On Brazil-Cuba South-South Cooperation
South-South cooperation is one of Brazil’s pillars of foreign policy and includes diverse cooperation in health biotechnology. For example, in 1986, Brazil and Argentina established a specific programme to support their cooperation in biotechnology, the Centre Brasileiro-Argentino de Biotechnologia, the goal of which was to foster training and joint research between the two countries. Currently, the two countries have the highest number of scientific co-publications in health biotechnology of any two developing nations. Brazil’s South-South cooperation has also focused on promoting economic and social development in Portuguese speaking Africa.
Among others, Brazil has funded the construction of a new pharmaceutical plant in Mozambique that will make anti-retroviral drugs to battle HIV/AIDS in Southern Africa. There is a strong Latin American emphasis in Brazil’s South-South cooperation which includes cooperation with Cuba. The two countries signed their first biotechnology agreement in 1993 and have since then worked together on several initiatives.
Fighting meningitis A infection
An impressive example of the Brazil-Cuba cooperation in health biotechnology focused on producing a vaccine against meningitis A infection. Neither of the two countries suffers from this disease, but it is a common health problem in Sub-Saharan Africa. The so-called “meningitis belt” stretches from Senegal in the West to Ethiopia in the East and includes around 300 million people. Each year the disease kills thousands of people and infects tens of thousands. The disease spreads well in dry and hot climates, and with the increasing occurrences of dry spells in the region, the outbreaks reflect how climate change can place an additional burden on global health.
Brazil-Cuba cooperation, a cost-effective solution
Widespread vaccination is the best way to control outbreaks of meningitis in the region. It was therefore a concern to the World Health Organization (WHO) in 2008 when Sanofi, the key global supplier of the meningitis AC vaccine, announced that it would halt its production of the vaccine against the serogroup A strain. As a response, the WHO submitted a call for proposals for the production of meningitis vaccines against serogroups A and C. While multinational companies or firms based in high-income countries often react to such calls, in this case a collaborative venture between the entrepreneurial arms of two public research organizations in Brazil and Cuba responded. Jointly, they proposed to manufacture necessary supplies of a polysaccharide vaccine. The two entities were Bio-Manguinhos from Brazil and the Finlay Institute from Cuba. The WHO decided to choose this cooperation to supply the vaccine in Africa; it also supported their collaboration and prequalified their vaccine.
The cooperation between Brazil and Cuba could provide WHO with a cost effective vaccine. The price was US$ 0.95 a dose compared to US$ 15 to US$ 20 a dose for polysaccharide vaccines against serogroups AC, W135 and Y, on the international market at the time, and US$ 80 a dose for a conjugated meningitis vaccine used in high income countries. The latter vaccine is superior in the sense that it provides broader protection and a longer immunization period than the polysaccharide vaccines, but the Brazil-Cuba vaccine was targeted to address the strain in Africa. By operating in developing countries and mostly focusing on developing countries’ markets, the two organizations have had to hone their skills in developing inexpensive health products, so they can be accessible to the local populations. The Brazil-Cuba cooperation was successful and by 2011 had supplied more than 19 million doses of the vaccine that were distributed through various organizations, such as the WHO, the United Nations Fund for Children (UNICEF), Doctors Without Borders and the International Red Cross.
Lessons for Successful South-South Cooperation
The field of health biotechnology is dynamic and a relatively inexpensive vaccine with a longer immunization period than the Brazil-Cuba one (the MenAfriVac) has now been developed in a partnership between WHO and the nonprofit organization PATH. While the Brazil-Cuba cooperation is no longer the key supplier of meningitis vaccine in Africa, it is important to understand the main lessons from the cooperation of these two countries. The main one is that relying on South-South cooperation can be a promising and a cost effective strategy to fulfil the missions of international and philanthropic organizations as well as governments in high-income countries, which are promoting health and development.
Building upon complimentary capacity
Additional lessons can be learned by considering the key features that made the Brazil – Cuba cooperation successful. First of all, the cooperation was built upon complementary capacity in the vaccine field. Cuba has a relatively strong record in new-to-the world innovation and researchers at the Finlay Institute developed an innovative meningitis BC vaccine in the late 1980s. Cuba therefore had expertise in the field of meningitis vaccines and provided the active ingredients of the Meningitis AC vaccine. Bio-Manguinhos had strengths in the manufacturing process it built by being one of the key contributors of vaccines to the Brazilian health system. This included strengths in the lyophilization process, which is freeze-drying to make the vaccine more stable and easier to store. By harnessing their respective strengths the two partners could respond faster and more effectively to the meningitis outbreak than either would have been able to do alone. What is also noteworthy is even though neither country had suffered from the serogroup A of Meningitis, they still had the capacity to deal with the outbreak in Africa.
Knowing each other’s potentials and conditions
Another key reason for the success of the Brazil-Cuba cooperation is that the two countries had already cooperated closely in the health sector when the call for proposals from WHO came and were therefore familiar with each other’s potentials and conditions. The governments in Brazil and Cuba have been steadily promoting cooperation between the two countries since the late 1990s, as a part of a political emphasis both countries have placed on South-South cooperation. They decided to emphasise the health sector as they share respective strengths in the sector as well as some health problems, such as tropical diseases and a growing non-communicable disease burden. Bio-Manguinhos had, for example, transferred affordable technologies from Cuba to produce interferon alpha-2b and erythropoietin. The driving forces of this collaboration were savings for the public health system in Brazil and income earnings from royalties for Cuba.
Supporting regulatory cooperation
The third key reason for the success of the collaboration, is that the WHO supported the collaboration between the drug regulatory agencies in the two countries so they could exchange information and help coordinate the regulatory process for the vaccine. Often it can be a challenge for international cooperation to have to go through regulatory approvals in the participating countries where the regulatory agencies may ask for different types of tests and other types of information. By supporting the cooperation of the regulatory process, WHO facilitated the manufacturing of the meningitis A vaccine.
South-South cooperation is a valuable approach to produce affordable and relevant solutions for countries in need. Governments and organisations, which are promoting health and development, should rely on it to a larger extent. As the products from the South are typically more affordable, the aid budgets of such organisations can stretch further than when relying solely on Northern suppliers.
|Author :||Halla Thorsteinsdóttir, Ph.D.
Dalla Lana School of Public Health
University of Toronto, Toronto
Small Globe Inc.