HAVANA — At around 4 p.m. most weekdays, children in red and white uniforms are walking home from school alongside their families. Almost all of them — along with their siblings over age 2 — are vaccinated against Covid-19.
Two years into the pandemic, Cuba has notched up a series of firsts.
Cuba is the only country currently vaccinating the majority of children as young as 2, inoculating them with its own Covid-19 vaccines, the smallest country in the world to have developed its own. Along with Chile, Cuba has the Americas' highest vaccination rate, with 94 percent of people having received at least one dose.
“It’s a terrible dichotomy,” said Helen Yaffe, a Cuba expert and lecturer in economic and social history at the University of Glasgow in Scotland. “Cubans themselves are acutely aware, on the one hand, that they are the only country in Latin America and the Caribbean to have produced a Covid-19 vaccine. And at the same time, Cubans are struggling to get antibiotics, paracetamol and diabetes drugs.” (Paracetamol is known as acetaminophen in the U.S.)
The island started vaccinating its pediatric population in September. Out of cash and wrestling with its biggest economic crisis in three decades, the island had to rely on donations of millions of syringes from groups in the U.S. But by the end of last year, doctors and nurses had fully vaccinated 95 percent of children ages 2-18.
“In my opinion, we're the only country that really performed a mass national mass vaccination campaign for children,” said Dr. Vicente Vérez, the director of the Finlay Vaccine Institute, the Cuban epidemiological research institute that developed The institute developed the Soberana 2 and Soberana Plus vaccines.
Vérez, along with other Cuban scientists and international public health experts, say mass vaccination of children — who are less at risk but are major transmitters of Covid — helped the island stave off the latest wave of the omicron variant of the coronavirus, which hit Cuba much less severely than had been feared.
“If you compare omicron in Cuba with omicron in Europe, you will find it was 10 times lower,” he said. It’s not possible, he went on, to explain that “just by saying that all the adults are vaccinated — because the adults are vaccinated in many countries.”
Infection rates in Cuba are down by more than 80 percent from their January peak, and the island is registering just a few hundred cases a day, with no Covid deaths in the last few days, according to data from the Public Health Ministry. The evidence is borne out anecdotally: When the delta variant was rampant last summer, everybody in the capital seemed to know someone who had Covid; now, hearing about somebody with the illness is rare.
With adult populations vaccinated against Covid, many countries have pivoted to immunizing children. The World Health Organization now recommends that countries vaccinate children as young as 5, provided adult and high-risk populations are covered.
China and Chile are vaccinating 3-year-olds. The U.S., too, is going younger: In October, the Food and Drug Administration greenlighted the use of the Pfizer-BioNTech vaccine in children as young as 5 (Pfizer will soon apply for FDA authorization to vaccinate children from 6 months to 4 years).
More data?
While vaccinating children means less Covid for everyone, public health experts said they’d like to see more data from Cuba about its Covid-19 vaccines. Cuba hasn’t published late-phase, large-scale trial data in peer-reviewed journals.
“The Cuban government, and the scientists who are working on these vaccines, do need to provide the global public community with data to instill confidence,” said William Moss, the director of the Johns Hopkins International Vaccine Access Center.
Cuban vaccine developers reply that they have published two articles with trial results of their vaccines in peer-reviewed journals — the Lancet America and Vaccine published data from phase 1 trials — and have more in the pipeline.
Trials, they say, found two doses of Soberana 2 followed by a dose of Soberana Plus to be over 90 percent effective, with no severe adverse effects in children. Adverse reactions were found in less than 0.01 percent of the 1.7 million children who were vaccinated, they say.
Cuba is applying for WHO “prequalification” for three of its Covid vaccines, a seal of approval needed if it is to sell its vaccines to COVAX, the WHO mechanism that has distributed 1 billion doses of Covid vaccines to low- and middle-income countries.
Vérez, the vaccine developer, said Cuba will submit all of the data to the WHO by the end of March.
Before it awards prequalification, the WHO assesses a vaccine’s safety and effectiveness and inspects the quality of its production facilities. Cuban vaccines have been prequalified in the past. But analysts say Cuba may be putting off submitting all data until a new vaccine production facility in the Port of Mariel, which was inaugurated in November, is fully operational.
Cuba, a one-party state, hasn’t allowed an anti-vaccination movement to take root, as similar movements have in the U.S., Canada and other Latin American countries. As the government controls the media, there aren’t voices on TV or in newspapers that question the vaccines’ safety.
But there are also positive reasons to explain the low rate of vaccine hesitancy on the island. Unlike mRNA vaccines, such as Pfizer-BioNTech’s and Moderna’s, or adenoviral-based vaccines, like Sputnik V, which use groundbreaking technology, the vaccine platform Cuban scientists have used to build their Covid shots has been around for decades.
“At the molecular level, we used somewhat more traditional technology,” Vérez said. “These recombinant protein [vaccines] are more traditional in the sense that we know what happens, because we have used some of them for a long time in children.”
Dr. Peter J. Hotez, the dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston, said, “Protein vaccines generally have a good safety track record.” He added that protein vaccines are common for inoculating children against hepatitis B and haemophilus influenzae type b.
Cuba began investing in biotech in 1981, just five years after the world’s first biotech company, Genentech, was incorporated in the U.S. The sector now employs 20,000 people.
“Cubans are used to domestically produced vaccines,” said Yaffe, the University of Glasgow scholar. The island produces eight of the 12 vaccines used in its childhood immunization program.
And on an island that has the world's highest doctor-to-patient ratio, rollout was rapid. “The culture of prevention through the use of vaccines is promoted by community health workers that know their neighborhood, know the families and help ensure that every child gets vaccinated,” said Dr. Jon K. Andrus, a former regional immunization program director for the Pan American Health Organization and a professor of public health at George Washington University.
Zenia Vega, whose 4-year-old daughter, Alexandra Albisa, was vaccinated last year, said: “My daughter’s more likely to stay healthy now she’s vaccinated. Children are a priority in Cuba.”
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