Combining health and social protection measures to reach the ultra ...

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Research resources1,61001,41,21908070600,8500,60,40,24030201001994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006MorbidityCoverture0Figure 4: Incidence and vaccination coverage by Haemophilus influenzae type b, in the period 1994–2006Scientific research in this field has enabled the country tobecome currently self-sufficient, with the production of 527drugs including the antiretroviral, anticancer andimmunosupressive drugs supporting the nationalprogrammes of HIV/AIDS, control of cancer and organtransplantation. Monoclonal antibodies, of wide application innephrology and oncology, human transference factor andgrowth factor used in the treatment of cancer, proctitis andulcers, and Surfacen for the treatment of respiratory distressof newborn are also included in the range of Cuban products.UltramicroELISA, a Cuban diagnostic technology forneonatal and infectious disease screening, is widely used inthe country, supporting the epidemiological surveillance ofseveral infectious diseases such as dengue, HIV, HBV andHCV and the screening in all pregnant women of neonataldisorders such as congenital hypothyroidism, phenylketonuria,galactosemia and other malformations. In the period 1982 to2006, more than 3 million pregnant women were screenedand 6748 congenital malformations were detected .24 . Also,more than 2.7 million (100%) of newborns were studied,detecting 731 with congenital hypothyroidism. Thesechildren were treated early, avoiding cretinism.UltramicroELISA has also been fundamental for the bloodcertification programme.A relatively recent national investigation allowed screeningof all individuals with some disability. The physical andpsychological characteristics of these persons and thecontributing factors for intellectual or mental disability weredetermined. In the Medical Genetic services, extended to allprovinces of the country as part of the National Programmeof Attention to Persons with Some Disability and theprogramme of Medical Genetics, 29 genetic pathologies andmore than 50 metabolic disorders are diagnosed. Severalinvestigations relative to schizophrenia and Alzheimerdisease, among others, are under way.The development of advanced technology medicalBCGHBDTwP - HB + HibAM-BCMMRDTwPHibDTAT(Vi)TTOPV (campaign)Table 1: Cuban immunization programmeRESEARCH (22)CholeraTuberculosisAdjuvantN. meningitides BMalariaLeishmaniaShiguella-SalmonellaLeptospiraPertussis acellularPseudomonasAnimal modelsMonoclonal antibodiesHIV/AIDSDengue8 Cancer vaccinesDEVELOPMENT (13)Cholera attenuatedDT, dT y t(reduced doses)Poli ACYW135Poli ACdT - Poli ViBCG intra vesicalVA-MENGOC- BC ®reduced aluminumVME as productCholera inactivatedAdjuvant CocleatoNeumococoHC therapeuticHB therapeuticNewbornNewborn2, 4 & 6 months3 & 5 month1 & 6 years18 months18 months6 years10, 13 & 16 years14 years
Research resourcespoliomyelitis and given the particular success of the Cubanvaccination strategy, several investigations supporting globalpolio eradication have been conducted in our country at therequest of the World Health Organization (WHO) and thePan American Health Organization (PAHO), allowingdemonstration of the circulation-time of the vaccine viruses inthe environment after the oral vaccination and the immunityof the inactivated vaccine. This new knowledge and theinvestigations in course will allow improved definition of thestrategy for global polio vaccination after eradication 25 . Newfindings of global impact related to dengue hemorrhagic fever(DHF), have been reported by Cuban scientists. Theconfirmation of secondary infection as a risk factor for DHF,the influence of the interval between infections and the roleof ethnicity and chronic diseases are only some examples 20 .Flexibility also characterizes Cuban science, allowingincorporation of new topics in the research agenda dependingon the epidemiological national and international situation.The preparation of the country in terms of surveillance,diagnosis and research to face new global epidemics such asWest Nile Fever, SARS and Avian Flu are recent examples.Current research needs and agendaAt present, the Cuban population shows a very high healthlevel with the Millennium Development Goals alreadyaccomplished 26,27,28 . However, the country is working to reachnew goals, with an infant mortality ratio of less than fivedeaths per 1000 live births, life expectancy at birth of 80years and quality of life improvement being the mostimportant new targets. At this new stage, research occupiesa leading place due to its direct impact on healthdevelopment. To achieve these new goals, differentinvestigations are under development, notable ones beingactive screening of risk groups and of the open population fordiseases that are the major causes of mortality. Theseinvestigations will allow early detection of the illness in orderto apply the appropriate treatment and management ofpatients, avoiding disability and death. Supporting this newstrategy, the accessibility of the health system has increasedby the introduction of advanced technology at the primaryheath care level.A totally different health picture is observed in many otherpoor countries. According to WHO, and as an example, Africashows an infant mortality per 1000 live births of 100, a lifeexpectancy at birth of 47 years for males and 49 for females,and HIV/AIDS and TB constitute major causes ofmortality 29,30,31 . Due to this serious situation, a new agenda forresearch and the implementation of research findings isneeded at the global level. In this sense, Cuba is developinga new model of regional and international cooperation inhealth, education and science. Currently, the country hosts22 000 students from developing countries in its medicalschools and more than 32 000 Cuban collaborators labour inmore than 80 countries. From the 1960s, more than132 000 health workers collaborated in 102 countries of thedeveloping world. This model of collaboration is having adirect impact on strengthening human capacities, thedevelopment of scientific research and public health. ❏Gustavo Kourí is a researcher, professor and Vice-President ofthe Cuban Academy of Science. He is also Director General of theInstituto Medicina Tropical Pedro Kourí in Havana, Cuba.María G Guzmán is a researcher, professor and Director of theWHO/PAHO Collaborative Centre for Dengue study and its vector.She is Chief of the Virology Department at the Instituto MedicinaTropical Pedro Kourí in Havana, Cuba, and is a Member of theCuban Academy of Science.José Luis Pelegrino is a researcher, professor and a Master inVirology. He is also a research coordinator and a member of staffof the WHO/PAHO Collaborator Centre for Dengue and its vector.He is also on the staff of the Instituto Medicina Tropical PedroKourí in Havana, Cuba.Alicia Reyes is an economist and Vice-Director of the InstitutoMedicina Tropical Pedro Kourí in Havana, Cuba.Luis Estruch is a researcher, professor and epidemiologist,Cuban Ministry of Health.Niviola Cabrera is a professor and National Director for Scienceand Technology, Cuban Ministry of Health.114 ✜ Global Forum Update on Research for Health Volume 4
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Editorial Advisory Board:Luis Gabri
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Contents096 Child immunization: acc
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IntroductionResearch contributions
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IntroductionType IType IIType IIIPr
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Introductionmaking), takes account
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Access to healthStrengthening healt
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Access to healthTraining more healt
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Access to healthimperative for acti
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Access to healthReferences1.Further
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Access to healthDeterminantsAvailab
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Access to healthThe authors are inv
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Access to healthCombining health an
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Access to health100%Availability of
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Access to healthMandatory clinical
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Access to healthWhile there are som
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Access to healthItemDefinition/Expl
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Access to healthReferences continue
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Access to healthintegrating individ
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Access to healthA social determinan
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Access to healthemployment conditio
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Access to healthMaking human rights
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Access to healthResources outsideth
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Decision-makingReferences1.Hawes H.
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