Cuban COVID-19 Vaccines for Children: Rinaldo Puga MD MS Principal Investigator, Pediatric Clinical Trials for Soberana 02 and Soberana Plus.

Cuba's decision in September 2021 to launch a massive vaccination campaign against COVID-19 for children as young as two years old turned heads around the world-of clinicians, immunologists, public health experts, governments and regulatory authorities alike. Since then-and just as pediatric COVID-19 hospitalizations reached record numbers globally-some two million Cuban children and adolescents have received the Cuban Soberana vaccines (1.7 million, or 81.3% of that population through December 16, 2021).[1] Why did Cuban health authorities decide to vaccinate children? What clinical trials provided the evidence for such a course of action, especially for the youngest? And what have been the results thus far? To answer these and other questions, MEDICC Review spoke with Dr Rinaldo Puga, principal investigator for the completed phase 1/2 clinical trials of the Finlay Vaccine Institute's Soberana 02 and Soberana Plus vaccines in pediatric ages. Dr Puga's 30 years as a practicing pediatrician have been accompanied by teaching and research, the latter earning him awards from the Cuban Academy of Sciences, among others. He is currently chief of pediatrics and chair of the Scientific Council at the Cira García Clinic in Havana, which granted him leave to lead the pediatric vaccine trials.

Researchers at Cuba's National Medical Genetics Center: Pioneering Studies on COVID-19.

Three fourths of the 175 staff at Cuba's National Medical Genetics Center (CNGM) are women. And women constitute 90% of the research team working on the Center's largest current project-unlocking the biological secrets of COVID-19 in the Cuban population. They are identifying particularly vulnerable groups and geographies, reviewing therapies applied and long-term sequelae of the disease, and contributing to ongoing vaccine research and trials. Their results are critical to determining effective preventive and treatment strategies as the country moves into the next phases of epidemic control. The national study is the first and only one of its kind in Latin America. Then the first COVID-19 cases were diagnosed in Cuba on March 11, 2020, the Center's role in epidemiological surveillance was activated, based on its experience with the Zika threat in 2015. This involved mobilizing the National Genetics Network anchored in primary healthcare facilities, comprised of 452 genetics counselors, nurses and clinical geneticists, supported by technicians, epidemiologists and family doctors. The Network's role would become key to the ensuing research. As the magnitude of the pandemic became clearer, CNGM investigators approached the Ministry of Public Health and government leaders with a broad-ranging proposal to study biological factors that would help explain differences in vulnerability, symptoms, immune response and severity of the disease, as well as its profile in different Cuban subpopulations. After approval, the studies got underway in June, encompassing Cubans who had been infected through June 11, 2020, and were by now convalescing. The nine main research lines were defined, and principal investigators went to work developing the instruments needed and training personnel across the island on their use. While final results are still being analyzed, CNGM Director Dr Beatriz Marcheco and four lead researchers talked with MEDICC Review about the scope of their work and some of the most intriguing preliminary findings.

Fallen in the Face of COVID-19: Graduates of Cuba's Latin American School of Medicine (ELAM).

The 2020 fall semester at Havana's Latin American School of Medicine (ELAM) began on an especially somber note: honoring 17 of its alumni felled as they battled COVID-19 in their home countries and beyond. A few were recent graduates among the 30,047 from 118 countries who received scholarships from Cuba to study medicine at ELAM. Others were members of its fi rst graduating class in 2005.

Economic Packages for COVID-19 Recovery Must Invest in More Resilient Health SystemsCristian Morales MS MPHPAHO/WHO Permanent Representative, Mexico.

Cristian Morales, an economist by training, has dedicated his career to improving health and health equity in the Americas through his work with PAHO/WHO. This has taken him from hurricanes, earthquakes and epidemics in Haiti to PAHO's Washington DC offi ces, where he was instrumental in achieving consensus on a resolution aiming for universal health-coverage plus access-approved by all governments in the Americas. In 2015, he was appointed PAHO/WHO Permanent Representative in Cuba, and in 2018 to the same post in Mexico.

We are calling for adoption of universal, redistributive and solidarity-based policies with a rights-oriented approach to leave no one behind.

Serving in her present role since the economic crisis of 2008, Alicia Bárcena is no newcomer to regional and global emergencies, economic or otherwise. She also has extensive experience in the UN system, including as chief of staff to the UN Secretary-General and later, during Ban Ki-moon's tenure in that position, as Under-Secretary General for Management. From 2016 to 2017, she co-chaired the International Resource Panel at the UN Environment Program. A biologist trained in her home country of Mexico, she later received a master's degree in public administra-tion from Harvard University, USA. For decades, Ms Bárcena has devoted her professional career to issues of sustainable development, fi nancing of public policies, and the environment. She has received Doctor Honoris Causa degrees from the University of Oslo, Norway (2014); the University of Havana, Cuba (2016); and the Universidad Autónoma de México (2019). Today, she is a board member of the Global Partnership for Sus-tainable Development Data and a member of the University of Oslo/The Lancet Independent Panel on Global Governance for Health.

We are living in the geologic age when human activities have dramatically affected our planet and its environment.

Dr Barry is incoming Board Chair of the Consortium of Universities for Global Health (CUGH) and past President of the American Society of Tropical Medicine and Hygiene. She is a member of the National Academies of Sciences, Engi-neering, and Medicine, and serves on the National Academy of Medicine's Board of Global Health. She has received the Elizabeth Blackwell Medal for outstand-ing contributions to women in the fi eld of medicine, and is founder of WomenLift Health, a global initiative to transform global health outcomes by unleashing and elevating talented mid-career women to become global health leaders.

In this kind of situation, health as a public good once again becomes paramount...

Dr Jeanette Vega is well known in global health circles for her work in the areas of health equity, social determinants of health and health systems. She has served as Chile's Vice Minister of Health, and as director of the country's National Health Fund (FONASA). For fi ve years, she was also WHO Director of Equity and Social Determinants of Health. She currently sits on the 13-member Global Preparedness Monitoring Board (GPMB), co-chaired by H.E. Gro Harlem Brundt-land, Former Prime Minister of Norway and Former WHO Director-General; and Mr Elhadj As Sy, Chair, Kofi Annan Foun-dation Board, and Former Secretary-General, International Federation of Red Cross and Red Crescent Societies. An independent international monitoring and advocacy body, the GPMB prepared the seminal 2019 report on the state of global preparedness, A World at Risk.

Stemming COVID-19 in Cuba: Strengths, Strategies, Challenges Francisco Durán MD. National Director of Epidemiology, Ministry of Public Health, Cuba

Dr Durán is a native of eastern San-tiago de Cuba and his early medical career began in this mountainous re-gion, where he also headed provin-cial prevention and treatment of HIV/AIDS. He went on to become rector of the Medical University of Santiago de Cuba and provincial health direc-tor. Later in Havana, Dr Durán was director of medical education and vice minister at the Ministry of Public Health (MINSAP). Abroad, he served as advisor to Angola's Minister of Health, and on his return, as deputy director of Cuba's Pedro Kourí Tropical Medicine Institute (IPK). Dr Durán has been "battle-tested" over the years by his involvement in stemming dengue epidemics and other infectious dis-ease outbreaks, good preparation for his current position as National Direc-tor of Epidemiology. Today, his is the voice and the face on the 11:00 AM briefing carried daily by Cuban television, reporting the latest data on the un-folding COVID-19 pandemic globally, in the Americas and.

Mobilizing Primary Health Care:Cuba's Powerful Weapon against COVID-19.

A strong foundation of primary care is critical to the health system and is particularly important during pandemics like COVID-19. Primary care practices should be a natural fi t for triaging, testing, treating, and educating patients.-Corinne Lewis, Shanoor Seervai, Tanya Shah, Melinda K. Abrams, and Laurie Zephyrin MD The Commonwealth Fund, April 22, 2020[1.

US Physicians Trained in Cuba Battle COVID-19 at Home:A Personal Account from the New York City Epicenter.

Speaking remotely with US graduates of Havana's Latin American School of Medicine (ELAM), I found them at work on hospital floors, in ICUs and health centers across the United States, putting their professional and personal commitment to the test against COVID-19. Nowhere was that more evident than in New York City, the disease's epicenter, where one grad told me virtually every hospital has at least one MD from the Cuban school, which has provided free 6-year medical training for some 30,000 doctors since the school's founding in 1999. The student body comes primarily from low- and middle-income countries worldwide, but Cuba also provided 200 US students with scholarships. One of them is Dr Joaquín Morante (ELAM Class of 2012), who did his medical residency in internal medicine, followed by fellowships in pulmonary disease and critical care medicine. Triple-licensed in internal medicine, pulmonary and critical care medicine, he is now an attending physician on staff at Jacobi Medical Center in The Bronx, one of New York City's public hospitals, and considered a 'hot spot' due to its COVID-19 caseload. I spoke with him during a break at home in mid-April.Dr Joaquín Morante, ELAM Class of 2012: Pulmonologist, critical care attending physician at Jacobi Medical Center, New York City.

"Retirement, what?"Herminia Palenzuela MD PhDCoordinator, National Pediatric Cardiology NetworkWilliam Soler Children's Heart Center, Havana.

"Our family wasn't rich, but we didn't want for anything," says Dr Palenzuela by way of introduction. In 1950s Cuba, her father drove a taxi and her mother was a homemaker, raising two daughters-one now an economist and the other a top pediatric cardiologist. In many ways, Dr Palenzuela's career rode the wave of social change that swept Cuba beginning in 1959. Like many others, time and again she stepped up to the plate, and in 1986, she became a founder of one of the Cuban health system's premier institutions: the William Soler Children's Heart Center, a tertiary facility in Havana. There, to this day, she balances multiple responsibilities-as coordinator of the National Pediatric Cardiology Network, head of the Center's Quality Assurance Program and lead professor of the annual National Certificate Course in Pediatric Cardiology. MEDICC Review spoke with her between phone calls, meetings and patient consults.

Cuba and the Global Year of Universal Health: Cristian Morales PhD Former PAHO/WHO Representative in Cuba.

A 2014 PAHO resolution that Cristian Morales helped formulate serves as a framework for the Americas' governments to actively work towards health for all their people, incorporating this aim into national programs for sustainable development. This September, the UN General Assembly will sponsor a High-Level Meeting on Universal Health . . . a first in its history. In part two of MEDICC Review's interview with Dr Morales, he outlines strategies he believes vital for transforming health systems to reach universal health-defined as coverage and access for all-and for turning words into action.

Of Glass Ceilings, Velvet Circles and Pink-Collar Ghettoes:Lilliam Álvarez MS PhDSecretary, Cuban Academy of Sciences.

She was a country girl from the northeast-ern Cuban province of Holguín, her father a farmer, her mother a teacher. Fast forward a few decades: Dr Lilliam Álvarez mastered mathematics, physics and nuclear science, finally specializing in numeric solutions to differential equations. She spent 20 years at the Cybernetics and Physics Institute in Havana, half that time as deputy director. For another eight years, she served as di-rector of science in the Ministry of Science, Technology and the Environment. Full professor and senior researcher at the Uni-versity of Havana, she is a member of the national academic authority that awards doctoral degrees in math and is Cuba ́s ambassador to the International Math-ematical Union. In 2000, she was inducted into the Caribbean Academy of Sciences, and in 2008, was elected a full member of the Third World Academy of Science (now The World Academy of Sciences). But over time, her rich bibliography, with titles the likes of Anumerical technique to solve linear and non-linear singularly perturbed problems began to be peppered with other provoca-tive gender-informed work: Women doing hard sciences in the Caribbean, Are Women Good for Math? and her 2011 book Ser mujer científi ca o morir en el intento (Be a Woman Scien-tist or Die Trying). Her focus on women in science-and their rights to belong in its leadership as well as its ranks-is also reflected in her activist approach internationally and in Cuba. She is a member of the Organization for Women in Science for the Developing World and heads its Cuban chapter. After her designation as a Distinguished Member of the Cuban Acad-emy of Sciences, she was elected Secretary in 2010 and also chairs its Commission on Women in Science.The Cuban Academy of Sciences was the right place to hear her story and to explore the way she sees women scientists in today's Cuba-and the country she would like to see in the future.

Weathering US-Cuba Political Storms: José Rubiera PhD Cuba's Chief Weather Forecaster.

Full disclosure: chief weather forecaster is not his official title, but rather one affectionally conferred on Dr Rubiera by the Cuban people, who look to him not only in times of peril, but also to learn about the science of meteorology. Anyone who has taken a taxi in Cuba during hurricane season (June 1 to November 30), and bothered to ask the driver, will receive a clear explanation about how hurricanes are formed, what the Saffir-Simpson scale is all about, and how the season is shaping up-all courtesy of Dr Rubiera's talent for communication during nightly weather forecasts and special broadcasts. It's no exaggeration to say that he is something of an icon in Cuba, a man people trust. Now, he is retired as chief of forecasting at Cuba's Meteorology Institute, but he stays on as an advisor, and since 1989 represents Cuba's Meteorological Service as the Vice Chairperson of the World Meteorological Organization's Hurricane Committee for Region IV (North America, Central America and the Caribbean). He also keeps a spot on nightly news and hosts two TV shows of his own: Global Weather and Weather in the Caribbean. And his PhD in meteorology serves him well as full professor at the University of Havana in-what else?-meteorology communications. Finally, he has been a driving force in Cuba for collaboration with Miami's National Hurricane Center (NHC) and other US meteorologists (in fact, the Chairperson of the Region IV Committee is the head of the NHC). But, as he says over a cup of rich Cuban coffee, it all started with a two-year-old in a yellow sweater.

Bridging the Divide: US and Cuban Scientists Speak Up.

This roundtable began with world-renowned US and Cuban experts in arboviruses (particularly those transmitted by mosquitoes) but was quickly transformed with the participation of globally recognized scientists in other fields. All have contributed and continue to contribute to the often frustrating efforts to advance bilateral health cooperation, for the benefit of the USA, Cuba and the world. Each from their own vantage point argues why such cooperation can release potential to create scientific synergies capable of addressing some of the most perplexing and urgent global health problems.

Translating the Shared Value of Solidarity Cristian Morales PhD PAHO/WHO Representative in Cuba.

Cristian Morales, an economist by training, has dedicated his career to improving health and health equity in the Americas through his work with PAHO/WHO. This has taken him from floods and earthquakes in Haiti to PAHO's Washington DC offices, where he was instrumental in achieving consensus on a resolution aiming for universal health-coverage plus access-approved by all governments in the Americas. Since 2015, he has served as PAHO/WHO Permanent Representative in Cuba and has recently been appointed to the analogous post in Mexico.

What Happened to the US Diplomats in Havana? Mitchell Valdés MD PhD Director, Cuban Neuroscience Center.

He was born in Chicago, Illinois, USA, but his family is Cuban. After 1959, they returned to the island, where Dr Mitchell Valdés received his medical degree at the University of Havana in 1972. He went on to study clinical neurophysiology, earning his PhD with a dissertation on the auditory system's sensory physiology.