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

Research resourcesBiotechnologists623 623937 PhD 937 PhDExcluding influenza and pneumonia, infectious diseaserepresents 1.1% of the total mortality. Infant mortalityin 2006 was 5.3 per 1000 live births, showing an 11-fold reduction from the figure reported in 19591070 Technologists1070 Technologists2560 2560 Researchers4800 Masters in Sciences4800 Masters in Sciences22 22613 Proffesors129 504 Health129 504 Health professionalsproffesionalsFigure 1: Health research workersSince 1959, human capacity building was considered asthe most relevant factor for the development of the country,with a direct impact on health development. The literacycampaign performed in 1961–1962 allowed the country tobe declared free of illiteracy. The improvement in theeducational level of the population in the following years andthe high number of technicians, professionals and scientistsare expression of this development. In this context, thenumber of medical doctors, scientists and techniciansworking in the biomedical branch is noteworthy (Figure 1).At present, the country has four medical universitiesincluding 21 faculties of medicine, four of stomatology, fourof nursing, four of health technology and one Latin-AmericanMedicine School with 12 000 students from 28 countries ofthe world. In addition, Cuba has 248 hospitals, 498policlinics and 14 078 medical posts. The medical and nonmedicalhigher educational institutions are the main source ofbiomedical scientists. Pre-graduate students are selected andenrolled in scientific institutions providing an early associationto research, with training and postgraduate studies in andoutside of the country. In total, the scientific health humanresource represents a high percentage of Cuban workers.Another expression of Cuban biomedical development inthe period of 1959–2007 is the number of patents and ofscientific publications in high impact journals. A trend ofincreasing patent numbers has been observed, with 156patents granted in Cuba and 66 abroad, and more than 650patent applications in the biotechnological field alone.Health research impact in the period1959–2007During this period of more than 40 years, the directrelationship between scientific development andimprovement of the health system positively influenced thehealth indices of the population. In spite of being a poorcountry with a low Gross National Income per capita, Cubashows health indices similar to those of developedcountries 8,9 .For example, the first five main causes of death are similarto those of high-income countries: cardiovascular disorders,cancer, cerebrovascular illness, influenza and pneumonia andaccidents. Excluding influenza and pneumonia, infectiousdisease represents 1.1% of the total mortality 8 . Infantmortality in 2006 was 5.3 per 1000 live births, showing an11-fold reduction from the figure reported in 1959 (Figure 2).Life expectancy at birth increased from 60 years in 1959 to77 years (75.1 for males and 78.97 for females) in 2006.Cuba’s immunization programme covers 13 diseases.Several infectious diseases such as poliomyelitis (1962) 10and malaria (1967) were eradicated and tetanus neonatorum(1972), diphtheria (1979), measles (1993), rubella (1995)and mumps (1995) have been eliminated. Others such astetanus, meningitis by Haemophilus influenzae type b, leprosy,meningococcal meningitis and hepatitis B, are no longer healthproblems. Table 1 shows the Cuban vaccination schedule.With the main aim of solving domestic problems, but alsoto collaborate with other poor countries, biomedical andbiotechnological research, which is fully supported by thegovernment, is organized in programmes. At national level,91 projects are included in the lines of vaccine, cancer anddrug development. Currently, more than 1500 researchprojects are in progress at the ministerial level.Some of the main scientific results with a crucial impact inhealth have been those related to the vaccine investigations.The Cuban vaccine against meningococcus B 11,12 (consideredat global level the first effective vaccine against thismicroorganism), the recombinant hepatitis B vaccineproduced in Pichia pastoris 13,14,15 and the Haemophilusinfluenzae type b vaccine 16,17,18 (the first one obtained bychemical synthesis) constitute good examples. Thesevaccines, already introduced in the Cuban immunizationprogramme, have had a strong impact in the control andelimination of these three diseases as health problems in thecountry. Figures 3 and 4 show the reduction in the numberof cases of hepatitis by hepatitis B and meningitis byHaemophilus influenzae type b.In order to reduce the number of immunizations, apentavalent vaccine (only produced in France and Cuba)combining diphtheria, tetanus, cellular pertussis, hepatitis Band Haemophilus influenzae type b vaccines was formulatedand clinical trials were developed. This new combinedvaccine was introduced in the national immunizationprogramme in 2006. Table 2 shows the registered vaccinesand those under development and research.At advanced stages of research are the vaccines againstcholera, HIV/AIDS, HCV and dengue. An attenuated vaccineagainst cholera, based on the deletion of the cassette of genescoding for the toxicity induced a low reactogenicity and highGlobal Forum Update on Research for Health Volume 4 ✜ 111