Cuba turned public investment and enforced self-reliance into medical capacity. Washington keeps attacking the relationships that capacity built.
The United States has spent decades trying to make economic isolation break the Cuban state. Cuba responded by building institutions designed to keep the country alive without reliable access to the American market. Nowhere is that contradiction clearer than in medicine.
Cuban laboratories developed therapeutic cancer vaccines, monoclonal antibodies and vaccines for diseases that carried little commercial urgency for pharmaceutical companies serving richer markets. Cuban medical teams became part of health systems across Latin America, the Caribbean, Africa and Asia. The country turned public health into domestic infrastructure, export revenue and a network of international relationships that Washington could not easily sever.
The embargo did not create Cuba’s biotechnology sector. Cuban scientists created it, backed by decades of deliberate state investment. The embargo shaped the conditions under which they worked. It restricted access to equipment, medicines, financing and nearby suppliers while making domestic capacity a survival requirement. Cuba could either develop more of what it needed or accept permanent dependence on a hostile power controlling the market ninety miles away.
That system produced real achievements alongside shortages, political repression and economic failures. The Cuban government restricts organized opposition and independent media. Its medical missions have also faced serious complaints about state control over workers and the share of foreign payments retained by Havana. None of that changes what the laboratories produced or why Washington has tried to weaken the international relationships built around them.
The argument is not that Cuba created a perfect society. It is that a blockaded country built medical capacity that became useful far beyond its borders, and the United States repeatedly treated that capacity as a political problem.
The Laboratories Produced More Than a Symbol
Havana’s Center for Molecular Immunology developed CIMAvax-EGF, an immunotherapy used in Cuba for advanced non-small-cell lung cancer. CIMAvax is a therapeutic vaccine for people who already have cancer. It prompts the immune system to produce antibodies against epidermal growth factor, reducing a signal that some tumours use to grow.
It is not a cure. Its value lies in helping selected patients live longer and in providing a platform researchers can test in combination with other treatments. Cuban studies moved it into clinical use, and Roswell Park Comprehensive Cancer Center in Buffalo began US trials in 2017. Roswell Park’s first trials have since closed, with additional studies planned. One registered early-phase trial has tested CIMAvax as a possible preventive intervention for people at high risk of lung cancer. Another examined it with the checkpoint inhibitor nivolumab.
The same Cuban research centre developed nimotuzumab, a monoclonal antibody that targets the epidermal growth factor receptor. It is not a pancreatic-cancer vaccine. A randomized phase III trial in China studied nimotuzumab with gemcitabine in patients with locally advanced or metastatic pancreatic cancer whose tumours were KRAS wild-type.
The trial enrolled 92 patients, with 82 eligible for analysis. Median overall survival reached 10.9 months with nimotuzumab and gemcitabine, compared with 8.5 months for gemcitabine and placebo. One-year survival was 43.6 percent in the nimotuzumab group and 26.8 percent in the control group. At three years, the figures were 13.9 percent and 2.7 percent.
Those results deserve neither dismissal nor mythology. KRAS wild-type tumours represent only a minority of pancreatic cancers, and the study population was small. For the patients covered by the trial, however, a measurable survival gain in one of the deadliest cancers was a concrete medical result.
Cuba’s vaccine institutes built other products around needs that the global pharmaceutical market had left unresolved. During a severe outbreak in the 1980s, the Finlay Institute developed VA-MENGOC-BC against meningococcal disease. Cuban researchers also helped develop a synthetic vaccine against Haemophilus influenzae type b, an infection that caused meningitis and pneumonia among children but remained expensive to prevent in poorer countries.
These were products of conventional molecular biology, immunology and vaccine science. Cuban researchers worked with fewer resources and less reliable access to suppliers than their counterparts in wealthy countries. The institutional answer was to link laboratories, manufacturing facilities, hospitals and the national health system so research could move from a public-health need to trials and production inside the same state system.
State Investment Built the Sector
Cuba began making biotechnology a national priority in the early 1980s. Scientists travelled to Finland in 1981 to learn how to produce interferon, then returned to establish domestic production. The government created specialized institutions, concentrated resources around immunology and genetic engineering, and continued financing pharmaceutical research through the economic collapse that followed the end of the Soviet Union.
That investment decision built the sector. The embargo raised the cost of almost every stage.
Laboratory equipment and reagents had to come through longer supply chains. Companies acquired by US firms could disappear as suppliers. Financing and payments became harder. A nearby pharmaceutical market with enormous productive capacity remained politically closed. Cuban institutions learned to manufacture inputs, integrate research with production and seek partners outside the United States.
The result was not autarky. Cuba still depended on imported equipment, ingredients and international cooperation. It built enough capacity to reduce the leverage created by that dependence and to exchange medical knowledge and products with countries facing their own access problems.
This is why describing the sector as a miracle misses the politics. Cuba made a long-term public investment in scientific capacity and organized it around health-system needs. Sanctions made that investment harder, more expensive and more necessary. The same policy designed to force dependence also strengthened the political case for institutions capable of working around it.
Washington Turned Biotechnology Into a Security Threat
On May 6, 2002, John Bolton, then the US undersecretary of state for arms control and international security, used a Heritage Foundation speech to accuse Cuba of maintaining at least a limited offensive biological-warfare research effort and transferring dual-use biotechnology to other states Washington opposed.
The accusation attached a weapons frame to the same scientific capacity Cuba used to make vaccines and medicines. Biotechnology is inherently dual-use in the broadest sense. Laboratories that study pathogens or manipulate biological materials can produce treatments, diagnostics or harmful agents. That fact applies to every country with an advanced pharmaceutical sector. Washington turned the general possibility into a specific allegation against Cuba.
The US government’s own record did not support Bolton’s certainty. Former president Jimmy Carter said that, before travelling to Cuba days later, he had asked US intelligence agencies whether Cuba had transferred technology that could be used for weapons of mass destruction. He said officials told him they had no evidence that it had. State Department analysts also challenged the evidentiary basis and wording behind the administration’s claims.
Washington still found ways to access Cuban medicine when an American company saw commercial or medical value. In 1999, the US Treasury authorized SmithKline Beecham to work with Cuba’s meningitis vaccine. In 2004, the Bush administration authorized CancerVax to license experimental Cuban cancer treatments.
The US government treated Cuban biotechnology as a proliferation danger and a potential pharmaceutical asset at the same time. The category changed with the political need. Scientific capacity became threatening when it demonstrated Cuban autonomy and useful when an American institution could extract clinical or commercial value from it.
The Obama-era thaw opened a larger channel. Roswell Park partnered with Cuba’s Center for Molecular Immunology and brought CIMAvax into US trials. The partnership showed what scientific exchange could look like when sanctions controls loosened enough for institutions to cooperate.
The structure remained vulnerable to executive policy. On January 14, 2025, President Joe Biden certified the rescission of Cuba’s designation as a state sponsor of terrorism. Donald Trump revoked that action on January 20, his first day back in office. Research relationships built across borders again sat inside a sanctions system designed to make ordinary exchange precarious.
Medical Internationalism Created Material Relationships
Cuba’s medical internationalism extended the same strategy beyond biotechnology. The country trained large numbers of doctors and sent medical workers to countries that lacked staff, especially in rural and underserved communities.
By June 2025, the Cuban government said more than 22,000 doctors were working in over 50 countries. By mid-2026, reporting placed the broader deployment of doctors and nurses at roughly 24,000. Host governments paid Cuba under bilateral agreements, making medical services one of the country’s most important sources of foreign revenue.
The system created a real conflict over labour and state power. Washington and some former participants describe the missions as coercive because Cuba retains a large share of the payments, regulates workers’ movement and uses the contracts to finance the state. Cuban officials and supportive host governments argue that participants earn more abroad than at home and that the agreements fund Cuba’s public-health system. Workers’ experiences vary, and the state’s control over the program deserves scrutiny.
Washington’s response has focused on dismantling the agreements. In February 2025, the State Department expanded visa restrictions against officials it accused of facilitating forced labour through Cuban medical missions. US pressure intensified in 2026 as several governments ended or reduced their contracts.
Other governments defended the program because their clinics depended on it. Mexico kept its agreement and said Cuban personnel served communities that lacked enough doctors. Caribbean leaders warned that removing Cuban workers without a replacement would damage or collapse parts of their health systems.
Those reactions expose the material power Cuba built. The missions are not simply diplomatic branding. They place Cuban labour inside hospitals and clinics where shortages already exist. A government can align itself with Washington and denounce Havana, but replacing thousands of doctors in neglected regions requires trained people willing to do the work.
This is how Cuba turned health policy into international resilience. The country supplied a resource that many governments needed, then used the revenue to sustain institutions at home. The relationship gave Cuba income, influence and allies. It also gave Washington another pressure point.
The Health Record Is Stronger Without Exaggeration
Cuba’s achievements lose nothing when the comparisons are stated accurately.
World Bank data put Cuban life expectancy at 78.1 years in 2023 and the US figure at roughly 78.4. Cuba did not exceed the United States in that year. It came close despite a vastly poorer economy, repeated shortages and six decades of sanctions.
Cuba’s reported adult literacy rate reached 99.8 percent in UNESCO’s data, reflecting the legacy of the 1961 literacy campaign and broad access to basic education. That figure cannot be directly compared with the 2023 US adult-skills survey as if both measured the same thing. The US assessment tested functional proficiency and found that 28 percent of working-age adults performed at Level 1 or below, up from 19 percent in 2017.
The defensible conclusion is not that Cuban literacy is exponentially higher. Cuba achieved near-universal basic literacy, while a wealthy United States recorded a sharp rise in adults struggling with more complex written information. Different measures point to the same political question: what capacities did each society choose to build and maintain?
Cuba’s current health system is also under enormous strain. Hospitals face shortages of medicine, supplies and power. Doctors have left the country. Domestic economic policy, bureaucratic control and the government’s response to dissent have deepened the crisis. US sanctions compound those failures by obstructing purchases, payments, shipping and investment. Both sources of harm operate at once, but only one is imposed from outside by a power claiming that deprivation will produce political freedom.
The Embargo Keeps Attacking What Cuba Built
The embargo failed to prevent Cuba from developing biotechnology. It succeeded in making the work more expensive, limiting access to Cuban medicines and pushing the country toward partners outside the United States.
It also helped turn medical independence into a question of national survival. Cuba invested in laboratories because dependence on the US market carried political risk. It trained doctors because universal care required personnel and because medical services could earn foreign currency. It exported those workers and products to countries that the dominant pharmaceutical and medical-labour markets had underserved.
Washington now attacks the revenue and relationships created by that strategy. In one period, Cuban laboratories become a suspected weapons program. In another, Cuban doctors become evidence of forced labour. Scientific partnerships open during a thaw and narrow when a new administration restores sanctions. The justification changes, but the pressure remains fixed on institutions that give Cuba room to operate outside US control.
Cuba’s laboratories did not defeat the embargo. They show what the embargo could not eliminate. Public investment created scientific capacity. Enforced scarcity pushed that capacity toward domestic production and South-to-South exchange. Medical missions turned trained labour into an export and placed Cuba inside health systems that could not easily replace it.
That is why the policy keeps escalating without reaching its stated goal. The United States can increase the cost of Cuban survival, worsen shortages and punish countries that cooperate with Havana. It cannot make the relationships built through useful medical work disappear by declaring them illegitimate.
Cuba built the institutions. The embargo made their independence more urgent. Washington is still trying to break the international ties those institutions created.
Sources
1. Roswell Park Comprehensive Cancer Center, “CIMAvax Lung Cancer Vaccine” | 2. ClinicalTrials.gov, NCT02955290, CIMAvax with nivolumab in non-small-cell lung cancer | 3. ClinicalTrials.gov, NCT04298606, CIMAvax-EGF for lung-cancer prevention | 4. Journal of Clinical Oncology, “Nimotuzumab Plus Gemcitabine for K-Ras Wild-Type Locally Advanced or Metastatic Pancreatic Cancer,” 2023 | 5. PubMed, CIMAvax-EGF real-world safety and effectiveness study, 2024 | 6. US Senate Committee on Foreign Relations, “Cuba’s Pursuit of Biological Weapons: Fact or Fiction?”, 2002 | 7. Wired, “The Cuban Biotech Revolution,” 2004 | 8. White House, “Initial Rescissions of Harmful Executive Orders and Actions,” January 20, 2025 | 9. US Department of State, “Expansion of Visa Restrictions Policy for Individuals Exploiting Cuban Labor,” 2025 | 10. Associated Press, “Cuban diplomat defends foreign medical missions under pressure from US,” June 2025 | 11. Reuters, “Mexico president says will uphold Cuban doctor agreement,” March 2026 | 12. World Bank, World Development Indicators, life expectancy at birth, Cuba and United States | 13. UNESCO Institute for Statistics, adult and youth literacy trends | 14. US National Center for Education Statistics, 2023 PIAAC national results
