Implications of Repealing the Cuban Embargo for US Medicine and Public Health
Cuban researchers have been conducting world-class medical research on vaccines and preventive medicines and are eager to establish collaborations with American scientists.
1 For several decades, Cuba’s Finlay Institute has successfully developed and produced inexpensive vaccines against hepatitis B virus (HBV), meningococcal meningitis, leptospirosis, and dengue virus that have been used worldwide. In 1989, Cuba produced a serogroup B meningococcal vaccine, based on the outer membrane vesicles of specific outbreak strains, to prevent childhood meningitis. The vaccine has been widely used throughout Latin America, but not within the US. The US Food and Drug Administration approved its first serogroup B meningococcal vaccine, which was manufactured by a subsidiary of Pfizer, in 2014.
In 1994, Cuban researchers at the Center for Molecular Immunology began developing novel therapeutic vaccine candidates for non-small-cell lung cancer (NSCLC), a leading cause of mortality among Cuba’s cigar-smoking population. The CimaVax-EGF vaccine, which contains a ligand of the epidermal growth factor receptor (EGFR) to stimulate anti-EGFR antibodies, has been shown to extend survival of NSCLC by several months in a phase 2 clinical trial.
3 Earlier this year, the Roswell Park Cancer Institute in Buffalo, New York, finalized an agreement with the Center for Molecular Immunology to conduct a clinical trial of CimaVax-EGF for a potential application to the US Food and Drug Administration for approval.
4 A second therapeutic vaccine candidate for NSCLC, racotumomab, is currently being evaluated in a multicountry phase 3 randomized controlled trial (
ClinicalTrials.gov #
NCT01460472). Fostering collaborations between innovative but underfunded Cuban scientists and American scientists could lead to more scientific and medical advancements.
In addition, American universities may develop more formalized programs to send students to Cuba to learn alternative approaches for delivering primary health care and preventive medicine within accessible community-based clinics (polyclinics) and neighborhood-based clinics (
consultarios).
1 Cuba recently became the world’s first country to receive validation from the World Health Organization for eliminating mother-to-child transmission of HIV.
5 They achieved this goal by integrating maternal and child health programs with HIV programs while maintaining a focus on universal health coverage. If the US and global health communities are to reduce the 240 000 new child HIV infections in 2013 to the target of less than 40 000 new child HIV infections per year,
5 then some lessons should be learned from Cuba’s accomplishment. Conversely, US graduate medical education programs may eventually draw upon Cuban foreign medical graduates for the hundreds of unfiled primary care residency positions each year, but this would first require change within the Cuban laws.
The US and Cuba have maintained two of the largest global health programs, and efforts to address HIV and emerging infections may benefit from greater cooperation. Cuba has sent over 100 000 physicians to work in developing countries since 1961
1 and recently deployed a large delegation of physicians to address the Ebola outbreak. Expanding opportunities to address existing and emerging global health challenges, perhaps in collaboration with the US President’s Emergency Plan for AIDS Relief program, could improve the global delivery of health services, infrastructure development, and medications.
Diplomatic relations between the United States and Cuba changed course in December 2014, when President Obama announced plans to improve ties with the small island nation. During the ensuing 8 months, there has been a flurry of executive and legislative activity—travel and banking restrictions have been eased, the sitting American President and Cuban President (Raúl Castro) met for the first time in over 50 years, respective embassies have been reopened, and new legislation has been proposed and approved. Although the Republican-led Congress has not yet repealed the 55-year-old US trade embargo against Cuba, a normalization of relations in the near future now seems almost inevitable.
In February 2015, Representative Charles Rangel (D, NY) and Senator Amy Klobuchar (D, MN) introduced the Freedom to Export to Cuba Act of 2015 in both the House of Representatives [HR 634] and Senate [S 491]. More recently, Senator Jerry Moran (R, KS), along with Representatives Tom Emmer (R, MN) and Kathy Castor (D, FL), introduced the Cuba Trade Act of 2015 [S 1543; HR 3238]. Both bills would lift the embargo by allowing private-sector businesses to trade freely with Cuba while still prohibiting taxpayer funds to be used on promotion or development of the Cuban market. They would also repeal or amend all of the primary bills that currently restrict trade and travel to Cuba, including the Foreign Assistance Act of 1961, Cuban Democracy Act of 1992, and the Cuban Liberty and Democratic Solidarity Act of 1996.
The process to repeal the Cuban embargo accelerated in July, when the Republican-controlled Senate Appropriations Committee passed a measure to allow for American citizens to travel freely to Cuba. The same committee also attached amendments to a financial services appropriations bill to allow private financing for agricultural sales and lift restrictions on ships that have docked at Cuban ports. The appropriations measure was the first piece of legislation to pass any congressional committee, and the amendments increased the likelihood that the embargo issue will be voted on by the full Senate.
A dismantling of the Cuban embargo by Congress will almost certainly have a greater impact on Cuba’s society and health care system. For example, better availability to more advanced technologies and expensive therapeutics might divert attention and funding away from Cuba’s historical focus on preventive medicine. However, there will also be effects on the US medical and public health communities. The single biggest positive change from normalizing trade and travel with Cuba may be improved opportunities for research collaborations between American and Cuban scientists.
Although opposition to repealing the embargo remains vocal, the overwhelming majority of Cubans and a growing majority of Americans support an embargo repeal and normalizing relations. A Pew Research Center poll conducted in July reported that 72% of Americans favor ending the embargo.
6 Even Latino and Cuban-American voters now favor a presidential candidate who supports normalizing relations over a candidate who would not.
7 The dissenting minority will argue that policy reversals will legitimize the Cuban government, but the US Congress has already concluded, “one of the most complex and longstanding embargoes in modern history has failed to achieve its stated purpose.”
8 Meanwhile, foreign companies have been rushing to get a foothold in the liberalizing Cuban market, which leaves American opportunities at a clear disadvantage once trade restrictions are repealed. Cuba already provides medical care for thousands of medical tourists from other countries, and US-based companies and Cuban health officials have begun preparing for an influx of the estimated 750 000 Americans who travel abroad for care each year.
7
President Obama has been clear on his desire to normalize trade relations with Cuba, and the two bills being considered in Congress would dismantle the embargo. Given the bipartisan backing of legislation and growing public support, a complete repeal of the Cuban embargo may occur soon. The result will be mostly beneficial for the US medical and public health communities, but will also create a new market for American medical tourism. Potential collaborations should be guided by the shared principles of equitable access to health care and may open up a new era of cooperation to achieve common global health goals, which—in the end—may also encourage democracy.
Just for a promising vaccine to fight lung cancer is enough for me.
So you stay up in S. Dakota and let the rest of the country be.