COVID-19 Vaccines in Cuba: From Production, to Clinical Trials,
to Widespread Use
The UAB School of Public Health welcomes Pedro Más Bermejo. MD, PhD, DrCs, Professor at the Tropical Medicine Institute “Pedro Kouri” in La Habana, Cuba. Dr. Mas is a physician with dual specialties in epidemiology and public health, has published five books and more than 90 papers primarily dealing with epidemiology and public health, is Editorial Board member Journal of Public Health Policy and MEDICC Review Journal and a member of the American Public Health Association.
Since the Cuban response to the COVID-19 pandemic began, Dr. Mas has been called by the country’s government to coordinate an ad hoc group to carry out epidemiological research to help the decision-making process. Please join us for his presentation “COVID-19 Vaccines in Cuba: from Production, to Clinical Trials, to Widespread Use.”
Good morning and welcome to this special preap webinar I’m Paul irn uh Dean and professor in the School of Public Health here at UAB and I want to welcome you to this uh seminar special seminar um that is being provided by my friend and colleague Dr Pedro
Maso uh let me provide a little bit of a little bit of an introduction and and then we will uh we’ll proceed with the with a webinar Dr pedras bero is a physician with dual Specialties in epidemiology and public health he is a Meritus research scientist at the tropical medicine Institute known as
Pedro kuri he is a Meritus member of the Cuban Academy of Sciences and full professor of epidemiology and Public Health at the National School of Public Health in Cuba Dr bomeo graduated from Central University in Cuba and trained in epidemiology he did his PhD in Charles at Charles University uh in the Czech
Republic he then served in the ministry of Public Health as National director of epidemiology and completed a fellowship uh at the Liverpool School of tropical medicine in the UK his major academic appointments were General director of the National Institute of hygiene and epidemiology in Cuba the Pan-American Health Organization as sustainable development
And environmental health advisor in Jamaica and coordinator of Cuban Cochran Center he has served numerous times uh as an adviser for who for pahoe that’s the panamerican Health Organization uh and for um who expert committees and the uh wh collaborating Center for Health and housing he has
Worked um in epidemiology and a health advisor in many uh countries uh including Ecuador Mexico Thailand Costa Rica Costa Rica uh Jamaica and and many more uh Dr Mero has published five books and more than 90 papers primarily dealing with epidemiology and public health he is an editorial board member
Of the Journal of Public Health policy and is a member of the American Public Health Association since the Cuban response to co 19 pandemic began he has been called by the country’s government to coordinate an ad hoc group to carry out epidemiological research that will help uh in making informed
Decisions uh I had the very good fortune of uh working with Dr bomeo on a manuscript a couple of years ago uh and have continued um uh collaborating with him uh most recently when uh I was able to visit Cuba uh in the early part of
This year uh we had um plan for Dr bomeo to be here at UAB in person uh and to travel with me to the APA annual conference unfortunately um he was unable to receive um a visa to be able to travel here and so uh we are making
This webinar uh available to you he is joining us from the pahoe offices uh in Havana Cuba so without uh without further Ado uh let me turn it over to uh Dr Pedro M bero and and welcome you virtually to UAB Pedro it’s all yours thank you very much for the
Introduction I I appreciate a lot the invitation for the to be here and to share with you some experience from you um I am really very proud to be here sharing with you these ideas results that well I am going to start with the this presentation as you know the time
Is is the not not too long I just put it in that the main results taking into account the the the qan vaccin from the production clinical trial thre use and these three three ideas I’m going to combine during the presentation and if you have some question I’m totally
Open well this the first of all I I have to speak about the health system here because it’s the place that we are working with the vaccine and the response to coid 19 um we have different the minister of Health National level we have a a province or
Municipality level the with the in the National level there are the National Hospital and the national Research Institute and of course the university because in Cuba the the doctor the the medicine University belongs to the minister ofth um at The District Health that meaning provincial in our case there are
District Hospital Health Service and training research place at that at that and the the division meaning at the we call here we have the health Cent is primary healthare most healthare Mon and of course in the the small village you have he workers but in our case all the head workers in our
Village are all of them are interconnected the national system and it’s a totally free the service and this connection meaning that you have a if you need extion for the National Hospital is will be used at the local place this one of the tou that we had in the andot the response to
The um this is one idea just to to show you how the system is this process of innovation because many things happen during the last year and this is Circle and you see the outside of the circle political historical demographic epidemiological socio economic cultural and geographical all the environment factors that
Included for children in the health system and of course there is a a political mean Health policy planning and the Health Resources the health needs intervention that have to to be done the process of Health Sy and of course finally we get the health more important for this processing of in of
Innovation I have no no time to explain this but maybe another time I can do be more here well this is a a publication that I read many years ago engage Innovation economic growth and health um they said that the traditional way view of of health is a
Is a guess is microeconomic Right health is Ru with follow and the other point you can read is this the the reference there and and the other point is EMP empirical evidence that some countries will low per capita growth is our case domestic prod have life expy comparable with those
With that’s our case and with the FY of line and now we have some approach in the public health that didn’t change because the the Cur situation world and talking now this is the health Sy now going to speak very short about the biotech cure is the state is the the
Main investor and the scientific and Technical preparation of the of the training is in University in of Excel and the significant invest investment in education and the and the training resource of human resource and gr close relation is very important one when I go deeply with the presentation about the Q vaccine is
Close relation between the health system and the health need of the population and this Pro development primar focus on the health need of the and the pr of devel subtitute for imports and sufficient National demands and National Health grows and the National Market is the highest Priority One Another point that is very
Important and this industry biotech is a is gr Center more than 15 or now it’s growing up it’s maybe we have around 20 now H completed they made research production marketing and after sales cycle and this cycle is very important for the approach of this and they have a Synergy between research
And development and free of any individual compromise each Institute contri contribut it and create a new prods and obtain that collaboration within and with the institution it’s a very important point because collaboration we are working in the research ter we are working like a net this and G in
International competition in term of quality production volume cost and and collaboration with developing count for us is a priority Pro that we have I I going to explain the vaccine and but there are men that we are produce and share with develop we see Cas later well this is a a
Photo screen with the all the not all but most of the center of Biotech and we include the University of abana on the left and the University of Medicine of of abana as well and all of them are coordinated by by CUA far is a national big Enterprise that have
A AC Church all you see the there very good condition very comp well I’m going to speak about the qan experience maybe some of you say why because to start with the immunization campaign with coid 19 is not like said well let’s do we it this that is why I want to
Share you the experience of 55 years in in coun this is a article is published in8 in the panamerican Health Organization this is in Spain but you can you can find in English and Portuguese if you I am talking about 55 years of imation and this table is in the article
I me a summary that the rate of incidence and mortality from vaccine of communicable disease and vaccination cover pre prior the land of human program 55 years later by on the right you can see the on the left sorry you can see the disase that this the
Incidence the the second one is you see thisa 20, population and Poli and hepatis and at that time the coverage is very very low very very low and of course the morality very after 55 years in 2015 you will see the incidence of this disase is zero just 0.5 one 100,000
Because this vaccine came after the problem with he Hepatitis B and mortality but you see how high is the coverage of the of the campaign more than 95% some of 100% And you see in he in in the hepatitis case is 99.9% it’s a q vaccine but now I going to speak about
This is just I I was looking for a one slide example how the health system and biote Industry works together this is the incident of tuberculosis this is the inci Hop influen type B Hepatitis B and Men menola and you see in the case of tuberculosis disease
VC that is the vaccine we started producing C and see this it’s not the Cuban vaccine the naal vaccine but we producing and you see the incident of tuulos but in the case of of theophilos influen diab we they develop a vaccine in cure and it
Started as you see around 2 20 years ago and you see what happened the red line is the cage of the vaccine and the green line is the influence of the of the influen Ty heati is the same is the you see you see the situationa B the in in
The green line and the VAC is a CU vaccine for Hepatitis CL that we are using for more than 25 years and you see the outcomes and then manal thisas the same happens with the r line coverage and we have a p a big p i remember that
And we we don’t don’t have vaccine at that time and see what happened this is a a summary that how the health system works with the biotech engry they develop vaccine of drugs and we are we have the the opportunity and the we have the challenge to introduce in the health system well
Now I’m going to speak about clinical trials a clinical trial because this the slide before the clinical TRS are was very important to us 25 years ago and since that time we have a regulatory Authority for drug and Equipment medical and medical devices for the Republic the name is see
On the on the left set and this is a building it’s a wonderful building that is with all the regulatory AU and this is a is a in in promoting a protection polic through a regulatory and the to have the guarante timely to access to Pro with quality safy e
Efficacy and through whole information for the national theal fuse this is one thing that is very important well what happened now I’m going to start with the with the co 19 vaccine because is the the main point that I want to with you okay well with the the B of vaccine
We have a big challenge with data monitoring Committee in the for the first q1 vaccine I I have to check you I have no time to explain that but at the beginning where the pandemic started there the first question that we had is how suppos vaccine and five candidat appear
F from this F we selected two this for is so and ABD meaning that all the outcomes I am going to present today is related the D I’m s because the other vaccine are still in clinical Tri and the in this occasion for for this we
Prepare we have a challenge of the data commit commit for the vaccine of coid 19 and this thing appointment by the sponsor of this samees is the data monitoring proit it’s a new experience that we had in theing the is independent external or seity Comm well how far the vaccin the cuan
Vaccine are have now let me explain in two minutes that when we started with the vaccines first and the clinical Tri then and finally it started with the vaccination campaign many many criticized appears and many opinions not not good opinions about the Kon vaccine and that is why we have to
Prepare a good clinical trial and good evidence about the vaccine new and at that time when we finish the the clinical trial we had experience to use the vaccine CU you see toana vaccine was used in Italy Nara Venezuela Iran and SAR Republic Arabic Republic and abdala was using in Vietnam Mexico
Mexico is d one vacine that they using Venezuela um Nicaragua and some Caribbean I all of them are we following even the the situation of the vaccination in those countries that they still using the well this is a what happened is that because well we said well the situation
Is very difficult with the pandemic we have we have no money to buy the the vaccine very expensive and on the other side because the Embargo may be the we have problem with the to buy the vaccines and we decided to start when the clinical trial finished with two vaccines I have tell
You before you and at that I I I have no time to explain what how we do that but maybe I I will try to summarize everything and maybe you if have some questions I I would like to answer well we start with the decided by the committee know scientific from the
Scientific point of view we decided to start with the vaccination in the old version mainly the qan do first the go get them and then people are are reach and then we we prepare the the Campa and I have I I put this example here because
I met were following all the time how these interventions continue and then the I I put this because it’s the good news that they did vaccine because the problem at that time with the with the people see the vaccine against the children because eal but finally the same make because
That the the previous outcom decided to use the for emergency use Vaca vaccine for the Patric population between s two to 11 years I think that this one of the of the of the countries that started to use with the vaccine for children very at the very beginning and what about the the
Widespread use this is another problem because all of you remember that the during the pandemic the service are very have very hard time with many things and we decided to because the primary health care that I mentioned before in summary and the the organization of the of the health system allow
All allows that we can start it with this organization and the other thing that we have to to take in mind to took in mind at that time is the C chain because you know that us is a very hot country and the the youth was May May June are the
Hottest mon the the the high temperature the well what we always have in mind Quality Security and effectiv and this started with the ruse and this is just characteristic of the vaccine a protein unit vaccine The inred is thein protein RBD Rector blinding domain um is is a is a technique that our Research Center will knew very well that time that this is the vaccine and this is the see a example of adala three with the 0.5 M and the interal 14 28 days and one month
The one one because it’s three more three three doses 14 28 28 and the more and after the third do we use the booster well going to the FI it’s it’s a summary there are many and I I I would recommend to use papers if you want to read and be this
Knowled well this is the one example it’s a stud that we because what happened let me explain because the the you see the C is the in this case incidence and and death is the blue line yes and you see that because the situation of the outbreak you have to do
Something and you have the vaccine you have the isolated Center we have many resources that we have to use it at that time but finally we we decide well we we have to follow the health the health system strategy with the research good research and we were
Working together at the same time since the since the very beginning and you see this is thetic week and and this is the in the rate of inci for the population and yeah I explain this incidence and this imortality sorry there are some words writing in spanic that not
And what happened that we started to the vaccination on May 12th that is why the gold change I before and then at that time appears in the the different strs and and what the omnr start in CU and when started the the vaccination we call H intervention because it’s a vaccination and
Other epidemological me and when we started appears a p and when we finish you see I will show you later on when we reach the pig here the h the finish the end of the massive intervention it’s a very big intervention and the mortality and the mortality and the incidence decrease and
Then in the we use a a booster in in different situation according the the vaccination and this it happen in 80% of the population in Havana more than 19 years age and this intervention was from May May June and 22nd of and we we work with the and then this is one
Example I I will show you some this is cu what happened in Cuba the red columns that you see here is the in of the disease and the numbers that you have is the percentage of immun remember we I spoke that we started with with intervention um if you see we are going
Up with the vaccines and the disease going up as well but when we reach a point this this point 38% percentage of the immunization the number of CAS the incidents of the of the of the of the coid 19 come down and start to decrease you
See very the yellow and you see this is It’s cage and this is R okay and you see very clear here and but this is just in ke meaning that the information in Cuba is too big and that’s we decided to preper the resarch the slide that I told
You before with Havana is the biggest of the city in the more than 2 million inhabitants and we decided to but we came back with the Matas proce Matas proce around 120 kilom from Havana and but this small than very famous for the beaches in mat but if you see here in
The the same happen with the with the vaccine in mat this mat in 2021 and you see the this is coverage and this is 35% meaning that around 30% between 30 20% the the population the the incident of the coid 19 this the but what happened is that we reach 1
Million doses in a short period of time because it’s not just the vaccination is the the speed of of the vaccination this one when we reach the million doses of thein well let’s go see now what is this is the number of doses according to a
Schedule of H by H gr this because remember there are three Doses and and and you see this million doses million of doses the the blue is in F less than two years and this is the less than 12 years and this is the other and you see it’s 8 million doses
In the first CH 7 million and something in the second this is normal what happen in the The communization Campaign and 10 million and but less than than the second and what is one just people used one dos very few people this is the the full scheme and this the
First and this what happen with the number of we’re talking about mil and you me how one system have the the Str to do this kind of things in very short time and this is a percentage is the same like this one but this the percentage of the of the Pediatric the
12 to 18 years another close than 19 years old the same one the first the right 1000 sorry it’s a percentage in this case but you see the percentage is very high and if you compare with the other count I have no time to do that we can
Do another time and you see that this High coverage of the complete scheme meaning 9% of well this is this is the the approach that we were working I told you is Polish doing research and polish and build and then this is a hard time for us mind but we’re preparing we working
The campaign working in the taking information processing information this article is poish was in September last year in last last review the label you have the metric of the article and there are is a cohort stud but to evaluate the effectivess in prevention sever deas there
For B sign because we were working with the population of Havana but just I I want to show you two things that you have in mind what we this this this graphic that you have is this is what happened in the the black sorry the black lines is what
Happen the the red is a is a PR that we are going to happen if nothing will the the blue is the middle and if what happen and and the and the on the red is the best meaning that we were better than the than the middle because the cuan approach the response
And the can well I have no time to explain this you it’s available you can read and there are many mention capture we reive a lot of it was a hard time to this this articles you know how hard is the we had the ref the beginning then
One know finish but then come back and so but finally it’s there you you can read it and and you can use we are using now for the teaching this is another article I I was in ch in contact with professor and one day we said well why
Comparing what happened what is the response on Tu and United stes that work in 20 25 2021 and and you have this article is the is has a lot of information about the response and I think that in the future maybe we can compare with more details because included V many things
And was a very Artic I am very happy with the with the and the UAB and course the all the the United St and this because this is thanks to Professor because I have not the report I was working with that rep but I was not the report in my hands the final
Because the situation with the the many many many things here United States very very very friendly people but very strong to evaluate the situation with the they had access to every place primary healthare Research Institute biotech Center place it because it was in September in the in the in that that
Moment in that moment we have the some places using the vacine and they visit everything they have access to every place and they make a report to report in the very big report is have the report and I I is they I am very happy not because they are because
The scientific level of that and how of they how when they have different opinion we discuss the the opinion very hard but very very professional group and this was a good support for for our vacine and I I I I think that was the results was very clear but we need and
They report in journal but we need this external evaluation group nothing to do with you and very very very high level and 45 and I am we are very happy it’s be happy and also I am very happy again to be here to share with you this mod
Experience and maybe in the future we have another time to have another another type of presentation because I am I am sure that s have to join all I spoke with before the conference I I told that during the campaign we were in collaboration giving the response 19 we have
Collaborated with is in many countries through the webinar and and it’s meaning that s is have not b not b and the the 19 show of that there no B is you need a new type of not that all thank you very much I’m fully open to thank you
Again thank you so much uh Dr bomeo um I’m uh looking at the Q&A box and right now we don’t have any questions in the Q&A box um let me um uh uh sort of reiterate a couple of points that you made in your presentation that I think
Um are are really important to uh to emphasize first of all um your your point that um that Cuba’s development of coid vaccines didn’t happen out of um you know in a in a vacuum or just um with with no history behind it Cuba has a long history of success in developing
Vaccines and then getting those vaccines uh into people um so highly successful long history of of vaccine development so that’s that’s one thing that I wanted to to emphasize the second thing that I wanted to emphasize um is that the clinical trials that that you described were actually
Carried out uh through the Cuban Health System um uh and and so you um you you had um uh you know all of the infrastructure of the family nurse doctor um consultorio uh you had the poly clinics and all of that infrastructure and that served as the uh the location if you
Will for the clinical Tri trials uh for the vaccine which uh in in my way of thinking is absolutely brilliant uh to be able to to do that uh because you uh you were able to complete uh your clinical trials um in a relatively uh much shorter period of time because you
Use the existing Health System um so I wanted to emphasize those U those points couple of more comments to to make uh the uh the American Journal of public health article that uh that we did together uh Dr bero uh was actually led by uh an undergraduate student uh here
At UAV who is the uh the lead author uh and she is now completing her Ms in public health at the University of Minnesota um very very proud of that um and then finally to um to make the point of one of your last slides that you showed about the highlevel uh us-led
Delegation um to um to assess the coid vaccine experience in in Cuba um one of those participants was uab’s very own jeie morat uh who at that time was um head of infectious diseases here and as people I think on this call will know she has now
Uh been tapped to replace Anthony fouchy at the National Institutes of allergy and infectious diseases of the NIH so we’re very proud of of Dr moro’s involvement uh in the um assessment of coid vaccines Dr bero while while we’re waiting a few more minutes uh to see if
Other uh any questions pop up um what um what is next um in terms of um work um uh research regarding um the coid vaccines there or um the the pandemic response there in Cuba any um anything that you want to comment on what is what is
Next we no since the the response the beginning 2021 we here delegation from the FR and at that time was you know very complicated situation but we keep in touch during the time and finally we decided to prepare a young project with friends and that is a project that
Is going on the we started last last June I to this is basic the University of in France and Paris University both and the this project I was there for a month with the I am the coordinator of pro and Professor Eric solo is fr um this idea that we are working
Is comparing what happened in CU and what happened in in the from the socieconomic socieconomic point of view what happen with the outcomes what happens with the vaccin use and what happen with the the trains the training the vaccine it’s a huge project we working here more than 20 people biotic mathematics
Epidemiology and people who are working with science it’s a big project now we are we’re working in the in the first article but comparing is very difficult because the French health system is different but we are trying to um and this is the idea wearing a first article and the first article is
Approach a general approach about the the pandemic how the was the resp but on the same time the sociologist are working in what happen both country the mathematics and thanks um there is a another group it’s a small group group will beest is working about the
How why I know I I think I one thing I I forget econom the econom point how much money allocation with um I I talking about the third group is talking about the how the response in the future what is going to to happen with another outbreak that
Will be Bey here with you I mean in the world um and now he included finally two days ago gual gu Lupe is a FR territory in the Caribbean and they they have a a big problem at the beginning and now good but in summary we are working in the in
All of points hot points during the pandemic response and the the second is four year project and the we’re in the first year now and in the third year where was from now we’re going this a small group of mathematics emology a geographical information Shem because
They have a good te there there and now we are working on one that we are doing in the international field the project is approv for everyone and we have a wonderful presentation there and on the other hand now we are trying to do the same that we did with
Three but not now now not with the with the incident morality no we are talking about what happened with the years L because Prat there many that is indicator let let me say is a a indicators of what happened in different count in that not in in how they left left
Okay well um thank you thank you for that um we’ve got about four minutes um if you open your chat Dr bero there’s a question there from Dr uh Kaa brookport uh who is an infectious disease epidemiologist here at UAB um and she’s asking about the challenges of monitoring vaccine
Effectiveness and safety long term very good question a very good question well ER you know in the healthy thing is Po and we have the all the thetic available we are talking about statistic are confident and yes we are we are doing this since I I had a
Meeting three days ago with the director of biotechnology biot Institute with the people of the of the immunization campaign and of course we are following adverse results ad result sorry and what maybe not in short time maybe in long time what is will be happening not that but this is a wonderful
Question and I am I am shair with my college here because he’s as he know experience and he’s saying there is all conflicts and challenges in the US say us and the US use a lot of a lot of different type of and now use the but even though even though we have
We are doing and we are following this we have to follow the children this is our idea now to follow the children but many things have to be and I fully agree it’s very important because I don’t in the world that never use Millions trillions of do of vacin
For thank you for thank you uh thank you for your response to the question um so I uh want to again thank you um Pedro for a wonderful seminar um that on the um uh Cuban uh coid vaccine experience and uh want to thank you again for your for your time and for
Providing us um with your insights I look forward to the time when uh we can be together again uh whether uh it’s in Cuba or here in the United States but thank you again for um for being with us on on the webinar today and thank you all for attending
Um I um I think that that uh that that is it and so we’ll um bring this webinar to a close thank you again