. . SUSTAINABLE DEVELOPMENT . .

An article from the United Nations Food and Agriculture Organization

The 36th Session of FAO’s Regional Conference for  Latin America and the Caribbean  ended today with FAO Members in the region agreeing to join efforts to fight COVID-19 and promote sustainable agri-food systems through innovation, digital technologies, partnerships and enhanced data, particularly to strengthen food value chains and support smallholders farmers and the most vulnerable communities.

FAO Director-General QU Dongyu and Edward Centeno Gadea, Minister of Agriculture and Livestock, Nicaragua and Conference Chair

During the three-day virtual meeting (19 – 21 October) hosted by the Government of Nicaragua, all 33 Members, as well as representatives from civil society and the private sector, highlighted the importance of developing and applying innovative approaches to overcome the challenges facing food and agriculture in the region, particularly in relation to scaling up the use of digital tools.

“We need innovation, science and digital technologies to reach the Sustainable Development Goals,” said FAO’s Director-General, QU Dongyu, during the event, stressing that innovation and digital technologies “are the only way out for us to go forward.”

Several Latin American and Caribbean countries stressed that policies and programmes to promote digital solutions should mainly target small and medium-sized family farmers and poor and vulnerable rural communities, bridging the gaps in the rural population and leveraging their potential for inclusive and sustainable development. The International Platform for Digital Food and Agriculture, whose development has been led by FAO, was mentioned as an important tool for the exchange of experience and coordination among countries.

The Director-General noted that digital technology also contributed to make the Regional Conference a tremendous success in terms of attendance. The level of participation was unprecedented. The event was attended by one Prime Minister, three Ministers of Foreign Affairs, 50 ministers and 40 vice-ministers, and 346 other government officials, as well as 103 Observers from a wide diversity of sectors and organizations. Furthermore, close to 30,000people are estimated to have followed the Conference through digital platforms.

“The Digital FAO is more transparent, more open to dialogue, more inclusive, and, above all, more responsive to the needs and priorities of its Members,” Qu said.

Enhanced partnerships and data

The Regional Conference affirmed that in the midst of the COVID-19 pandemic, it is fundamental to strengthen partnerships, multilateralism and international solidarity. In this sense, countries welcomed FAO’s comprehensive COVID-19 Response and Recovery Programme and requested support from the UN agency for the design, implementation and assessment of public policies and programmes. These, they noted, should focus  on job creation, social and productive inclusion, healthy food for the whole population, school feeding, access to water for production and consumption and increasing productivity.

“The FAO COVID-19 Response and Recovery Programme is now in motion. We must work together to minimize the impact that the pandemic will have on our food systems, livelihoods and health,” the Director-General said.

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(Click here for a Spanish version of this article.)

What is the relation between movements for food sovereignty and the global movement for a culture of peace?

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The importance of data collection and analysis for the development of a new generation of public policies and programmes was also highlighted by countries, as well as agreements and alliances between the public, private, scientific, academic and civil society sectors, to promote governance of food systems that enable healthy diets and sustainable food systems.

In this context, countries supported the Hand-in-Hand Initiative to promote effective cooperation mechanisms between recipient and donor countries, as well as to mobilize resources from financial institutions and the private sector, particularly to reduce the development gaps that affect lagging rural territories in the region. The initiative is equipped with state-of-the-art tools – the Hand in Hand Geospatial Platform and the Data Lab for Statistical Innovation – to support countries and other stakeholders with data collection and analysis for decision-making and impact assessment.

Transforming food systems towards better nutrition in the region 

The Regional Conference held a special event organised by the Committee on World Food Security (CFS) to discuss ways to transform food systems and ensure healthy diets for all, entitled “Driving Transformation Toward Sustainable Food Systems and Healthy Diets.”

The region of Latin America and the Caribbean is undergoing a rapid nutritional transition. Since 2014, hunger has grown again by 13 million people, and the economic impact of the COVID-19 pandemic is likely to lead to an increase in the incidence of hunger. Today, almost 48 million people suffer from hunger in the region. At the same time, obesity levels are also on the rise affecting around 25 percent of the population.

“We need to join all our efforts and work together, now more than ever before”, said FAO Director-General QU Dongyu opening the special event. “Because, we are not on track to eradicating hunger, food insecurity and all forms of malnutrition by 2030. And because the COVID-19 pandemic comes at a time when food insecurity was already increasing in the region”.

He noted that the pandemic and the related containment measures are especially damaging for Small Island Developing States, which heavily depend on food imports, and called on the countries in the region to step up efforts to make their food systems more efficient, healthy and sustainable, stressing that agri-food systems transformation should be country-owned and country-led.

For his part, the CFS Chairperson and Permanent Representative of Thailand to the Rome-based Agencies, Thanawat Tiensin, noted that the CFS Voluntary Guidelines on Food Systems and Nutrition are currently under negotiation by all CFS members and are expected to be adopted at the next CFS Plenary session in February 2021. He urged all stakeholders including governments, parliamentarians, private sector and civil society to improve cross-sectoral policy coordination and join efforts to turn policies into action.

During the event, the FAO Director-General and the CFS Chairperson were joined by Senator Jorge Pizarro of Chile, President of the Parliament of Latin America and the Caribbean (PARLATINO); Marisa Macari, El Poder del Consumidor, Mexico, Representative of the CFS Civil Society Mechanism; and Maria Nelly Rivas, Cargill, Representative of the CFS Private Sector Mechanism, as well as regional policy-makers and experts. 

The CFS was established in 1974, hosted by FAO, as an intergovernmental body to serve as a forum in the United Nations System for review and follow-up of policies concerning world food security. It is considered the most inclusive platform in the UN System.

In his closing remarks to the Regional Conference, the Chairperson and Minister for Agriculture and Livestock of Nicaragua, Edward Centeno Gadea, highlighted the importance of FAO’s work to support rural families, particularly the most vulnerable ones, and affirmed that “fighting against poverty is an act of peace.”

More information about the Regional Conference for Latin America and the Caribbean can be found here.

. . SUSTAINABLE DEVELOPMENT . .

An article by Rita Jill Clark-Gollub, Erika Takeo and Avery Raimondo for the Council on Hemispheric Affairs (See original for 48 footnotes)

An array of UN agencies is predicting a global hunger pandemic triggered by COVID-19 lockdowns, with the head of the World Food Program stating that there is “a real danger that more people could potentially die from the economic impact of COVID-19 than from the virus itself.”[1] At least 10 million more Latin Americans are expected to join the 3.4 million who were already experiencing chronic food insecurity.[2] These devastating effects will be long-term, as each percentage point drop in global GDP is expected to cause 0.7 million more children to be stunted from undernutrition.[3] There are clear signs that the food shortages have already arrived, as flags indicating hunger are spotted outside homes from Colombia to the Northern Triangle of Central America,[4] while violently repressed hunger protests have occurred in places such as Honduras[5] and Chile.[6] As a street vendor in El Salvador put it, “If the virus doesn’t kill us, hunger will.”[7]

But in the second poorest country in the Western Hemisphere, there are no hunger flags flying. The market stalls are stocked, customers are buying, and prices are stable. Nicaraguan small farmers produce almost all the food the nation consumes, and have some left over for export. We will examine how this is possible.

Lucila Reyes of the Marlon Alvarado community, in Santa Teresa, Carazo where women play an active role in the construction of food sovereignty through peasant organizations and government programs. Shown with tomatoes grown in her agroecological garden. Photo-credit: Asociación de Trabajadores del Campo (Rural Workers Association or ATC)]

At the June 9, 2020 launching of his Policy Brief: The Impact of COVID-19 on Food Security and Nutrition,[8] UN Secretary-General António Guterres not only called for urgent action to address this hunger crisis, but also to take the opportunity to shift towards more sustainable food systems. This transition is something that the world’s peasants have been calling for since they founded La Vía Campesina (LVC) in 1993. It is now urgent to listen to what over 200 million peasants, women farmers, indigenous and Afro-descendant peoples, fisherfolk, and pastoralists have been saying about our food systems:

“The pandemic has highlighted yet another ill of countries becoming too dependent on large international food industries [and their international supply chains]. For decades, governments did little to protect small farms and food producers which were pushed out of business by these growing dysfunctional corporate giants. … They stood idle as their countries grew increasingly dependent on a few major suppliers of food who forced local producers to sell their produce at unfairly low prices so corporate executives can keep growing their profit margins.”[9]

Agribusiness is also exacerbating the world’s most pressing problems: its Confined Animal Feeding Operations (CAFOs) crowd immune-stressed animals, making them susceptible to viruses that can cross over to humans;[10] its fossil fuel- and chemical-intensive practices account for at least a third of the greenhouse gas emissions driving climate change;[11] and its genetically modified seeds are known to diminish biodiversity. Moreover, in Latin American commercial food systems, it is fueling price increases during the pandemic.[12]

La Vía Campesina’s answer is food sovereignty, which is defined as “the right of people to healthy and culturally appropriate food produced through ecologically sound and sustainable methods, and their right to define their own food and agriculture systems.”[13] It prioritizes: 1. local agricultural production in order to feed the people; and 2. peasants’ and landless people’s access to land, water, seeds, and credit. This approach actually works in combating hunger, as peasants and smallholders produce 70-75 percent of the world’s food on less than one quarter of the world’s farmland.[14] When peasant movements partner with progressive governments, the results can be astounding, as in the case of Nicaragua.

The peasant movement in Nicaragua

The Asociación de Trabajadores del Campo (Rural Workers Association or ATC) was founded during the war to overthrow the U.S.-backed Somoza dictatorship, one year before the 1979 victory of the Sandinista People’s Revolution. It brought together peasants, both small farmers wanting to procure their own land as well as farm workers organizing for union rights. The ATC has continued to represent these groups of workers throughout its 42-year history and was one of the national organizations that founded La Vía Campesina in 1993.[15]

In the 1980s, the Nicaraguan revolutionary government launched a massive land reform program, which distributed about half the country’s arable land (5 million acres) to 120,000 peasant families. Several other peasant groups formed during that first decade of the revolution as the cooperative farming movement prospered, even coming to include the families of former contra fighters, who had been adversaries of the Sandinista government. Later, during the neoliberal administrations of 1990-2006, these groups worked to defend the gains of the revolution, sometimes including worker occupations of state farms to prevent them from being privatized. By 2006, and inspired by the 1987 Constitution that guarantees protection against hunger,[16] some 73 Nicaraguan organizations belonged to the Interest Group for Food and Nutritional Sovereignty and Security (GISSAN) that was advocating for a Food Sovereignty Law. Several of them helped the Sandinista National Liberation Front (FSLN) get elected back into office at the end of that year.[17]

Food Sovereignty since 2007

In the current stage of Sandinista governance that started in 2007, the strategy to increase food sovereignty by providing land has continued. Almost 140,000 land titles (some from land distributed during the 1980s land reform) were issued to small producers from 2007 to 2019. Women have particularly benefited from receiving proper titles to their land (55 percent) and 304 indigenous and Afro-descendant communities on the Caribbean coast have received collective titles. The titled area amounts to 37,842 Km2, or 31.16 percent of the national territory.[18]

Social programs that help small farmers feed themselves and their communities have imbued life in the countryside with dignity while reducing hunger. These initiatives are inspired by Augusto C. Sandino’s vision of an economy based on land-owning peasants and indigenous peoples farming in organized cooperatives—a core component of the FSLN’s Historic Program. Law 693 on Food and Nutritional Sovereignty and Security, enacted in 2009, was one of the first in Latin America to recognize the concept of food sovereignty and actually build it with government support.[19] The commitment of the FSLN government to food sovereignty has led to dozens of programs to improve the livelihoods and autonomy of small farmers while strengthening local food systems.

The signature initiative is the Hambre Cero (Zero Hunger) program which began in 2007 and provides pigs, cows, chickens, plants, seeds, and building materials to women in rural areas to diversify their production, improve the family diet, and strengthen women-led household economies.[20] By 2016, the program had benefited 150,000 families or 1 million people, increasing both their food security and the nation’s food sovereignty.[21]

Interviews completed as part of a solidarity testimonies project[22] with ATC members in the Marlon Alvarado community, many of whom are also beneficiaries of government programs, illustrate the impact of Hambre Cero. For example, one woman said:

“I have always been in social movements, since I was young. We are a group of women working here. We are united and in solidarity, all of us. …The ATC has taught us about women’s entrepreneurship… The government is encouraging us to always cultivate our land, so that we have our food. They give us citrus, they give us bananas, papaya, lemons. We just have to go harvest. We have jocote, mango. They always continue the [Hambre Cero] program so that we grow something. In our plot, we are always growing something.”

Another woman in the same community said:

“I have two male pigs, boars, for breeding: if someone else has a sow, they bring it to the boar and I get a piglet in return. For every sow they bring to the boar, I get a little pig. Or if someone says to me, ‘I have all the piglets sold; I’ll give you the money. What do you say?’ ‘Okay,’ I say. We agree.”

Additionally, the Ministry of the Family, Community, and Cooperative Economy (MEFCCA) and municipal governments organize farmers markets to improve peasant incomes while making nutritious, locally-grown food accessible to consumers, that is produced without chemical fertilizers or pesticides. The Nicaraguan Institute of Agricultural Technology (INTA) works to improve and maintain the country’s genetic material by organizing community seed banks,[23] and the National Technological Institute (INATEC) provides free technical degrees in agriculture, livestock care, value-added processing, and beekeeping, to name a few.[24] A new program called NicaVida will reach 30,000 rural families with tools, fencing, water tanks, chickens, and other materials to improve family diets and household economies in the Dry Corridor[25] areas which are particularly impacted by climate change.[26]

The breadth and territorial reach of these programs keep Nicaragua’s peasants and small farmers free from dependence on global markets; their diversified production is organized to feed their families and local communities, with increasing access to seeds, water, and credit, thereby creating the conditions to achieve food sovereignty.

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A poverty and hunger fighting program targeting urban residents is Zero Usury, which is part of the national food ecosystem since it serves many who work in open-air markets. This program, administered by the MEFFCA, gives low interest loans and grants to small business owners (primarily women) and offers free entrepreneurship training, funded in part by Venezuela and other ALBA countries. Over 800,000 women have benefited from the program since 2007, which has been crucial to the success of the popular economy (self-employed workers, small farmers, family businesses, and cooperatives) which accounts for over 70 percent of employment.

Long-time activist and current presidential advisor Orlando Núñez explains the philosophy behind these programs and why they work:

“The heart of the Hambre Cero program is giving capital to peasant families. A cow is capital because she reproduces; sows, seeds, and hens reproduce. The first message is not to treat people like poor people; they are only poor because they have been impoverished. … Offering poor people a glass of milk or a slice of bread is an act of charity, not revolution. … The revolutionary thing about Hambre Cero in Nicaragua is that it treats people like economic actors. …That is the most revolutionary message of the Sandinista revolution.”[27]

The initiatives for this second phase of the Sandinista Revolution are all complemented by the grassroots work of social movements. The ATC and LVC have established a campus of the Latin American Institute of Agroecology (IALA) in Nicaragua for youth from Nicaragua and throughout the Mesoamerican and Caribbean region. The school not only imparts technical training on agro ecological production of crops and animals, but also political and ideological education so that students come to understand today’s clash between two models of agriculture: one (the agribusiness model) in which food is a business for the benefit of corporations, and another (the food sovereignty model) in which food is a human right for all. The program encourages peasants to be each other’s teachers and have agency over their own lives, reclaiming their peasant identity and culture. It is an education that focuses on staying in the countryside and producing food that stays within the local market.

Throughout the country the ATC and other peasant organizations have been organizing local workshops to train agroecological promoters, support women’s cooperatives in marketing their farm products, formalize peasants’ land titles, and prepare on-farm biofertilizers and composts. All of this supports the construction of food sovereignty.

Hunger outcomes in Nicaragua and Central America

All indications are that these programs have resulted in a better fed population in Nicaragua. In its 2019-2023 Strategic Plan for Nicaragua, the United Nations World Food Program said that “In the last decade… Nicaragua is one of the countries that has reduced hunger the most in the region,”[28] while the government reports that chronic child malnutrition dropped from 21.7 percent in 2006 to 11.1 percent in 2019 for children under 5 years of age.[29] Nicaragua was also one of the first countries to achieve Millennium Development Goal Number 1 of cutting undernutrition in half from 2.3 million in 1990-1992 to 1 million in 2014-2016, placing it among the countries of the region that had reduced hunger the most in the previous 25 years. Vitamin A deficiency among children under 5 was also eliminated.[30]

Nicaragua’s advances are reflected in the Food and Agriculture Organization’s Hunger Map.[31] Unfortunately, that map shows that neighboring Honduras and El Salvador did not achieve the Millennium Development Goal on hunger reduction, and that Guatemala did not even make progress. This stagnancy may be related to the fact that US exports to the Northern Triangle countries increased substantially since the signing of the Dominican Republic-Central American Free Trade Agreement (CAFTA-DR). These three countries imported about US$5.9 billion of agriculture products from the world in 2016, including beans and dairy products from Nicaragua, and corn, soybean meal, wheat, poultry, rice, and prepared foods from the US. Imports of many of these US foods increased by 100 percent or more from 2006-2016, coming to comprise about 40 percent of all food imports for these countries.[32] Unfortunately, food prices in these countries are on the rise precisely when people have less income with which to purchase food due to COVID-19 lockdowns at home and in the US, from which Central American countries receive remittances. Parts of Guatemala are already receiving half the remittances they received at this time last year.[33] Even Nicaragua’s wealthier neighbor to the south, Costa Rica, has become dependent on imported beans, rice, beef, and corn after opening the market through free trade agreements. At a recent LVC regional meeting, a Costa Rican peasant leader discussed how vulnerable the country has become, saying “COVID is stripping us bare.” Not only are grain prices rising while vegetable crops rot because they cannot reach consumers, unemployment is expected to double from 12.5 percent to 25 percent,[34] and 57 percent of Costa Ricans report having trouble making ends meet.[35] This brings major worries of increased hunger.

Food sovereignty and the pandemic in Nicaragua

Ninety percent of the food consumed in Nicaragua is produced within the national borders, 80 percent of it by peasants.[36] This includes all of the beans, corn, fruits, vegetables, honey, and dairy products, while there is sufficient surplus of beans and dairy to export. Nicaragua’s food self-sufficiency is growing precisely while other developing countries are increasingly becoming agro-exporters of a few crops (e.g. pineapples or bananas) while ever more dependent on imports to feed their populations. Rice is the only component of the basic diet that is not completely homegrown, but domestic rice production has increased from meeting 45 percent of the country’s demand in 2007 to 75 percent of demand today. The government is working with producers to bring it up to 100 percent within 5 years. Nicaragua is indeed very close to achieving food sovereignty, the true anti-hunger model, which bodes well for times of crisis such as now with the economic impacts of the pandemic and the interruption of food distribution supply chains in other countries.

In the context of the pandemic, both the government and social movement organizations are determined to take food sovereignty to the next level. For example, the government just launched a National Plan for Production focused on increasing production of basic grains to cover all internal food needs, and also guarantee the production of crops for export.[37] Food stocks are normal, prices are stable, production has continued normally since there has not been a work lockdown and most food is produced in small family units, and the rains have started for what looks to be a good planting season. Meanwhile, the Nicaraguan member organizations of LVC are launching the Agroecological Corridor, a process of territorializing agroecology based on peasant-to-peasant exchanges as a response to the threats being posed by climate change.[38] Because training of youth also must continue, coursework at LVC’s flagship Latin American Institute of Agroecology is taking place online[39] while the institute’s campus is implementing a full food production plan that includes grains, root vegetables, and animals. LVC has also launched the emergency campaign “Return to the Countryside”[40] to be adopted not just in Nicaragua, but internationally.

Other challenges to Nicaragua during the pandemic

COHA has previously reported on the Nicaraguan government’s robust response to COVID-19 within the health sphere, amidst a vigorous disinformation campaign waged against the population and government in what clearly appears to be a regime change operation funded by the US.[41] That regime change effort is no doubt partially inspired by Nicaragua’s food sovereignty policy, which threatens the dominance of US corporate agribusiness around the globe. For example, USAID has flooded food systems with Monsanto (now Bayer) GMO seeds in countries ranging from India[42] to Iraq[43] to several countries of Africa[44] and Latin America.[45] This approach could be undermined if more developing countries decide to produce their own food through agroecological practices.

USAID was one of the agencies funding opposition groups involved in a violent attempted coup in Nicaragua in 2018, as is well-documented in Live from Nicaragua: Uprising or Coup?[46] It is not surprising, then, that the representative of Cargill in Nicaragua and head of the U.S.-Nicaragua Chamber of Commerce was one of the leaders of the opposition during the attempted coup.[47] While Nicaragua does not have the oil and minerals that draw international attention to Venezuela and Bolivia, agribusiness is a hugely profitable industry and the Nicaraguan peasants are setting a powerful example by rejecting it and feeding their people to boot.

Fighting a disinformation campaign while the country faces the same pandemic that has overwhelmed much wealthier countries will certainly be challenging for Nicaragua, particularly since unilateral coercive measures illegally imposed by the US block access to aid funds. But at least her people have the comfort of knowing that there will be no death caused by hunger. In fact the food system recently withstood a formidable test during the 2018 coup attempt, when violent roadblocks held all the main roads and highways captive. Thanks to local food production and distribution systems, and clever determination to circumvent the roadblocks, people using the popular economy were still able to get food and at relatively stable prices, even when the Walmart-owned supermarket chains had empty shelves.

In an interview in late April, the leader of a peasant women’s organization was asked about Nicaragua’s handling of the coronavirus. Her concern was not as much about catching the virus as that,

“We will have food. It’s true that it is going to be hard; we will probably have a recession. But the important thing is that we have all the basic foodstuffs. We Nicaraguans are not quite 100 percent food self-sufficient. But we [in the Fundación Entre Mujeres] will do everything within our power to be as self-sufficient as we can so that the government does not need to give us aid and can give it to people who have greater needs than we have. We are taking a stance of dignity, being part of the solution.”[48]

That attitude, coupled with a commitment to agroecology and food sovereignty, is what has Monsanto/Bayer, Cargill, and their guardians at USAID worried.

. . SUSTAINABLE DEVELOPMENT . .

An article by Helen Yaffe reprinted by Transcend

The response of socialist Cuba to the global SARS-CoV2 pandemic has been outstanding both domestically and for its international contribution. That a small island nation, subjected to hundreds of years of colonialism and imperialism and, since the Revolution of 1959, six decades of the criminal United States blockade, can play such an exemplary role is due to Cuba’s socialist system. The central plan directs national resources according to a development strategy which prioritises human welfare and community participation, not private profit.

Video of Cuban Isolation Center

Cuban authorities reacted quickly to Chinese information about SARS-CoV2 at the start of the year. In January, authorities established a National Intersectoral Commission for COVID-19, updated their National Action Plan for Epidemics, initiated surveillance at ports, airports and marines, gave COVID-19 response training for border and immigration officials and drafted a ‘prevention and control’ plan. Cuban specialists travelled to China to learn about the new coronavirus’ behaviour and commissions of the government’s Scientific Council began to work on combating the coronavirus. Throughout February, medical facilities were reorganised, and staff trained to control the spread of the virus domestically. In early March a science and biotechnology group was created to develop COVID-19 treatments, tests, vaccines, diagnostics and other innovations. From 10 March inbound travellers were tested for COVID-19. All of this was before the virus was detected on the island.

On March 11, three Italian tourists were confirmed as the first cases of COVID-19 in Cuba. Cuban healthcare authorities stepped into action, organising neighbourhood meetings, conducting door-to-door health checks, testing, contact tracing and quarantining. This has been accompanied by education programmes and daily information updates. The population went under ‘lockdown’ on 20 March, required to abide by social distancing rules and wear facemasks when leaving homes on essential business. Business taxes and domestic debts were suspended, those hospitalised had 50% of their salaries guaranteed and low-income households qualified for social assistance and family assistance schemes, with food, medicine and other goods delivered to their homes. Workshops nationwide began to produce masks, bolstered by a grassroots movement of home production, and community mutual aids groups organised to assist the vulnerable and elderly with shopping for food as long queues became the norm. On 24 March, Cuba closed its borders to all non-residents, a tough decision given the importance of tourism revenue to the state. Anyone entering the country was required to spend a fortnight in supervised quarantine, under a testing regime. Defence Councils in the Provinces and Municipalities were activated.

In April payment of utility bills was suspended, likewise local and regional transport, while transport was guaranteed for medical staff and other essential workers. Havana and other cities were disinfected. 20 communities in six provinces were placed under total or partial quarantine. A Cuban-designed mobile phone app, ‘Virtual Screening’, went live with an opt-in application allowing users to submit an epidemiological survey for statistical analysis by the Ministry of Public Health (MINSAP). Measures were taken to keep the virus out of prisons, with active screening twice daily and no reported cases by 23 April.

By May 24, a Cuban population of 11.2 million had reported 82 deaths and fewer than 2,000 confirmed cases; 173 confirmed cases per million people, compared to 3,907 per million in Britain. Not one healthcare worker had died, although 92 had been infected by mid-April.

Cuba’s exemplary response is based on five features of its socialist development. First, its single, universal, free public healthcare system which seeks prevention over cure, with a network of family doctors responsible for community health who live among their patients. Second, Cuba’s biopharma industry which is driven by public health needs, produces nearly 70% of the medicines consumed domestically and exports to 50 countries.[1] Third, the island’s experience in civil defence and disaster risk reduction, usually in response to climate-related and natural disasters. Its internationally applauded capacity to mobilize national resources to protect human life is achieved by a network of grassroots organizations which facilitate communication and community action. Fourth, the island’s experience in operating infectious disease (border) controls. For decades, Cuba has sent healthcare professionals to countries which have infectious diseases long-since eradicated on the island and has invited tens of thousands of foreigners from those countries to study in Cuba. It has well-developed procedures for quarantining people (re)entering the island. Fifth, Cuban medical internationalism, which has seen 400,000 healthcare professionals providing free healthcare for underserved populations in 164 countries; some 28,000 medical personnel were serving in 59 countries when the pandemic began. By late May, an additional 2,300 healthcare specialists from Cuba’s Henry Reeve medical brigades, specialists in epidemiological and disaster response, had gone to 24 countries to treat patients with COVID-19.

A commitment to high-standard public healthcare

In 1959, Cuba had some 6,000 doctors but half of them soon left; only 12 of the 250 Cuban teachers at the University of Havana’s Medical School stayed. There was only one rural hospital. The revolutionary government faced the challenge of providing a high-standard public healthcare system almost from scratch. To that end, in 1960, the Rural Medical Service (RMS) was established and over the next decade hundreds of newly graduated doctors were posted in remote areas. RMS physicians served as health educators as well as clinicians. National programs were established for infectious disease control and prevention. From 1962 a national immunization program provided all Cubans with eight vaccinations free of charge. Infectious diseases were rapidly reduced, then eliminated. By 1970, the number of rural hospitals had reached 53. Not until 1976 was the pre-revolutionary ratio of doctors to citizens restored. By then, health services were available nationwide and indicators had improved significantly. A new model of community-based polyclinics was established in 1974 giving Cuban communities’ local access to primary care specialists. Training and policy emphasized the impact of biological, social, cultural, economic and environmental factors on patients. National programs focused on maternal and child health, infectious diseases, chronic non-communicable diseases, and older adult health.

In 1983, the Family Doctor and Nurse Plan was introduced nationwide. Under this system, family doctor practices were set up in neighborhoods, with either the doctor or the nurse living with their family above the practice, so medical attention is available 24 hours a day. Family doctors coordinate medical care and lead health promotion efforts, emphasizing prevention and epidemiological analysis. They rely on history-taking and clinical skills, reserving costly high-tech procedures for patients requiring them, holding patient appointments in the mornings and making house calls in the afternoons. The teams carry out neighborhood health diagnosis, melding clinical medicine with public health, and individualized ‘Continuous Assessment and Risk Evaluation’ (CARE) for their patients. Family doctors and nurses are also employed in large workplaces and schools, child day-care centers, homes for senior citizens and so on.

By 2005, Cubans had one doctor for every 167 people, the highest ratio in the world. Cuba now has 449 policlinics, each attending to 20,000 to 40,000 people and serving as a hub for 15 to 40 family doctors. There are more than 10,000 family doctors spread evenly throughout the island.

Primary Health Care as the backbone of Cuba’s response

An article in April 2020 Medicc Review describes Cuba’s primary health care system as a ‘powerful weapon’ against COVID-19. ‘Without early access to rapid tests, massive testing was clearly not in the cards as a first strategic option. However, primary health care was.’ Cuban authorities ensured that everyone in the healthcare system, including support staff, received COVID-19 training before the virus was detected. Senior medics from each province were trained at Cuba’s world-famous hospital for tropical diseases, Instituto Pedro Kourí. On returning to their provinces they then trained colleagues in the second tier – hospital and polyclinics directors. ‘Then they went on to the third tier: training for family doctors and nurses themselves, lab and radiology technicians, administrative personnel, and also housekeeping staff, ambulance drivers and orderlies. Anyone who might come into contact with a patient’, explained a polyclinic director, Dr Mayra Garcia, who is cited in the Medicc article.

Each polyclinic also trained non-health sector people in their geographical area, in workplaces, small business owners, people renting homes, especially to foreigners, or managing childcare facilities, telling them how to recognize symptoms and take protective measures. Senior medical professionals in the polyclinics were sent to family doctors’ offices as reinforcement. Medical staff were posted in local hotels to provide 24-hour detection and health care to foreigners residing there. Walk-in emergency services were re-organized to separate anyone with respiratory symptoms and to provide 24-hour assessment. Non-COVID-19 related appointments were postponed where possible or shifted to home visits for priority groups.

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How can we work together to overcome this medical and economic crisis?

Does Cuba promote a culture of peace?

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The Medicc article underscores the importance of the CARE model for combating COVID-19. All Cubans are already categorized into four groups: apparently healthy, with risk factors for disease, ill, and in recovery or rehabilitation. Doctors know the health characteristics and needs of the community they serve. ‘The CARE model also automatically alerts us to people who are more susceptible to respiratory infections, the people whose chronic diseases are the risk factors most commonly associated with complications in COVID-19 patients’ explained Dr Alejandro Fadragas.

Throughout Cuba, CDRs, or street committees, organized public health information meetings for family doctors and nurses to advise neighborhoods about the pandemic. Once the first cases were confirmed, the family doctors daily house visits were extended and became the ‘single most important tool’ for active case detection, to get ahead of the virus.[4] Some 28,000 medical students joined them going door to door to detect symptoms. This procedure means the whole population can be surveyed.

People with symptoms are remitted to their local polyclinic for rapid evaluation. Those suspected of having COVID-19 are sent on to one of the new municipal isolation centers established throughout the island. They must remain for a minimum of 14 days, receiving testing and medical attention. If the case appears to be another respiratory illness, they return home but must stay indoors for at least 14 days, followed up in primary care. Hospitals are reserved for patients who really need them.

Primary healthcare professionals are also responsible for rapid contact tracing for all suspected cases; those contacts are tested and must isolate at home. In addition, the homes and communal entrances of patients sent to isolation centers are disinfected by ‘rapid response’ teams consisting of polyclinic directors and vice directors, alongside family members. Family doctors’ offices are also disinfected daily. Meanwhile, workers in hotels where foreigners are lodged are checked daily by medical staff. The polyclinic provides them with PPE and disinfectants. Polyclinics and family doctors are also responsible for 14 days follow-up for COVID-19 patients discharged from hospitals.

Home-grown medicine

The Cuban treatment protocol for COVID-19 patients includes 22 drugs, most produced domestically. The focus has been placed on prevention, with measures to improve innate immunity. Early on the potential of Cuba’s anti-viral drug Heberon, an interferon Alfa 2b human recombinant (IFNrec), was identified. The biotech product has proven effective for viral diseases including hepatitis types B and C, shingles, HIV-AIDS, and dengue. Produced in Cuba since 1986 and in China since 2003 through a Cuban-Chinese joint venture, ChangHeber, in January 2020 it was selected by the Chinese National Health Commission among 30 treatments for COVID-19 patients. It soon topped their list of anti-viral drugs, having demonstrated good results.

The drug has most efficacies when used preventatively and at early stages of infection. In Wuhan, China, nearly 3,000 medical personnel received Heberon as a preventative measure to boast their immune response; none of them contracted the virus. Meanwhile, 50% of another 3,300 medics who were not given the drug did get COVID-19. Cuba’s IFNrec is recommended in the medical protocols of several countries, by the World Health Organisation (WHO), Johns Hopkins Medical Centre and the World Journal of Paediatrics among others. The product was already registered in Algeria, Argentina, Chile, Ecuador, Jamaica, Thailand, Venezuela, Vietnam, Yemen and Uruguay. By mid-April requests for its use had been received from some 80 countries and it was being administered by Cuba’s Henry Reeve medical brigades treating COVID-19 patients overseas. On 14 April it was reported that 93.4% of COVID-19 patients in Cuba had been treated with Heberon and only 5.5% of those had reached a serious state. The mortality rate reported by that date was 2.7% but for patients treated with Heberon it was just 0.9%.

Other Cuban medicines reporting promising results include:

Biomodulina T, a immunomodulator which stimulates the immune systems of vulnerable individuals and has been used in Cuba for 12 years, principally to treat recurrent respiratory infections in the elderly.

The monoclonal antibody Itolizumab (Anti-CD6), used to treat lymphomas and leukemia, administered to COVID-19 patients in a severe or critical condition to reduce the secretion of inflammatory cytokines, which cause the massive flow of substances and liquid in the lungs.
CIGB-258, a new immunomodulatory peptide designed to reduce inflammatory processes. By 22 May, 52 COVID-19 patients had been treated with CIGB-258; among those in a severe stage, the survival rate was 92%, against a global average of 20%. For those in a critical condition the survival rate was 78%.

Blood plasma from recovered patients.

Cuban medical scientists are producing their own version of Kaletra, an antiretroviral combination of Lopinavir and Ritonavir, used to treat HIV/AIDS. Domestic production will eliminate costly imports from capitalist big pharma and subject to the US blockade. Meanwhile, the homeopathic medicine, Prevengho-Vir, which is believed to strengthen the immune system has been distributed for free to everyone on the island. Medical scientists are evaluating two vaccines to stimulate the immune system and four candidates for specific preventative vaccine for COVID-19 are under design.

By early May, Cuban scientists had adapted SUMA, a Cuban computerized diagnostic system, to detect antibodies for COVID-19 rapidly, allowing for mass testing at low cost. ‘The objective is to find new cases and then intervene, isolate, seek contacts, and take all possible measures to ensure that Cuba continues as it is now’, said Cuba’s top epidemiologist, Francisco Durán during his daily televised update on 11 May. This means the island no longer relies on donated tests or expensive ones purchased internationally. Cuba’s comparatively high rate of testing is set to soar.

BioCubaFarma is mass producing facemasks, personal protective equipment (PPE) and medical and sanitary products, as well as coordinating state enterprises and self-employed workers to repair vital equipment, such as breathing ventilators. Cuban efforts to purchase new ventilators have been obstructed by the US blockade which, for almost 60 years, has included food and medicines among its prohibitions.

Leading the global fight

On March 18, Cuba allowed the cruise ship MS Braemar, with 684 mostly British passengers and 5 confirmed COVID-19 cases, to dock in Havana after a week stranded at sea, having been refused entry by Curacao, Barbados, Bahamas, Dominican Republic and the United States. Cuban authorities facilitated their safe transfer to charter flights for repatriation. Three days later, a 53-strong Cuban medical brigade arrived in Lombardy, Italy, at that time the epicenter of the pandemic, to assist local healthcare authorities. The medics were members of Cuba’s Henry Reeve Contingent, which received a World Health Organization (WHO) Public Health Prize in 2017 in recognition for providing free emergency medical aid. It was the first Cuban medical mission to Europe. By 21 May, over 2,300 Cuban healthcare professionals had gone to 24 countries to treat COVID-19 patients, including a second brigade in northern Italy and another to the European principality Andorra.

The threat of a good example

Cuban medical internationalism began in 1960, but the export of healthcare professionals was not a source of state revenue until the mid-2000s with the famous ‘oil for doctors’ program under which 30,000 Cuban healthcare workers served in Venezuela. US President Bush’s administration responded by attempting sabotage Cuba’s medical export earnings with the Cuban Medical Parole Programme. This induced Cuban professionals, who had paid no tuition costs, graduated debt free and voluntarily signed contracts to work abroad assisting underserved populations, to abandon missions in return for US citizenship. President Obama kept the Programme, even while praising Cuban medics combating Ebola in West Africa. It was ended in his last days in office in January 2017.

The Trump administration has renewed attacks on Cuban medical missions, fuelling their expulsion from Brazil, Ecuador and Bolivia, and leaving millions of people in those countries without healthcare. The motivation was the same; to block revenues to a nation which has survived 60 years of US hostility. In the context of the pandemic, when the US government’s wilful failures have resulted in tens of thousands of unnecessary deaths, socialist Cuba’s global leadership has represented the threat of a good example. Lashing out, the US State Department has labelled Cuban medics as ‘slaves’, claiming that the Cuban government seeks revenues and political influence. It has pressured beneficiary countries to reject Cuban assistance in their time of urgent need. These attacks are particularly vile; it is likely that Cuba is receiving no payment, beyond costs, for this assistance.

Meanwhile, the criminal US blockade, which has been punitively tightened under Trump, is preventing the purchase of urgently needed ventilators for Cuba’s own COVID-19 patients. A Chinese donation to Cuba of medical equipment was blocked because the airline carrying the goods would not travel to Cuba for fear of US fines. There is now a growing international demand for an end to all sanctions, not least against Cuba which has shown global leadership in combating the SARS-CoV2 pandemic. We must all add our voices to this demand. There are also calls from organisations and individuals worldwide to nominate Cuba’s Henry Reeve Contingents for a Nobel Peace Prize. What is clear from its history of principled medical internationalism is that, with recognition or without, revolutionary Cuba will continue to fight for global healthcare wherever its citizens, and its example, can reach.