Mr Danilo Alonso Mederos, Cuban ambassador in Prague, gave us this interview on the subject of the Covid-19 pandemic, vaccines and the right to health.

All over the world there is a struggle to win the Covid-19 pandemic. There are important advances, but unfortunately also major contradictions and delays in tackling this problem. We heard that Cuba is working to produce a vaccine against Covid-19.

When could it be ready for use?

Cuban researchers, since the beginning of the COVID-19 pandemic, began working tirelessly to obtain a vaccine against this disease that has done so much damage to humanity.

Today the country has five vaccine candidates: Soberana 01, Soberana 02, Abdala, Mambisa and more recently Soberana Plus.

The Soberana 02 vaccine began its third phase in early March of this year and is expected to conclude this stage in June. It is the first vaccine in Latin America to reach this phase of study. If the results continue to go as they have so far, it should be ready for use in July 2021.

What is the possible schedule for vaccinating all Cubans?

Once phase III of Soberana 02 is completed in June, it is estimated that vaccination of the entire Cuban population could begin in July, and there is the will and the decision to immunise all Cubans before the end of 2021.

The country has the necessary production capacity to produce 100 million doses of the vaccine this year, which makes it possible to ensure 100% vaccination of the entire population and to have an additional quantity to meet requests from different countries.

What do you think of the proposal to suspend patents on Covid-19 vaccines, promoted by India and South Africa and supported by more than 100 countries?

The issue of patents and the commercialisation of scientific productions, in my personal opinion, would require a different approach.

Even if it is a fair proposal, I think it is extremely difficult for it to succeed despite the fact that many countries support it. There are many economic interests involved and it does not seem that the pharmaceutical transnationals and the most economically powerful countries would make this idea viable.

It is not just about COVID-19, the issue of patents covers all scientific production in the different fields of knowledge and its commercialisation.

Science and scientists could build a better world based on international collaboration where solidarity and not selfishness prevail.

Surely, if there were more cooperation and a fairer distribution of resources in the world, the poverty, misery and famine suffered by millions of people today could be eradicated.

Europe has great doubts about the technological capabilities of other states and, therefore, a certain suspicion about vaccines that are not produced in the West. What is your point of view?

These doubts are unfounded and have no scientific basis. This is not only true for vaccines but also for many medicines that are not developed by transnationals.

On the one hand, it may be related to the protectionism of these transnationals that favours the production of their vaccines and the market they might lose.

It may also have to do with the neo-colonialist thinking that underlies some and the disbelief that countries with fewer resources are capable of making important contributions to scientific knowledge.

The mass media also play a negative role in these doubts. Not much is reported about what is being done in countries that belong to geographical areas outside the so-called West.

If you look into the origins of scientists working in universities and research centres in the West, you will find many renowned scientists who were born in other parts of the world and have migrated for economic reasons to Western countries. In many cases they have obtained these jobs through self-management, but in others through substantial material offers to develop their activity in the West. This is what is known as brain drain.

The data show that the impact of the coronavirus in Cuba has been minimal. What measures have been taken to minimise contagion?

First of all, health is a right of every Cuban citizen and this is enshrined in the Constitution. In Cuba there is a national public health system that provides free care to all Cubans regardless of their economic resources, race, religious and ideological beliefs or any kind of discrimination.

In our country, health is not only a right, but a priority. There is nothing more important than human life. Based on that principle, no effort or resources are spared in the prevention of disease and its treatment.

It is understandable that the pandemic aggravated the economic situation in Cuba because, in addition to the persistence of the economic, commercial and financial blockade that the United States government has imposed on our country for more than 60 years, there were also the effects of an extremely aggressive US administration against Cuba, which imposed more than 240 new measures last year to asphyxiate the country and cause Cubans to give up their gains and their sovereignty.

In Cuba, the purpose of the health system is not only to guarantee the health of citizens through appropriate treatment, but also to ensure timely prevention. In this respect, we have had several positive experiences.

It is also worth noting that the ratio of doctors per 1000 inhabitants is one of the highest in the world. Cuba has high health indicators, many of them equivalent to those of Western countries and in many cases higher than those of more economically developed countries. Among the main values are the infant mortality rate and life expectancy at birth.

Specifically, in the fight against the COVID pandemic, active screening is a key element. This refers to the search for people suspected of being infected before any symptoms appear. It is noteworthy that in Cuba more than 50% of the detected cases have been asymptomatic.

Another important measure is the early hospitalisation of all infected persons and the confinement of their possible contacts until it is determined whether or not they have been infected. This prevents transmission of the disease in communities.

International experiences are also studied and many of the measures that have been used successfully in other countries and the recommendations of the World Health Organisation are applied.

In addition, protocols for the care of the sick and those admitted to intensive care units are continually being developed and improved.

Medicines developed by the Cuban biopharmaceutical industry are used with good results in other similar diseases. Medicines have been distributed to the healthy population to boost their immunisation levels so that, in the event of acquiring the disease, they are better prepared to overcome it.

To date, more than 90 per cent of Cubans who have fallen ill have recovered, and the case fatality rate in Cuba is 0.6 per cent, one of the lowest in the world.

There is a major lack of vaccines in Europe; the Czech Republic is in a state of emergency, but there is currently no possibility of using the Russian or Chinese vaccine. What do you think of this situation, which I call the “cold war of vaccines”?

This question is partially answered in the previous topics.

Perhaps the regulatory bodies and mechanisms in place should have been more expeditious while remaining rigorous and safe. If these vaccines have proven their efficacy and effectiveness in line with established standards, there would be no reason not to use them.

The pandemic has no ideology and neither do vaccines. The longer immunisation with vaccines is delayed, the more people will continue to contract the disease and, sadly, the more people will die.

Last year, Italy was suddenly hit by the virus in a devastating way. Help came from China, Russia and Albania. The Italians were moved by the arrival of doctors and nurses from Cuba. What can you tell us about these solidarity missions?

International solidarity is a principle that characterises the Cuban people. For us, solidarity does not mean giving what we have to spare, but sharing what we have.

Our people have always been grateful for the many expressions of solidarity we have received at different times in history, and our way of expressing this gratitude is to offer solidarity to all those who need it.

Since the early years of the Cuban Revolution, medical brigades have gone to different parts of the world to face natural disasters or health needs in countries that have required it. To cite just a few examples, I can mention the earthquakes that struck Pakistan and Haiti, or the Ebola response in Africa. Cuban doctors have gone to the most remote places in the world to contribute to the care of people in need.

In 2005, following the hurricanes that hit the Central American region, the Henry Reeves Brigade was formed, a contingent of specialised doctors to deal with disasters and serious epidemics in any country that requires it. Fifteen years after its creation, the brigade has left its mark on the world

The COVID pandemic was no exception, and given the international situation and the requests from numerous countries, the presence of Cuban doctors was not long in coming.
I can tell you that in the course of 2020, their presence has reached 39 States. More than 550,900 people have been treated and 12,488 lives have been saved. More than 3,800 Cuban health professionals have participated, 61.2% of whom are women.

For the first time, European countries requested the presence of the Cuban medical brigade, among them Italy. The Italian people welcomed our doctors, who, with their daily work and the Cuban character, won the affection of the Italians.

Cuban doctors and health personnel are permanently ready to help in any country in the world. For these reasons, the Cuban Medical Contingent has been nominated by numerous personalities and organisations for the Nobel Peace Prize in 2021.

What technology is the Sovereign 02 vaccine based on?

The Soberana 02 vaccine is a conjugate vaccine because it has an antigen that fuses with a carrier molecule to reinforce its stability and efficacy. It has a very safe technology because it uses a technological platform that has already been used successfully in other vaccines manufactured in Cuba.

In its development, a toxin was attached to the protein with which the virus attaches to the cell. Its action is based on a type of antigen that is used on the spike of the virus, which is the key with which the pathogen enters the cell. Thus, when the virus tries to enter the cell using this protein, an immune reaction is generated against the toxin carried by the protein, blocking its entry into the cell.

Another important issue is that Soberana requires only 8 to 2 degrees of refrigeration. The antigen is safe as it does not contain the live virus but parts of it, so, according to experts, it generates immunity but does not cause major reactions and therefore does not need extra refrigeration like other COVID vaccines developed in other laboratories…

Are there any age-related restrictions on its use? In particular, can it also be used with older people or are there age limits?

So far, no age restrictions have been established for its use.

However, as part of the Phase III efficacy testing process, it has been decided to administer the vaccine to 44,000 people within 30 days from 8 March 2021, which will allow the completion of efficacy studies.

People between 19 and 80 years of age have been selected for this phase III trial, but other age groups will be tested at a later stage to ensure that there are no age restrictions.

The phase III trial should demonstrate that the vaccine candidate meets the expectations and requirements not only of the national regulatory agency but also of international agencies.

Will it be administered in 1 or 2 doses?

The final decision on how many doses will depend on the results of the Phase III trial.

Phase II studies concluded that after the two doses more than 80% of those vaccinated had a positive response. This % rose to 96% when a third dose was administered.

In Phase III, one group of people will be given two doses and followed for three months. Another group will be given three doses and will also be followed up to finalise the study and establish a definitive vaccination schedule.

Do you have any data on the effectiveness in terms of the new strains or mutations of the virus that are appearing?

According to the Cuban researchers, Soberana can protect people from the variants of the virus that have emerged in different countries by applying two doses of Soberana 02, and a third dose of Soberana Plus is being considered to reinforce the antibody response to the virus.