 first lot of 150,000 vials of cells. This is a technology vaccine candidate, based on Soberana 02, and more already widely used in Cuba evidence from preclinical recently that it was scaling up and the world to obtain studies, as well as phase 1 production at BioCen subunit vaccines. On results and preliminary results (National Biopreparations December 7, 2020, phase 1 from phase 2 trials. The IFV Center), another entity clinical trials were begun for research team explained that belonging to BioCubaFarma, both candidates. 44,010 volunteers in Havana in its plant usually dedicated will be included, divided into to production of parenteral Commonly known asAbdala , 3 groups: one receiving 2 formulations. Large-scale the CIGB 66 vaccine doses, another receiving a production is designed to candidate is formulated from placebo, and a third provide sufficient doses to the protein's RBD, with receiving 2 doses plus a carry out the phase 3 trial, and aluminum hydroxide as booster consisting of a to reach 1 million doses by adjuvant, for intramuscular Soberana 01 formula. April. administration. Its clinical evaluation began at the This phase 3 trial will be IFV also announced plans to Saturnino Lora Provincial carried out at 47 clinical sites begin the first phase 1/2 Clinical–Surgical Teaching distributed in 8 of the clinical trial in pediatric Hospital in Santiago de Cuba, capital's municipalities, with population (5–18 years old) and the phase 1 study the accompanying challenges with Soberana 02 in the included 132 volunteers aged for organization and coming weeks. 19–54 years divided into 6 supervision. Health groups, which received 3 authorities have also said that GENETIC ENGINEERING doses of 2 formulations with phase 3 studies could be AND BIOTECHNOLOGY different concentrations: 25 pursued in other countries to CENTER (CIGB) and 50 micrograms (mcg). Its broaden the scope of administration used 2 research and ensure better CIGB's strategy led to schemes for the 3 doses: a consistency of results. development of two short-course cycle at 0, 14 and

OUR NEWS 27 Development of the Soberana 02 vaccine candidate. Photo: Alejandro Ascuy, Cubadebate

28 days; the other a long- Abdala's phase 3 study is Center (CENATOX) in Havana. course cycle at 0, 28 and 56 expected to include some These studies aim to evaluate days. 42,000 volunteers (30,000 in safety and immunogenicity in Santiago de Cuba and 12,000 Mambisa alone and in First results indicated only in Guantánamo) who will be combination with Abdala. minimal and mild adverse immunized at 20 clinical sites effects reported for both in the provinces' capital The 88 volunteers (19–54 formulations used in the cities. BioCubaFarma has years) were divided into 4 trial. Immune response already initiated large-scale groups that received 3 doses measured about day 42 in production of the candidate of different combinations of short-course participants for this study at the Aica the vaccine candidates: 2 indicated satisfactory Laboratories in Havana. Its groups received Mambisa immunogenicity, allowing directors note that the alone, intranasally; and 2 start of phase 2 to be industry has experience groups first received 1 expedited, while concluding producing pharmaceuticals intramuscular dose of Abdala, phase 1 of the long-course according to good followed by 2 intranasal doses group. manufacturing practices and of Mambisa. The study has sufficient installed evaluates an administration On February 1, phase 2 was capacities with the short course of 0, 14 and 28 started with 660 volunteers technology needed to days, as well as a long course (19–80 years old), including produce more than 100,000 of 0, 28 and 56 days. those receiving a placebo. vials per day. Results of the randomized In this first clinical phase only double-blind trial are being The second candidate, known mild adverse events were assessed by an independent asMambisa , is CIGB 669, a observed. Researchers are committee charged with formula based on the same now evaluating immune evaluating clinical trials. Its protein RBD, plus the antigen response and preparing the report of results is expected of the nucleocapsid of dossier of results for in the coming days, and hepatitis B, intranasally presentation to CECMED, in work on a phase 3 trial has administered. Phase 1 and 2 order to proceed to phase 2 started, a study slated to clinical trials were carried out trials for Mambisa's selected begin by the end of March. at the National Toxicology dosage and immunization

28 OUR NEWS Development of the Soberana 02 vaccine candidate. Photo: Alejandro Ascuy, Cubadebate

schemes. At the same time, established to evaluate the www.who.int/publications/i/ consideration is being given clinical studies for the Cuban item/10665338400 to study its use in COVID-19 vaccine convalescent patients. candidates, including 2 Hanquet G et al. Vaccine effects bioethical aspects. All current and impact of vaccination SCIENTIFIC RIGOR and future clinical trials are programmes in post-licensure MAINTAINED being registered in the studies. Vaccine. 2013; Cuban Public Registry of 31(48):5634- 5642. Cuba's experience in vaccine Clinical Trials (rpcec.sld.cu), a development—as well as the WHO Primary Registry 3 Ibídem strength of its regulatory (https://www.who.int/clinical- system that is a reference for trials-registry- 4 Organización Panamericana de la the Americas Region—has platform/network/primary- Salud (OPS). Experiencia cubana facilitated accelerated registries). en la producción local de progress towards clinical medicamentos, transferencia de trials implementation, even The regulatory agency tecnologías y mejoramiento en el overlapping some phases in CECMED has approved each acceso a la salud. 2ª edición. consideration of the urgency of the trials and inspected Delgado BM, Uramis E, Fajardo imposed by the pandemic. clinical sites for phases 1 and EM, editores. Havana: Editorial 2. Accordingly, it is designing Ciencias Médicas; 2019. Nonetheless, scientific rigor follow-up work on phase 3 of and fulfillment of all both Soberana 02 and 5Organización Mundial de la Salud regulatory requirements have Abdala, including inspections (OMS). [Internet]. Los distintos been a priority, never of the entire manufacturing tipos de vacunas que existen. sacrificed. Based on process. Ginebra: OMS; 2021 [updated 12 recommendations by the Pan Jan 2021; cited 5 Mar 2021]. American Health 1 World Health Organization Available at: Organization and the World (WHO). [Internet]. Covid-19 https://www.who.int/es/newsroom/ Health Organization vaccines: safety surveillance featurestories/detail/the-racefor-a- (PAHO/WHO), a centralized manual. Geneva: WHO; 2020 covid-19-vaccineexplained joint committee (Comité [updated 22 Dec 2020; cited 5 Mar Centralizado Adjunto) was 2021]. Available at: https:// By: Eng. Ileana Fleitas Estévez

OUR NEWS 29 CONFRONTING COVID-19 IN CUBA: A VIEW FROM THE NATIONAL MATERNAL–CHILD PROGRAM

The Cuban Ministry of Public family doctor offices to An alert on multisystem Health's Maternal–Child intensive care units (ICUs). inflammatory syndrome in Department, together with the That first pillar of care, located children (MIS-C) was national expert groups and in the community, is in the launched in April 2020.This scientific societies devoted to hands of family doctors and alert mobilized health neonatology, pediatrics, and nurses, whose primary aim has authorities and prompted obstetrics and gynecology, been prevention. They preparatory have followed the evolution of encourage families to stay videoconferences. A MIS-C the novel coronavirus since the home and seek medical care surveillance system was first reports of atypical promptly at the first established, allowing timely pneumonia in Wuhan, China, appearance of symptoms. detection of a case in July and have devoted themselves 2020, which evolved to preparing the country's Both maternal–child services satisfactorily after health services to properly and sexual and reproductive compliance with medical manage people affected by health services have been protocols. Children with MIS- COVID-19. considered essential during the C have polyserositis, pandemic, and reorganization myocarditis, pericarditis, This was a daunting task, strategies protect them. As coronaritis and various forms considering the initial dearth of such, they have continued to of vasculitis. Some also information available on function, and intersectoral experience significant COVID-19 in these population protocols were designed respiratory compromise. groups. The premise was that guaranteeing patients' safe children were less susceptible and timely arrival. Guidelines were also to the virus—both less likely to established for convalescent catch it, and more likely to be Clinical-epidemiological triage consultations, to be carried asymptomatic if they were was established in all pediatric out at the primary care level infected. This prompted emergency services, in order at family doctor-and-nurse strategies that included further to both minimize subjectivity offices with further study of the disease; and to classify patients as comprehensive evaluation organization of care for either suspected cases or and assessment by related children, adolescents, and contacts of confirmed or specialists at the secondary pregnant women affected by suspected cases, when care level. Such COVID-19; and training and appropriate. If thus consultations have resulted preparation of personnel determined, these pediatric in the diagnosis of involved in patient care. patients were hospitalized, myocardial and pericardial initiating the established alterations, pulmonary The Cuban health sector, action protocol that included fibrosis and psychological responsible for leading the RT-PCR SARS-CoV-2 alterations. It should be fight against the virus, confirmation. noted that innovative Cuban designed an integrative biotechnology products, epidemiological and clinical At the same time, “ICUs especially interferon and care plan using the latest without walls” were established Jusvinza, have been quite available science, which has and in the red zones, teams valuable in the treatment guided action to date. included pediatricians, critical and satisfactory evolution of care doctors, nurses and most cases. Cuba's national COVID-19 paramedics with proven Clinical Management pediatric competencies. Protocols for the care of Protocols are both dialectic Multidisciplinary teams pregnant and postpartum and robust, focused on guaranteed adherence to women were drawn up using providing individualized care. therapeutic protocols and what little evidence was Services have been timely diagnosis, avoiding late available at the beginning of established at all levels, from arrivals to the ICU. the pandemic. Integrated

30 OUR NEWS Cuban girls and boys in pandemic times.

into the national COVID-19 pandemic without affecting special attention to care for Clinical Management Protocol, care required by other health pregnant and postpartum they have been enriched and issues. women and pediatric updated as more information patients, while at the same has become available, The first pediatric case in time guaranteeing essential incorporating transdisciplinary Cuba was diagnosed on services so as not to lose actions that cover the entire March 21, 2020 in Granma advances made by the scope of the disease, ranging Province. By the end of that National Maternal–Child from prevention to year, 1279 pediatric patients Health Program (PAMI). convalescent patient care. were confirmed positive for The fact that no deaths Pregnant and postpartum the virus. Most were between have been reported in these women were considered 15 and 18 years old. By the populations is noteworthy. vulnerable groups, among end of 2020, 90% of The Program has received those more likely to fall ill and pediatric COVID-19 patients collaboration from UN develop complications. in Cuba had recovered. agencies such as the Pan American Health Suspected and confirmed The first COVID-19–positive Organization/World COVID-19 obstetric patients pregnant woman in Cuba was Health Organization have been treated in regional diagnosed on April 1, 2020. (PAHO/WHO), the UN hospitals, where specialized By the end of 2020, 95 Population Fund (UNFPA) human resources, equipment, pregnant women, 17 and the UN Children's Fund supplies and medicines were postpartum women and 2 (UNICEF), which have made available for their care, patients who underwent provided personal including that related to operations for ectopic protective equipment, possible deliveries or obstetric pregnancies had been contraceptives, medicines, complications. The diagnosed. All these patients and other essential regionalized system has recovered without requiring supplies and technical proven to be a strength in the intensive care or ventilatory expertise. Cuban COVID-19 response, as support, and all had it allows patients to be seen at satisfactory clinical evolution. By: Dr. Lissette del Rosario specialized institutions, López GonzálezMS , organizing priorities according Throughout the pandemic, Dr. Mercedes Piloto Padrón to the demands of the health protocols have paid andDr. Duniesky Cintra

OUR NEWS 31 Photo: Cubaperiodistas

CUBA'S INTERNATIONAL COOPERATION: EXPANDING SOLIDARITY TO CONFRONT COVID-19

WHO's Director-General (officially, the 'Henry Reeve Their greatest challenge came declared the novel International Contingent of with the 2014 Ebola outbreaks coronavirus a public health Physicians Specializing in in Guinea, Sierra Leone and emergency of international Disaster Situations and Liberia—West African concern on January 30, Serious Epidemics') was countries affected by the 2020, and a pandemic on created on September 19, disease for the first time. In March 11 the same year. 2005, aimed at providing recognition of its work there, From then on, the Cuban assistance to countries WHO awarded the Henry government began receiving requesting cooperation. Its Reeve Contingent the Dr. Lee requests for collaboration members are health Jong-W ook Memorial Prize for from various countries professionals in different Public Health during the 2017 interested in receiving help fields, specially trained to World Health Assembly. from Cuban health work in situations of natural professionals to confront the disasters or health Before providing services pandemic. The Ministry of emergencies. abroad, team members Public Health (MINSAP) receive specialized training evaluated the requests and Since its creation and before on infectious diseases at the started organizing teams of the pandemic, the Contingent Pedro Kourí Tropical the Henry Reeve Contingent had sent 28 teams to 22 Medicine Institute (IPK). Over to provide assistance to countries, mobilizing 7950 the last few months, given other nations. health professionals to the teams' COVID-19 confront the effects of 16 mission, training has focused The Henry Reeve Emergency floods, 8 hurricanes, 8 on the disease, emphasizing Medical Contingent earthquakes and 4 epidemics. prevention measures and the

32 OUR NEWS necessary protocols. The total of 4941 Cuban health cared for people with teams created to address the professionals have served COVID-19. pandemic are composed abroad during the pandemic, primarily of physicians 2821 of them women, The Contingent also traveled specializing in family providing care for some to the Principality of Andorra medicine, critical care and 1,090,799 people in various and Azerbaijan, as well as the epidemiology. They are regions: Europe; Latin British Overseas Territories of joined by nurses specializing America and the Caribbean; Anguilla, Turks and Caicos in emergency situations and and Africa and the Mideast. Islands, British Virgin Islands allied health workers. Some of and Montserrat; and the these teams have been In Europe, for the first time in French Department of dispatched to countries where the history of Cuban medical Martinique. Cuban medical collaborators cooperation, teams were sent are already posted—more to Italy and Andorra. In Italy, In the Mideast, health than 59,000 Cuban health professionals from that nation professionals were professionals serving in 28 were joined by two teams of dispatched to Kuwait, United countries—bolstering this Cuban professionals, one in Arab Emirates and Qatar. In cooperation to confront the Lombardy and the other in Qatar, two teams joined 500 COVID-19 pandemic. Piemonte. Those dispatched Cuban health professionals to Lombardy reported 5000 already staffing the Cuban To address the pandemic, 56 patient-care visits by Hospital of Dukhan, which brigades have been mobilized physicians and 3668 by was converted into the main to 40 countries. Many of nurses. They worked in the hospital for care of COVID-19 these teams have already region's main hospital as well patients. After 8 months of returned to Cuba so that by as in a field hospital and an difficult work, the teams February, 2021, 25 were assisted-living facility for returned, reporting some active, with 2500 members. A older adults. In each, they 270,342 patient-care visits by

Cuban medical team dispatched to collaborate in Barbados. Photo: Cubadebate

OUR NEWS 33 TEAMS OF THE HENRY REEVE CONTINGENT:

LATIN AMERICA: Honduras Peru Mexico Suriname Nicaragua Venezuela Panama

CARIBBEAN Anguilla Jamaica

Antigua and Barbuda Martinique

Barbados Montserrat

Belize St. Kitts and Nevis Dominica St. Vincent and the Grenadines AFRIC Grenada St. Lucia

Haiti Trinidad and Tobago Turks and Caicos Islands British Virgin Islands

physicians and 338,772 by Mexico and three Central Cuban teams to confront the nurses. American pandemic. countries—Nicaragua, Cuban teams have been sent Honduras and Mexico—also In South America, Peru and to the Caribbean: to Antigua received Cuban medical Venezuela received the and Barbuda, Barbados, collaboration. Noteworthy is Contingent. On August 20, Belize, Dominica, Grenada, the fact that on August 13, 2020, the Cuban team Haiti, Jamaica, St. Kitts and 2020, Honduras's National received the Francisco de Nevis, St. Vincent and the Congress decorated the Miranda Order in Caracas, Grenadines, St. Lucia, Henry Reeve Contingent with after providing medical Suriname, and Trinidad and the 'Cruz de Comendador' services for five months to Tobago. The latter country award, citing its combat the pandemic. received the Contingent's distinguished contribution to first-ever all-women team, the population's health. Four teams totaling 85 health composed of 11 university- Honduran physicians, who professionals served in the trained nurses, 45% of whom were graduates of Havana's Peruvian regions of Ancash, had already served abroad. Latin American School of Piura, Ayacucho and Medicine (ELAM), joined the Moquegua. By virtue of a

34 OUR NEWS : COLLABORATION TO CONFRONT COVID-19

EUROPE AND ASIA:

Azerbaijan United Arab Emirates Italy Kuwait Principality of Andorra Qatar

CA

Angola Sao Tomé and Principe Cape Verde Equatorial Guinea Sierra Leone Guinea-Bissau Kenya South Africa Kingdom of eSwatini Guinea Togo Source: MINSAP

bilateral government Contingent teams have been in international health agreement, the Cuban sent to Angola, Cape Verde, cooperation, among specialists served alongside Guinea-Bissau, Guinea, South populations with the greatest Peruvian professionals. In Africa, Togo, Sao Tomé and needs, learning about Ancash, the Cubans received Principe, Equatorial Guinea, different cultures, languages thanks from the residents in Sierra Leone, eSwatini and and traditions and the the city of Huaraz, many of Kenya. importance of respecting whom recalled the Cuban them. In their encounters medical teams and field Cuba's ability to offer with health professionals hospitals sent after this medical cooperation abroad from other countries, they Andean region suffered the relies on university programs share experiences and mutual 1970 earthquake. that have resulted in nearly learning in an atmosphere of half a million trained health respect, friendship and The African continent was the professionals and the highest solidarity that accompany first to receive Cuban medical doctor-patient ratio in the them throughout their assistance 57 years ago. To Americas. During their professional lives. address the current studies, these programs pandemic, Henry Reeve foster student competencies By: Dr. Duniesky Cintra Cala

OUR NEWS 35

PAHO/WHO COLLABORATING CENTERS' CONTRIBUTIONS TO CUBA'S COVID-19 RESPONSE

Cuban scientists and other Organization (PAHO/WHO) SARS-CoV-2 immunological experts have been directly Collaborating Centers have biomarkers; and assesses the involved in the country's contributed to the fight against cost and social aspects of the response to the COVID-19 the novel coronavirus, aiding in pandemic. pandemic since it first began, its prevention, diagnosis and turning their efforts toward treatment. Some of their most IPK has provided advice at the developing protocols, important activities are national level on issues treatments, vaccines, highlighted below. pertaining to biosafety, laboratory tests and other including on proper use of elements to help combat the PEDRO KOURÍ TROPICAL personal protective equipment disease. In this context, digital MEDICINE INSTITUTE (IPK), and biosafety cabinets certified platforms have been which houses both the for personnel in the laboratory developed, giving greater Collaborating Center for the network. At the same time, it visibility to their work both Study and Control of Dengue has continued to systematize nationally and internationally. and the Collaborating Center experiences of the Cuban for Tuberculosis Elimination, National Program for In the Americas, various has devoted its laboratory Prevention and Control of institutions have been working resources, working groups and Tuberculosis in times of to support the COVID-19 experts to COVID-19 research COVID-19 and to monitor response, including and treatment since the possible impact of the disease coordination of international pandemic's start. IPK joined on the country's plan for TB virtual events to address issues other health, scientific and elimination. related to evidence, policies, academic institutions in protocols, mental health and preparing the National IPK has also been responsible health promotion, among Coronavirus Prevention and for training Cuban national others. Control Plan to address the health system personnel, novel disease, and also played including members of the McMaster University in Canada a major role in establishing the Henry Reeve Medical co-directed the COVID-19 Cuban network of SARS-CoV-2 Contingent currently fighting Evidence Network diagnostic laboratories. COVID-19 in various regions of (COVID-END), guiding the the world. preparation of rapid evidence IPK has distinguished itself in profiles designed to help guide evaluating SARS-CoV-2 THE NATIONAL MEDICAL government decision-making serological and molecular GENETICS CENTER (CNGM) during the pandemic. Brazil's diagnostic kits, as well as other has undertaken national Center for Studies, Research equipment, reagents and monitoring (through prenatal and Documentation on Healthy supplies used in the pandemic ultrasounds) of Cities (CEPEDOC) developed response. IPK specialists and COVID-19–positive pregnant an online repository of tools, experts continue to carry out women and is working on the materials and publications epidemiological studies diagnosis and possible related to COVID-19. involving patients with teratogenic effects of Santander Industrial suspected COVID-19 infection SARS-CoV-2; in addition to University's Proinapsa Institute and their contacts, and to monitoring possible in Colombia developed and explore chains of transmission. teratogenic effects of therapies led virtual academic events on They also study the disease's used in COVID-19 disease diverse topics such as behavior and have made management. Women and breastfeeding, adolescence decisive contributions to their infants receive follow-up and COVID-19; and E-MERS knowledge on the clinical care after delivery by medical (Strategies for Healthy presentation, immunology, and genetics services offered Municipalities, Environments genetic and epigenetic aspects nationwide. and Ruralities)[1] and the of COVID-19. IPK research pandemic. delves into symptomatic and CNGM also designed and asymptomatic patients; executed a national research In Cuba, Pan American Health examines the epidemic's project aimed at identifying Organization/World Health prognosis, severity and genetic risk factors influencing

OUR NEWS 37 COVID-19 severity in Cuban as well as a COVID-19 patient flow that patients. The project was a COVID-19 Publication avoids contact with other cross-sectional, case–control Repository patients and health personnel, study including Cuban patients (http://covid19.sld.cu/). plus training of health workers who tested positive for the in proper use of personal SARS-CoV-2 virus who had been Additionally, they adapted protective equipment, of discharged and were free of the Cuba's SORMAS Epidemic disinfectant solutions for disease, as well as any first- Management Software to aid in cleaning hands, surfaces and degree relatives who were living the surveillance, analysis and fomites, and of sodium in the same epidemiological management of epidemic hypochlorite solutions for foot 'bubble' but who did not outbreak response. This traffic at all facility entrances become ill and whose RT-PCR software fully integrates these and exits. tests came back negative. processes, facilitating multidirectional, independent During the pandemic, the THE NATIONAL work flows for each illness, Collaborating Center's experts ENDOCRINOLOGY based on cases. have thus far authored seven INSTITUTE'S CENTER FOR publications (four national and HUMAN REPRODUCTION THE COLLABORATING three international) and have RESEARCH conducted a review CENTER IN PUBLIC HEALTH continued supporting hospital of COVID-19's effects on sexual AND AGING AT THE management in other Cuban and reproductive health that RESEARCH CENTER ON provinces. covered general aspects of the AGING, LONGEVITY AND disease, as well as gender and HEALTH (CITED) prepared THE COLLABORATING health system services during documents for managing older- CENTER FOR THE the pandemic. The Center also adult patients, for strategies in REGULATION OF HEALTH developed two research nursing homes and therapies in TECHNOLOGIES AT CUBA'S protocols for COVID-19 Urgent Care Units, as well as CENTER FOR STATE –positive Cuban patients: one informational materials for CONTROL OF MEDICINES on the sexual and reproductive caregivers and older adults AND MEDICAL DEVICES effects of COVID-19 confined at home. CITED (CECMED) has participated convalescent women, and the personnel joined other experts actively with other national other on quality of semen from to develop and update clinical regulatory authorities in the men affected by the virus. management and follow-up region in seminars and virtual protocols for convalescent meetings convened by PAHO In addition, Center experts patients aged 60 years and and WHO for regulatory joined WHO's Sexual Health older, including those who had updates and technical and Reproductive Cancers (SRC) developed severe forms of discussion on issues relevant to group in Geneva to carry out a COVID-19. the evolution of the COVID-19 systematic review entitled pandemic. “Presence and persistence of GUSTAVO ALDEREGUÍA SARS-CoV-2.” LIMA HOSPITAL'S CECMED participated in the COLLABORATING CENTER Ventilator Working Group CUBA'S NATIONAL MEDICAL IN HOSPITAL where regulatory and SCIENCES INFORMATION MANAGEMENT, management issues on CENTER (CNICM/INFOMED) ORGANIZATION AND equipment use were discussed created the Coronavirus QUALITY has carried out and information provided on Infections Portal training and continuing national strategies for (https://temas.sld.cu/coronaviru education initiatives for health ventilator development and s/covid-19/) and developed an workers at different levels of production, as well as use of application for mobile devices care. As part of its leadership emergency ventilators. that provides current, reliable in health services organization, In its role as part of PAHO's information on COVID-19. Also, the Collaborating Center has Regional Working Group on with the aim of monitoring, supported hospitals and other Medical Devices, CECMED's compiling, analyzing and institutions in healthcare Collaborating Center also visualizing scientific and delivery, helping to guarantee addressed the prolonged use, technological information early identification, adequate reuse and reprocessing of N-95 published worldwide on the isolation, timely confirmation masks and other equipment, disease, they designed and and best treatment of given shortages that arose implemented a Scientific COVID-19 patients. This has during the pandemic. CECMED Observatory (https://temas.sld. included advising on developed regulations and cu/coronavirus/covid- 19 reorganization of emergency procedures establishing /observatorio-cientifico/) medical services to facilitate emergency-use authorizations

38 OUR NEWS Pulmonary ventilator manufactured in Cuba.

for In Vitro Diagnostic Medical develop a continuous positive medical devices during the Devices (IVDs), ventilators and airway pressure (CPAP) device COVID-19 pandemic. ultraviolet lamps, and and an automatic resuscitator. As the competent authority established transitory charged with evaluating and regulations extending the times CECMED also actively authorizing clinical trials in Cuba, during which certifications monitors use of medical CECMED designed and granted remain valid. devices used in priority health established prioritized, fast-track programs, including those for evaluation procedures for At the same, CECMED's care of persons with confirmed applications submitted related to Collaborating Center has and suspected COVID-19 and COVID-19. To evaluate Cuban actively and systematically their contacts. Since the vaccine candidates, CECMED maintained regulatory support pandemic's beginning, 15 risk established a multidisciplinary for national manufacturers communications, 10 team of its specialists—including developing medical equipment manufacturer communications pharmacists, physicians, and devices in response to the and 3 safety alerts have been biochemists, microbiologists and pandemic. As of August 2020, issued, allowing timely veterinarians, all with extensive six registrations had been dissemination of information experience in vaccine granted for IVDs (four related to the safe use of development—which managed domestic and two imported), medical devices for the Cuban to speed up the evaluation and authorizations issued for health system. PAHO's process without sacrificing use and marketing of 80 Regional Working Group on scientific and technical rigor. oxygen concentrators Medical Devices has manufactured in China. They highlighted the importance of CECMED also carries out also evaluated emergency-use the role played by the Report inspections at vaccine candidate authorization requests for Exchange Program on Medical clinical study sites, ensuring that manufacture of germicidal Devices between National data is both impartial and of ultraviolet lamps, manufacture Regulatory Authorities in the high quality, and that results of PCUVENTE lung ventilators; Region of the Americas obtained are reliable, credible and production of swabs used (REDMA), developed at the and acceptable for both Cuba in RT-PCR sampling. They are Collaborating Center, for and abroad. currently supporting several sharing information on adverse projects, notably one to events related to the use of By: Roxana González López MS

OUR NEWS 39 PAHO Director Dr. Carissa F. Etienne

PAHO/WHO COVID-19 RESPONSE: CRISIS COMMUNICATION

The development of communication actors' roles. Organization (PAHO), an information and It is no longer possible to infodemic is “an communications speak absolutely of overabundance of technologies, as well as the transmitters or receivers information on a problem appearance of new, more because in practice these that makes it hard to find interactive platforms, has functions alternate: people trustworthy sources and greatly modified consume content, but they reliable guidance.” False, or communication processes. also produce it. 'fake' news constitutes untrue Currently, communication content that is disseminated does not always flow linearly In this context, what has through various channels to from a sender to a receiver, been termed an 'infodemic' purposely misinform. or even from an issuer to an has thrived, alongside false audience. They occur rather or 'fake' news. According to Unfortunately, these between different actors in the “COVID-19 Glossary: communications phenomena ways that could be Outbreaks and Epidemics. A have accompanied the characterized as chaotic or resource for journalists and COVID-19 pandemic since its disorderly. This has also communicators,”1 prepared beginning. This problem has related to modifications in by the Pan American Health been exacerbated by the

40 OUR NEWS daily flood of information on members of PAHO's Some of the most discussed COVID-19, much of which leadership team also appear topics underscore the priority comes to people who lack at these sessions for the that should be given to the the necessary elements to region's media, including region, as the pandemic's critically evaluate information Assistant Director, Dr. Jarbas epicenter; the need for on a novel virus that is Barbosa. global and regional affecting the entire world at cooperation to facilitate the same time. Accordingly, a These sessions have been access; the call for nations to lot of inaccurate content has held since COVID-19 was first prepare for vaccination and circulated during this declared a pandemic in to reduce gaps in vaccine information avalanche. March 2020. To date, more coverage in each territory; as than 40 have been organized, well as detailed information Due to the above issues, and making it possible to delve about the COVAX mechanism given that information and into multiple issues of public and plans established for communications management interest related to the novel vaccine acquisition. must be an important part of coronavirus, including the the response to any crisis effects it has had on the "Expanding equitable access situation, PAHO leaders and Americas and the rest of the to COVID-19 vaccines in the communicators have worked world and useful measures Americas must be a global intensely on targeted for its prevention and control. priority," said Dr. Etienne on communication strategies This is in addition to offering March 3, 2021. “Wealthy designed to provide clear consistent updates on the countries are rolling out and precise information to effects of the pandemic on vaccines, while many nations different audiences, clarifying the region: case numbers, have yet to receive a single issues of public interest. deaths, countries' existing dose. This disparity harms capacities for medical care our principles of solidarity. For example, PAHO has and circulating COVID-19 But more than that, it's a self- provided accurate variants, among other defeating strategy. As long as information and reliable aspects related to the current COVID-19 endures in one guidance through the and evolving epidemiological part of the world, the rest of organization's official social situation. Much emphasis has the world can never be safe." networks, part of which has been placed on public health involved separating myths actions needed to mitigate In relation to vaccine from reality. It has also transmission of the virus. deliveries through COVAX, promoted training and she commented: “As vaccine updating activities, including Other socioeconomic and production increases, there seminars and virtual health problems have also will be more shipments to the exchanges aimed at helping been addressed, including region month after month. In public health communications the need to organize services the short term, doses will professionals manage the to continue caring for chronic continue to be limited, and infodemic and the circulating disease patients; the we must use them wisely, rumors. Part of this initiative importance of addressing prioritizing those at greatest has involved publishing mental health during the risk, such as our healthcare technical papers with useful pandemic, coupled with the workers, older adults and recommendations. urgency of strategies for people with pre-existing offering psychological care; conditions,” she concluded. At the same time, various the effects of the pandemic informational sessions have on certain population Dr. Jarbas Barbosa has also been organized by leaders sectors, such as women, provided detailed information and experts from PAHO, Indigenous peoples and Afro- on COVAX, a coalition led by WHO and other prestigious descendants; and steps taken WHO, the Global Alliance for organizations with long to mobilize resources needed Vaccines and Immunizations scientific track records. for adequate response and to (GAVI) and the Coalition for Among these, the weekly boost medical supplies Epidemic Preparedness “Ask an Expert” session during the emergency. Innovation (CEPI), in an effort stands out, in which people to ensure equitable access to have been able to address Lately, the information COVID-19 vaccines. "The Pan their concerns to specialists sessions have devoted a American Health Organization at the highest levels; as well good part of their exchanges has provided technical as the weekly information to the vaccination campaigns support to the Member States session with PAHO Director, now beginning in several to support them in each phase Dr. Carissa F. Etienne. Other countries of the Americas. of their participation in the

OUR NEWS 41 PAHO Assistant Director Dr. Jarbas Barbosa

COVAX Mechanism and in means that vaccine including the ones produced preparation of their national candidates must have in India and South Korea. COVID-19 vaccination plans," completed clinical research There are a number of other he stated in a press release phases; reports have been vaccine candidates awaiting dated January 31, 2021. prepared on their safety, this rigorous approval immune response and process. During March, 2021, Under COVAX, vaccines will efficacy for protection against four countries in the Americas be donated to one group of the virus; and these reports will begin receiving some countries, while another will have been evaluated by the vaccines and delivery will purchase them. All these national regulatory agency, continue throughout the year nations have signed which then can give until the predefined agreements with COVAX to authorization for use in agreements are fulfilled. formalize their inclusion in emergency situations. the program, which is 1 Pan American Health Organization designed to cover 20% of the All these documents and (PAHO). COVID-19 Glossary: world's population, with processes are thoroughly Outbreaks and Epidemics. A priority given to healthcare reviewed by WHO's resource for journalists and workers and persons with risk prequalification team, which, communicators [Internet]. Available factors. after detailed consultations at:h ttps://www.paho.org/en/ and evaluations, decides if the documents/covid-19-glossary- A prerequisite for accessing vaccines are accepted. To outbreaks-and-epidemics-resource- the COVAX platform is that date this has only happened journalists-and-communicators the vaccines to be used must with the Pfizer and be prequalified by WHO. This AstraZeneca vaccines, By: Tania del Pino Más PhD

42 OUR NEWS NOTEWORTHY

BENEFITS OF A CÚRCUMA LONGA PROJECT DURING THE PANDEMIC

Tania Valdés González heads Laboratory was inaugurated in Cú rcuma longa is used in Calixto García University 2015 in Havana, Cuba, in traditional Chinese, Unani and Hospital's Theragnostics collaboration with the Center Ayurveda medicine. It has Laboratory and is passionate for Applied Nuclear Technology antioxidant and anti- about natural, traditional and Development (CEADEN). The inflammatory properties, and complementary medicine; laboratory was founded with has reported medicinal effects especially the use of Cú rcuma the conviction that scientific for arthritis, atherosclerosis, longa (Cúrcuma ) in benefitting testing of natural products' liver dysfunction, and human health. medicinal properties is essential respiratory and gastrointestinal for developing therapeutic disorders. Its antiviral, This intelligent, motivated nutritional supplements and antibacterial, antifungal and professional is currently a senior phytopharmaceuticals tissue-healing properties have researcher at Cuba's Ministry of also been described. Public Health (MINSAP), where The laboratory's creation, she is leading two interesting dedicated to the search for Cúrcuma longa's disease projects: “Nutraceutical and clinical applications of natural prevention qualities have been Phytopharmaceutical products to different reported in neurodegenerative Development of Cú rcuma pathologies, gave rise to the diseases and cancer. Its longa” and “Developing project “Nutraceutical and medicinal properties are Cú rcuma longa Nutritional Phytopharmaceutical attributed to the bioactivity of Supplements: Evaluating Development of Cú rcuma the components produced in Cúrcuma longa's Preventative longa” in MINSAP's National its secondary metabolic routes: Effects on Cognitive (now Sectorial) Natural and phenolic compounds (mainly Deterioration and Infectious Traditional Medicine Program, curcumin) and volatile oils. Respiratory Disease in Geriatric in coordination with Havana's Most studies have been either Patients.” Provincial Health Department preclinical or related to (DPS). traditional uses. The first of these initiatives tells us a little more about Cú rcuma Cúrcuma longa supplements Cú rcuma longa supplements longa, as well as Curmeric, a developed by the developed by the natural product containing Theragnostics Laboratory for Theragnostics Laboratory have Curcuma longa extracts, and use in clinical research are been used since 2018 by their uses during the COVID-19 produced in facilities run by chronic disease patients in pandemic. Havana's Provincial Pharmacy Calixto García University Company's (FARMABANA) Hospital's outpatient service HOW AND WHEN DID THE Natural and Homeopathic dedicated to monitoring IDEA FOR THIS PROJECT Products Pharmacy. hypertension and nutrition. ARISE? Results obtained have CÚRCUMA LONGA'S demonstrated positive Calixto García University PROPERTIES AND HEALTH changes in body composition Hospital's Theragnostics BENEFITS in overweight and obese

NOTEWORTHY 43 Community-based team working on the project during the pandemic.

patients, and decreases in Microbiology Institute Havana's Calixto García blood sugar levels, cholesterol (INHEM), contains among its University Hospital during and triglycerides in patients components Cú rcuma longa March and April 2020. There with diabetes and extracts and was formulated were no positive cases among dyslipidemia. to be used as a the 91 health professionals gargle/mouthwash or as nasal working in high-exposure Wide use has not yet been drops, forming a natural areas who used Curmeric. observed in Cuba, although preventive screen against However, 12 positive cases reports on scientific research respiratory diseases. were reported among 108 on the plant and cultivation health professionals working has become more widespread Curmeric has demonstrated in less exposed areas who as its beneficial properties antibacterial activity against were not using the product. become more widely different bacterial strains acknowledged. These reports isolated from respiratory Following these results, also promote knowledge disease patients at the facilities at the National and aboutCúrcuma longa 's health Calixto García University Homeopathic Products benefits so that individuals Hospital. It also has Pharmacy were used to can choose whether or not to demonstrated antiviral produce Curmeric. Since April consume it after taking into activity, as it inhibits bovine 2020, more than 25,000 units account their specific needs. coronavirus, according to in of Curmeric mouthwash have vitro results obtained in joint been produced through large- CONTRIBUTIONS studies with Cuba's National scale cooperative production DURING THE COVID-19 Center for Animal and Plant between FARMABANA and PANDEMIC IN CUBA Health (CENSA). CEADEN, with the support of the Provincial Health The natural product Curmeric, As part of actions promoted at Department (DPS), the developed by the the beginning of the government of Havana, and Theragnostics Laboratory and COVID-19 pandemic to MINSAP's Pharmaceutical registered with the regulatory protect Cuban health Services Department. Curmeric entity of Cuba's National personnel, Curmeric was nasal drops were added as a Hygiene, Epidemiology and provided to health workers at new product and began

44 NOTEWORTHY production in September. Under the guidance of an research. Studies are carried Following COVID-19 outbreaks Innovation Committee out with the support of in May 2020 in different areas organized by MINSAP to MINSAP's Pharmaceutical of the Cuban capital (such as study drugs capable of Services and Natural and Cuatro Caminos, Puentes combatting COVID-19, three Traditional Medicine Grandes, Punta Brava, Arroyo observational clinical Departments. Arenas, Santa Felicia, intervention studies of Manduley), distribution of Curmeric mouthwash and Clinical studies are published Curmeric mouthwash began in Curmeric nasal drops were in Cuban Public Registry of the municipalities where the carried out in primary health Clinical Trials (RPCEC), the outbreaks occurred, in the care in populations under results of which have pharmacies closest to the COVID-19 quarantine in the prompted authorization of a epicenter of each event: capital municipalities of Plaza Curmeric clinical trial Cotorro Municipality de la Revolución and Regla designed to investigate its use (3 pharmacies), Centro Habana from September to the end in primary health care for (4 pharmacies), La Lisa of November, 2020. COVID-19 prevention. (3 pharmacies) Marianao (3 pharmacies), San Miguel del In order to confirm the safety MINSAP's National Program Padrón (1 pharmacy), Habana and prophylactic effects of for Health, Longevity and del Este (1 pharmacy) and Curmeric, in January 2021 a Aging recently approved a Plaza (5 pharmacies). study was initiated in dental project entitled “Developing clinics in the Plaza Cú rcuma longa Nutritional These pharmacies were Municipality to confirm the Supplements: Evaluating responsible for public effectiveness of the product Cúrcuma longa's Preventive education about Curmeric and in preventing COVID-19 Effects on Cognitive training of personnel involved. transmission in those Deterioration and Infectious Students from the University of services. Respiratory Disease in Havana's Nutrition and Geriatric Patients.” The final Pharmacy School joined in the CEADEN, FARMABANA, objective of these projects is packaging of the Curmeric Calixto García University to generalize the use of mouthwash for the COVID-19 Hospital, municipal health natural Cúrcuma longa's outbreak areas from May to institutions, Havana DPS and products based on scientific August, which also served as a the National Clinical Trials evidence, thus contributing practicum for their university Coordinating Center to solving our population's studies. (CENCEC) participate in this health problems.

Community-based team working on the project during the pandemic.

NOTEWORTHY 45 OVER A CUP OF COFFEE WITH... CONCEPCIÓN CAMPA HUERGO The Finlay Vaccine Institute suffered very severe sequelae: So, it was decided to carry out (IFV) and its VA-MENGOC-BC deafness, blindness, loss of a massive vaccination in the meningococcal vaccine have limbs or intellectual disabilities. whole country, which was also come up often in Cuba during It was very hard, and the a big challenge since until the last few months. IFV is children and adolescents were then, we had produced leading development of two the most affected. 100,000 doses but on a small Cuban vaccine candidates for scale. Now, we had to scale up COVID-19, an achievement The world had vaccines for to industrial production with with roots in that meningitis other types of meningococcal the same biological risks and vaccine developed 30 years disease, for groups A and C, also making certain to pass on ago. but not for group B, the one our knowledge and the that was ravaging Cuba. So we technology to new workers. Concepción Campa Huergo had to cultivate these highly From the 10 people who PhD is closely related to both pathogenic micro-organisms in developed the vaccine, we the Institute and the original the lab without the protection suddenly ballooned to 1000 vaccine. She is a founder of of a vaccine, and at the same working on it. This was a huge Finlay, was its first director, and time, with the risk of becoming challenge, because we were headed the research that asymptomatic carriers, since making vaccines for healthy resulted in the world's first that's also possible with children, and very small vaccine effective for serotype B meningitis. In such a case, the children at that. It was a great meningococcal disease. bacteria colonize the responsibility. nasopharyngeal region and the Listening to her is both infected person can transmit That vaccine was produced for interesting and moving, since the disease to their families all of Cuba at the end of the not only does she speak with and others. 1980s, between 1988 and feeling, but also offers details 1989. Once the epidemic about the more recent history We were a small group. Ten of ended, we went on to help of science in Cuba. In this issue us were the vaccine patent's other countries. There was a of Andar la salud (Along the authors, and you could say that huge epidemic in Brazil in Path to Health), Conchita (the Finlay was born from that 1990, and they requested name most people know her group. We put together the millions of doses, I think ten by) shares reflections and institution with the help of million in all if I recall correctly. memories related to her fruitful many centers, many people All that manufacturing was career, which is also linked to and scientists, not only in Cuba done in Cuba, at Finlay. Later, natural, traditional and but from the whole world. We the vaccine production plant complementary medicine. had tremendous collaboration; was built and we began everyone we called responded. producing other vaccines: the YOU DIRECTED THE FINLAY triple bacterial vaccine; for INSTITUTE FOR MANY We carried out a clinical trial leptospirosis; for typhoid fever; YEARS. WHAT WERE SOME that was advised and conjugated vaccines. OF THE MOST IMPORTANT conducted by the Centers for CHALLENGES YOU FACED Disease Control and Later came the great epidemic AND WHAT DOES THE Prevention (CDC) in Atlanta, in Africa of meningitis A, C, Y INSTITUTE MEAN TO YOU? USA, always with assistance and W-135. We had been from the Pan American Health prequalified by the World The Finlay Institute is just like a Organization (PAHO), which Health Organization (WHO) child for me. And likewise, the facilitated contacts with those and the vaccine was produced challenges remind me of the and other international in collaboration with Brazil, ones we have when we experts who also hoped to since here we didn't have the conceive a child, watch them find a solution to the problem capacities for the millions of be born and go through all the of B-group meningitis. doses requested. In Cuba, we stages growing up to reach produced the antigens and maturity. Finlay was born The clinical trial was carried out finish-and-fill was done in amidst the great battle against with 110,000 students between Brazil. meningococcal disease. There 12 and 14 years old, in which were only two of us when we we also used a placebo vaccine In general, I worked a great started on the mission to see for comparison. The result deal in the world of what we could do about it. At showed the that VA-MENGOC- meningitis, and all of it at that time, in the 1980s, a great BC was indeed effective, the Finlay, which at the beginning epidemic in Cuba was killing at first one effective against was called the Meningococcal least one child a day, and those group-B meningitis, protecting Vaccine Center. In addition, who managed to survive against this terrible disease. since there were so many

OVER A CUP OF COFFEE WITH... CONCEPCIÓN CAMPA HUERGO 47 seriously ill children, in order the entire world—is a complex to treat them we produced a Developing a system. So it's through the lens meningococcal gamma of complexity that the causes globulin by transfusing some vaccine in the midst must be viewed. I remember a of the people already of an epidemic visiting epidemiologist once vaccinated. Thus, the vaccine told us: epidemics are prevented the disease and the for a virus that denunciations of social gamma globulin saved many is so contagious, conditions. That is, just as lives. illness in a person demonstrates so lethal, and individual imbalances, an HOW DO YOU ASSESS so mysterious epidemic in a society exposes CUBA'S EFFORTS TO social imbalances; but when DEVELOP FOUR VACCINE has great merit. there is a pandemic, it is a CANDIDATES FOR denunciation of imbalances COVID-19? involving all of humanity. and, in general, Cuba has all I feel a great deal of respect, the necessary conditions for So then I learned to give admiration and satisfaction these vaccines to help the nutrition, emotions and other when I see our scientists country, the region and the aspects their due, and thus I making such great efforts to world. understood that epidemics and help address this pandemic pandemics are multifactorial with Cuban vaccines. I'm also WHY WERE YOU INCLINED complex systems. You can't pleased to see that there are TOWARDS NATURAL, limit analysis to just one four candidates because this TRADITIONAL AND element. Pasteur himself said means that there are many COMPLEMENTARY that the causes of disease groups determined to find MEDICINE? WITHIN THIS, don't depend on micro- solutions. There is nothing WHAT AREAS HAVE YOU organisms alone, but rather simple about attempting a CONCENTRATED ON? AND where these organisms settle vaccine for a new disease. WHAT DO YOU THINK as well. Otherwise, how can it ABOUT ITS USE IN CUBA TO be explained that this To make a vaccine, first you HELP ADDRESS COVID-19? coronavirus isn't harmful at all have to have a good for some people, such as those understanding of the disease, I knew nothing about natural who remain asymptomatic, the causal agent's behavior medicine, but in the 1990s, we while for others it manifests as and that of the people had a neuropathy epidemic in a simple cold and for others infected. In the case of Cuba and in that context, the still, it leads to an intensive COVID-19, vaccines are being National Operational Group care unit and death? developed in various parts of was created, including experts the world at the same time that from a number of fields. There Natural medicine's fundamental scientists are gaining an were great debates among the philosophy is rooted in the understanding of the disease scientists, since those of each concept of complexity, and I fell and the virus. Viral disease specialty wanted to in love with the approach vaccines are also more demonstrate that the understood and used by this challenging than bacterial epidemic's causes resided in medicine to address health disease vaccines, since virus their field. The nutritionists problems, as well as its mutations can jeopardize the thought that it was a nutritional approach to prevention, work already carried out. It all problem; the biologists mitigation and cure of disease. depends on the mutation's believed the cause was a During the neuropathy speed and the form it takes. pathogen, specifically a epidemic, I came in contact with Developing a vaccine in the Coxsackie virus; the experts in different specialties midst of an epidemic for a virus toxicologists said it was a of natural medicine. This field that is so contagious, so lethal, toxin. The debate went on for has a million methodologies, and so mysterious has great several months. International techniques, visions, but always merit. experts came from each of these are cosmic views that start these fields, and finally the with a multifactorial analysis of Here in Cuba, we have well- most interesting thing was that any disease process. At that trained scientists, installed the causes turned out to relate time, from my post at Finlay, I technology, knowledge and to all three factors. encouraged exchanges with skills, quality control systems, experts in all the related experience in clinical trials, a That epidemic taught me that modalities: homeopathy, floral strong regulatory authority that any illness—whether in one therapy, magnet therapy and monitors the whole process person, a group, a country or aroma therapy, among others.

48 OVER A CUP OF COFFEE WITH... CONCEPCIÓN CAMPA HUERGO Concepción Campa Huergo PhD

What I have most tried to to help prevent and mitigate INTERNATIONALLY. WHAT promote is homeopathy, which symptoms, and make this WOULD YOU SAY TO has been applied during pandemic more bearable. This COLLEAGUES IN CUBA AND various epidemics here in is the case with diet therapy, AROUND THE WORLD Cuba, including those of for example, that helps people RIGHT NOW? leptospirosis, conjunctivitis, decide what to eat when, at hepatitis A in eastern Cuba, what point during the year, and First, I would pay tribute to all A/H1N1 influenza and dengue. also emphasizes the need to those who are making such an Another of my favorites is floral avoid toxic habits like smoking, effort to help control this therapy, which works on the as well as the importance of situation, and I would wish emotions. Managing emotions getting enough rest and them all the best, and most is quite important for avoiding unnecessary stress. importantly, great success in maintaining health. It's vital to maintain such their work. I'd also say they balance, whether nutritional, should do their work with great In the context of COVID-19, environmental, emotional or love and tranquility, since this I'm very pleased with the use biological, so that the immune is vitally important. That way, of PrevengHo-Vir as part of the system is at peak performance you can better observe country's response to the to better combat disease. processes and phenomena, pandemic. This PrevengHo-Vir with greater precision and at formula was developed with Within natural medicine, you the same time, with a broader help from the international can find many things that help perspective. homeopathic community. the immune system. One Curmeric , that comes from example is moringa, with which We have to realize that Cú rcuma longa, is another I'm working now, a magnificent COVID-19 is a disease pharmaceutical that has been immune system stimulator that influenced by many factors, used, and is also very good. contains many antioxidants, including mental health. The Cúrcuma longa has many vitamins, minerals and essential sadness that some people may properties. amino acids. feel that comes with isolation or confinement isn't good. And Additionally, I think that any YOUR REPUTATION AS A that is something also aspect of natural medicine that SCIENTIST PRECEDES YOU deserving of research, of our promotes equilibrium is going BOTH IN CUBA AND attention.

OVER A CUP OF COFFEE WITH... CONCEPCIÓN CAMPA HUERGO 49 A STORY TO TELL

During the pandemic in Cuba, DR. RICARDO PEREDA Dr. Ricardo Pereda González has worked in one of the most GONZÁLEZ: COVID-19 sensitive areas, since he is responsible for coordinating CLINICAL EXPERTS clinical patient care and related to it, the performance COMMISSION of health professionals in hospitals and especially in intensive care units (ICUs) for COORDINATOR all serious and critical patients.

Dr. Pereda González is a first- degree specialist in internal medicine and a second- degree specialist in critical care medicine; as well as an associate professor and adjunct researcher at the Medical University of Havana. He coordinates the Clinical Experts Commission that has been part of the island's response to the pandemic. He shared his thoughts on what this assignment has meant to him:

“Above all it has been a huge challenge—both personally and professionally. I have felt the great trust that the Ministry of Public Health (MINSAP) has placed in this group of clinical experts, from the National Commission to those in each health institution participating in the COVID-19 response.

“At the same time, I have had the opportunity to learn by systematically interacting with doctors in the red zone and with expert commissions in the different hospital s of the country. To my personal stores of knowledge, I have been able to add lessons from the daily practice and experiences of these specialists caring for patients on the front lines of the pandemic.

On a daily basis, I have witnessed the immense potential of the Cuban scientific community: doctors, Dr. Ricardo Pereda Gonzá lez (left) with MINSAP's National Director of Epidemiology, Dr. Francisco Alberto Duráí n Garc a

engineers, mathematicians, operational working group American Health Organization sociologists and geographers; that goes from the ministerial (PAHO) have been very useful, people who, with the greatest level to each health including the innumerable possible humility and institution dedicated to conferences and exhibits transparency, have shared the COVID-19 patient care. featuring each member experience they have gained Several times a day, the country's experiences during through years of dedicated group discusses and the pandemic. Likewise, WHO research. The results of these evaluates the clinical guidelines have been a great Cuban scientists and the situation of the people who asset in our understanding island's magnificent research are sick, and makes decisions and management of the virus. centers have been made regarding therapeutic Collaborative work and available for whoever needs strategies or changes, and collective intelligence have them. the follow-up they require, both been promoted in a true based on these analyses. expression of the socialization “Interacting with the scientific of knowledge. community has always The main strengths of this provided new perspectives process lie in its transparency “In general, the fight against regarding action in the face of and the intellectual and COVID-19 has been very challenges posed by a novel professional enrichment made intense, and rest has been put disease that is still not yet possible by such ample on the back burner by most of fully understood, but these debates. The scientific or the people working in the challenges have enabled the academic rank of the country's response to the individual and collective participants doesn't matter; pandemic. One of the most growth of the Cuban medical much has been learned from interesting things about this community. excellent young physicians pandemic is that it is not an working in the red zone. They individual phenomenon, but a “Additionally, I have had the are the true heroes of the collective one. During this chance to work directly with Cuban response, who with context of dedication and the President and the great sacrifice have solidarity, I have experienced country's highest leadership contributed to the results we great human, spiritual and as part of our work in have seen. We are also scientific growth. I am proud confronting the COVID-19 constantly learning from our to be part of the medical pandemic, which is a scientists and evaluating the community that, together with testament to the high priority best international the state and the government, the Cuban state has given to experiences. has confronted this situation addressing the disease. in Cuba. Being able to offer “Regarding international my modest contributions to “The Clinical Experts experiences, activities help our society fills me with Commission constitutes an convened by the Pan joy.”

A STORY TO TELL 51 PUBLICATIONS: HEALTH PSYCHOLOGY'S ROLE IN ADDRESSING COVID-19 IN LATIN AMERICA (Spanish)

Read the book at: https://alapsa.net/wp- content/uploads/2021/02/alapsa2021a.pdf

This book was compiled by the Latin American Health Psychology Association (ALAPSA) with support from the PAHO/WHO Offices in Cuba and CEDEM publishers.

Its aim is to share the experiences of psychologists in 11 Latin American countries in their professional, scientific and academic endeavors since the beginning of the COVID-19 pandemic.

The book offers a sample of the psychological intervention strategies used to address the difficult epidemiological conditions and growing demand for services as a result of the disease itself and measures to control it, obliging professionals to search beyond The Pan traditional means for providing psychological care. American Health Organization (PAHO) works with the countries of the Americas to improve their populations' health and quality of life. Founded in 1902, it is the world's oldest international organization dedicated to health. It acts as the Regional Office for the Americas of the World Health Organization (WHO) and is the Inter-American system's agency specializing in health.