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
José A. de la Osa
• 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
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
1976: Second tetanus dose for
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
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
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
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
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
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.