Considerations of public health and
commercialism in the Cuban biotech sector and
vaccine industry.
Lecture by Jens Plahte, cand. philol.,
Research Fellow,
Centre for Technology,
Innovation and Culture
University of Oslo
Visiting Researcher,
Centre for Health and
Welfare Studies
University of Havana
First Annual Latin America Research Conference:
Contributing to a better future? The role of Norway based Latin America research
Oslo, 12–13 November 2009
Centre for Technology, Innovation and Culture
[email protected]
Outline of presentation
• Doctoral dissertation
• The Cuban biotech sector and vaccine industry
• Two paradoxes
Centre for Technology, Innovation and Culture
Ph.D. dissertation
• “Vaccine innovation for public health or profits – The
Cuban vaccine industry in a national and global
context ”
• Funded by the Research Council of Norway
• Papers:
– A decision centered vaccine innovation model (with Lisbeth Meyer
Næss, NIPH)
– Tiered prices of vaccines: not a subsidy, but a win-win-win
situation (Lancet Inf Dis 5(1), 2005)
– The pneumococcal vaccine Advance Market Commitment may
create a market, but seems to fail as ‘market-pull’
– Strategic evaluations and techno-economic networks. Vaccine
innovation in the Cuban biotech sector: for public health – or
profits?
– Development, organization and management of techno-economic
networks: the Cuban biotech sector and vaccine industry
Centre for Technology, Innovation and Culture
The Cuban biotech sector
•
•
•
•
An industrial district of western Havana
≈ 20 000 workers
≈ 10 research and production centres
Biopharmaceuticals are the second most important
foreign currency earner of Cuba
• Diagnostics, therapeutics, vaccines
• Massive investments since 1981
• Long term focus on science, education and health
since 1959
Centre for Technology, Innovation and Culture
The Cuban vaccine industry
• Main centres
– Centro de Ingeniería Genética y Biotechnología
– Centro de Inmunología Molecular
– Instituto Finlay
• Main products
–
–
–
–
Meningococcal group B vaccine
Hepatitis B vaccine (hepB)
Haemophilus B vaccine (HiB), synthetic
Pentavalent DTP-HiB-hepB
• Vaccines are important in the total biotech product
portfolio
Centre for Technology, Innovation and Culture
Two paradoxes
The initial rationale of the
biotech initiative was to
target ’modern’ diseases
(cancer, cardiov. and
cong. dis.)
… but …
High priorities of the Castro
Government are public
health, medical diplomacy,
as well as export revenues
generation
Why?
… vaccines target
’traditional’ infectious
diseases
Centre for Technology, Innovation and Culture
… but …
… Cuban vaccines are not
sold on the global public
sector markets
Strategic and techno-economic
evaluations
Health transition required ’modern’ measures (products)
Centre for Technology, Innovation and Culture
Adapted from Callon (1992)
Economic revenues as
rationale: Two sides of the same coin
Use domestic
supplies to legitimate
creating an export
oriented sector
Centre for Technology, Innovation and Culture
Finance
domestic supply
by commercial
exports
Late 1970s: Morbidity and
mortality transition
Patterns:
Interventions:
Traditional
– Infectious diseases
– Malnutrition
– Neonatal and maternal mortality
Modern
– Cardiovascular conditions
– Congenital disorders
– Cancer
–
–
–
–
Immunization
Sanitation
Primary health care
Essential drugs
– Secondary and tertiary health
care
– Prenatal diagnosis
– Advanced biopharmaceuticals
Depletion of traditional measures  Need for modern measures
Centre for Technology, Innovation and Culture
The meningococcal epidemic 1976-91
•
•
•
•
•
National emergency
No vaccine available
Domestic vaccine innovation project 1983 
Group B meningococal disease eliminated in 1991
Finlay Institute founded in 1991
– Vaccine innovation capabilities
– Based on traditional bacteria fermentation technologies
Centre for Technology, Innovation and Culture
Endemic hepatitis B
• Recombinant vaccine developed by Merck in 1986
• Creation of a platform technology: Yeast based
expression system
• CIGB founded in 1986
– Vaccine innovation capabilities
– Based on single cell organism recombinant technologies
• Cuban recombinant hepatitis B vaccine licensed in
1992
Centre for Technology, Innovation and Culture
Altered strategic evaluations
Vaccine innovation capabilities were developed
– National meningococcal epidemic
– Endemic hepatitis B
– Platform technology development, technological window of
opportunity
 Vaccine innovation became important because
capabilities had been developed
Centre for Technology, Innovation and Culture
Strategic and techno-economic
evaluations
Health transition
Strategic
Established
evaluations
capabilities
required
were
facilitated
’modern’
altered further
(menB
measures
vaccine
and(products)
hepB
innovation
vaccines)
Centre for Technology, Innovation and Culture
Adapted from Callon (1992)
Two paradoxes
The initial rationale of the
biotech initiative was to
target ’modern’ diseases
(cancer, cardiov. and
cong. dis.)
… but …
… vaccines target
’traditional’ infectious
diseases
Centre for Technology, Innovation and Culture
The Castro Government
has public health and
medical diplomacy as a
high priority, as well as a
commercial motivation
… but …
… Cuban vaccines are
not sold on the global
public sector markets
Markets for Cuban vaccines
Middle income countries: Argentina, Venezuela,
China, Russia, South Africa, South Korea
Global public sector markets
• Least developed countries in Africa, Asia and LatinAmerica
• Procurement services by UNICEF and PAHO
Centre for Technology, Innovation and Culture
Price discrimination
Plahte 2005, Lancet Inf. Dis., Vol. 5, No. 1:
Tiered prices of vaccines: not a subsidy, but a win-win-win situation
Single market
Centre for Technology, Innovation and Culture
Low price market
High price market
The Cuban health system
• Top national priority (with education and science)
• Medical diplomacy: Medicine as an instrument of
foreign policies
• Foreign currency generation by exportation
– of medical services
– of biopharmaceuticals
Centre for Technology, Innovation and Culture
Possible explanations
• The Cubans are unaware of the price discrimination
mechanism????
• Political considerations????
• Lack of commercial motivation?????
• Cost ????
– Embargo raises production costs
Explanation: Philanthropy sometimes
requires a competitive edge!
Centre for Technology, Innovation and Culture
Conclusions
1) Despite the transition towards ’modern’ public health
challenges, ’traditional’ products became important.
One important reason is that vaccine innovation
capabilities were established because
– a national emergency had to be countered
– of the need and opportunity for technology platform creation
Once established, these capabilities opened windows of
opportunity for further vaccine innovation
Centre for Technology, Innovation and Culture
Conclusions
2) Despite it being profitable to do so,
… and despite its focus on public health and medical
diplomacy,
… and despite being a self declared socialist state,
… Cuba does not sells vaccines on the global public
sector markets
Most probable reason: Uncompetitive production costs
Centre for Technology, Innovation and Culture