50 years of immunization in Cuba: A revolution in health
• Tens of thousands of lives saved and disabilities avoided as a result of vaccination programs and campaigns
by José A. de la Osa
Source: Granma International
• HOW may lives have been saved, and aftereffects of illnesses avoided in these last 50 years as a result of Cuba’s mass immunization programs, today standing at 11 vaccines providing protection against 13 diseases which, together with other preventive programs have made our country at present free of 15 contagious diseases?
"Tens of thousands!" was the response to Granma’s question put to specialists Marlén Valcárcel and Miguel Angel Galindo at a meeting of Health, Epidemiology, and Microbiology professionals headed by Deputy Health Minister Luis Estruch Rancaño.
As officials in the Ministry of Public Health (MINSAP), they are responsible for the design, control and development of vaccination programs, undertaken by the Revolution as long ago as February 26, 1962.
That day saw the initiation, with popular support, of the first Anti-Polio Vaccine Campaign, which protected more than 2.2 million minors under the age of 15, equivalent to 30% of the country’s total population at that time. Some 70,000 members of the neighborhood-based Committees for the Defense of the Revolution, 1,000-plus Cubans within the National Association of Small Farmers and several thousand members of the Federation of Cuban Women.
The results were quickly visible: three months after the completion of the campaign, the last case of polio was reported in May 1962. That same year saw a vaccination program against five other diseases: diphtheria, tetanus, whooping cough, typhoid fever, and serious forms of tuberculosis.
The issue of immunization was of such magnitude to the Revolution when it triumphed on January 1, 1959, that Fidel, speaking at the inauguration of Havana’s Victoria de Girón Institute of Basic and Preclinical Science in 1962, stated: "How can the Revolution attack diseases? By preventing them through immunization against the types of disease that can be prevented via vaccination. And in this way we will set about fighting disease by disease, thus diminishing the number of epidemics, the number of victims. That will be fulfilling the larger objective of moving from therapeutic medicine to preventive medicine. In other words, avoiding citizens falling sick."
A brief synthesis (see Complete Chronology) demonstrates the colossal effort of a society that has struggled and is struggling for true social justice for its citizens. At the beginning of the 1970s measles became of part of the *immunization program: in 1982, German measles; in 1986, the triple viral against measles, German measles, and mumps; in 1988, meningococcal meningitis B and C; in the 1990s, the hepatitis B vaccine; and in 2000, immunization against type B influenza (an aggressive bacteria that can lead to death or consequences like as mental retardation and deafness in the early years of life) was included in the immunization program.
The Ministry of Public Health also administers other vaccines to groups potentially exposed to leptospirosis; influenza; rabies, both canine and human; and yellow fever, given to Cubans serving on international missions in regions where this disease is endemic.
At present nine of the 15 vaccines used within the immunization program are produced in Cuba, and the remaining six are acquired from pharmaceutical companies abroad.
The Cuban state directs $50 million per year into manufacturing, importing, and acquiring supplies to support the program, which is undertaken via 700 immunization centers throughout the country. •
Vaccination Chronology: 1960-2010
1962: Vaccination against polio and the triple bacterial vaccine (tetanus, diphtheria and whooping cough)
1964: Vaccination centers established in polyclinics for the regular immunization of the population. Immunization levels rise to average of 60%.
1968-69: Immunization campaign against diphtheria, tetanus, and whooping cough; campaigns against tuberculosis and smallpox for minors up to 15 years in rural areas.
1971: Vaccination against measles for children from 6 months to 5 years.
1974: Community Polyclinics created and immunization levels increase to 75-80%.
1975: first National Immunization Campaign against tetanus for homemakers, covering 98%.
1976: Second tetanus dose for homemakers.
1979: In reaction to an increase of Meningitis A and C, three million persons immunized.
1980: Vaccination in schools against typhoid fever, diphtheria, tetanus, whooping cough, and serious forms of tuberculosis.
1982: Long-term strategy for protecting girls against congenital rubella (German measles) implemented. (The response to serious epidemics of German measles in 7-year cycles: 1967, 1974, and 1981). Girls aged 12, 13, and 14 vaccinated against German measles during the school year.
1982-83. In subsequent school years: 1983-84, 1984-85, and 1985-86, girls aged 12 immunized, so that by 1986 all females aged 12-17 protected, a total of 50,000-plus by 1986.
1984-85: Anti-tetanus vaccination campaign for the elderly. Third- and fourth-year medical students in a work-study program immunized 200,000 persons aged 60-plus.
1985: Tetanus booster for homemakers and senior citizens, 10 years after the 1975 vaccination program.
1986: As part of the strategy for eliminating the congenital rubella syndrome, an immunization campaign against German measles was carried out, reaching 600,000 women of fertile age (from 18 to 30 years), for a coverage of 75%. At the same time, vaccination of the entire population of less than 15 years with the triple viral vaccine (measles, German measles, and mumps) reaches more than two million people, with 96% coverage.
1988-90: The entire Cuban population under 20 years (close to 3 million) vaccinated against meningococcal meningitis B, the only such program in the world.
1990: Field tests for Hepatitis B vaccine begin.
1991: Meningococcal meningitis B vaccine included in immunization program.
1992: Hepatitis B vaccine included in the immunization program. More than 12 million doses administered. By 2010, the entire population under 31 years protected, as well as other high-risk groups.
1999: Vaccination campaign against Haemophilus influenzae B, for all children born since January 1998, plus those born in 1999.
2000: Vaccine against Haemophilus influenzae B included in the immunization program.
2004: Second dose of triple vaccine against mumps, German measles and measles for children in first grade.
2005: Tetravalent vaccine for protection against diphtheria, tetanus, whooping cough, and Hepatitis B incorporated in the immunization program for infants up to 12 months.
2006: Incorporation of pentavalent vaccine into the program, providing single-injection vaccination against five diseases, now including Haemophilus influenzae B.
2007: Campaign against measles, German measles, and mumps in the population aged 12-24 years, thus protecting one million-plus persons in that age group.
2010: Vaccination against pandemic influenza A (H1N1), during which more than one million persons in high-risk categories related to complications were immunized.