The COVID-AM blog is a partnership between the UMI 3157 iGLOBES and the Institut des Amériques, coordinated by François-Michel Le Tourneau, Deputy Director and Marion Magnan, researcher at the Institute. About the blog.

cuba and the "epidemiological tradition": a look at the 19th century

May 1, 2020


by Romy Sánchez, historian and CNRS researcher at the Institut de Recherches Historiques du Septentrion (IRHiS) of the University of Lille. She received the Prix de thèse IdA award in 2017.



As in everything far and wide pertaining to Cuba, the COVID-19 crisis did not fail to create new controversies between those favorable to the government of the island and its critics.


Sending doctors overseas is part of Cuban diplomacy (here in Brazil in 2013, source Flickr)
Sending doctors overseas is part of Cuban diplomacy (here in Brazil in 2013, source Flickr)

And so the announcements by the Ministry of Public Health (1 501 cases infected with COVID-19 and 61 deaths in the country by April 30, 2020) is an opportunity for some to point out that the numbers are not always reliable. The controversy permeates all facets of the pandemic. When Granma, an official mouthpiece of the Cuban Communist Party, also published an article that stated that Interferón, an antiviral considered as "a crown jewel of cuban biotechnology", "is used in China on patients who have the virus" and its "effectiveness" would be "confirmed", in the adverse camp, it was said that "according to a study published in the journal Cell [...] those results are rather questionable [1]". As for the famous "Cuban doctors" of the "white brigades", they are the ones who put Cuba on the international pandemic scene: "heros" for some, for others "modern slaves" at the service of castroism propaganda, they were sent to the French Overseas Territories, Italy, eleven Latin American countries and South Africa.

It is evident that information on the epidemic is no exception to the rule: Cuba's intervention on the international scene is an opportunity to rekindle the terms of a Manichean debate. But aside from this usual polarization, the underlying issue of "medical tradition" — and more precisely this time "epidemiological" — is what lies at the center of the disputes. Is it this label literally pinned on the island that gives it this relatively low official rate of contamination and mortality? Or should these "results" be attributed to the country's relative isolation, far from the highways to globalization connecting the biggest clusters of the pandemic?

All national traditions are historic mirages: their roots seem time honored and by definition impossible to place in history. And yet, perhaps by exploring the genealogy of Cuban epidemiology and the management of global epidemics on the island, we can circumvent the castroist doxa of a nation helping the world, from the supposed fringes that make up the Global South. Indeed, the "healing nation" claimed by contemporary Cuba was not created during the 1959 Cuban Revolution. Quite the opposite. This extraordinary medical destiny took shape while the island was still part of the Spanish empire, during two global epidemiological incidents: the American vaccination campaign against smallpox launched by the Spanish Crown at the turn of the 18th and 19th centuries, and the 1817 to 1837 cholera epidemic. A quick overview of this medical, social, economic and political convergence can shed light on Cuba's position in the current epidemic of 2020.


All through the 19th century, Cuba had more board-certified doctors and surgeons than any other nation in the world. According to the historian Adrián Denis López, in 1827 the country already had 715 doctors per million population, which is a lot more than most European countries in the 1890s. In Havana alone, in the 1830s, when the cholera global epidemic arrived on the island, there were 1 400 doctors per million population, a highter rate than Paris' in the 1870s. This level of professional medicalization can be explained by a multitude of factors of which the predominant share is attributed to slavery in Cuban plantation society, dedicated to sugar in the 1820s. As a matter of fact, the island bases its commercial windfall on the illegal trade of men and women exported from Africa. The Creole doctors use this population vital to the country's economy as a terrain for experimentation, specializing themselves during "rounds" of the sugar and coffee plantations: exams or autopsies, the slaves are ideal guinea pigs in a booming profession. To this particular characteristic is added a strong urbanization and growing militarization on the Great Antille: the convergence of these three criterias is, still according to Denis López, one of the explanations for the Cuban medical exception that was created during the Spanish imperial domination.


it is in fact the imperial power and the problematic circulation of knowledge it implies that are at the heart of one of the big epidemiological themes at the start of the 19th century. The smallpox vaccine developped at the end of the 18th century by Edward Jenner in Great Britain was at the root of the big so-called "philanthropic" expedition launched by the Spanish crown to its American possessions. In 1804, the Real Expedición Filantrópica de la Vacuna arrived in Havana where the stakes were high: at a time when the Cuban sugar was replacing Sainto Domingo's, which became independant Haiti, the slaves needed to be "protected" from all health threats. Without them, no sugar. And as the Cuban saying goes "Sin azúcar no hay país" (Without sugar, no country). According to Stéphanie H. González, the smallpox vaccine is initially an "empire's tool" to help the Antillean colonial machine prosper. When the first Cuban war of independance erupted in 1868, the vaccination campaign stopped and was replaced in 1898 by a United States smallpox and yellow fever commission, during the period of American occupation that preceeded the island's independance. From Spanish monopoly held by the Creole medical elites in the name of the Crown, vaccines became the vector of a strong patriotic sentiment: Cuba must make its own medicine and liberate itself from foreign tutelage, not for the protection of slaves, but rather for all its new citizens.


In 1833, the cholera that is hitting half of the planet arrives in Havana which, at the time, is definitely at the center of the American and Atlantic world's commercial trades. The lawyer José Antonio Saco then publishes a  Letter on Asian cholera-morbus in which he compiles all the knowledge he was able to glean on the epidemic. The debate that is again raging in Havana says a lot on the social-economic realities of the island: Saco explains that, according to some, the illness was brought to Cuba via the clandestin slave ships. Taken from there, it is a short leap to consider the slaves as vectors of the contagion, which the Creole racists take gladly. Saco grabs this controversy to remind Cuba that it must stop the illegal trade and count on a white immigration to "cleanse" its economy dependent on the "despicable commerce". In Spain, the situation is an opportunity to reaffirm that the island needs an imperial tutelage in order to manage this crisis.


Two centuries before the current epidemic, Cuba's "epidemiological specialty" was already a theme in itself in the press and the publications of that era. But this speciality was inherently tied to very specifique social-economic problems: the importance of sugar and therefore slavery in the economic boom of an island under imperial domination. Today, it is the economic side of this health crisis that worries the Cubans: the "medical tradition" of the island will not do much for the potential shortfall that is predicted. There again, the debates will surely polarize the causes of this anticipated deterioration.    

[1] Granma, La Havane, April 29, 2020, « Confirman efectividad de Interferón cubano contra la COVID-19 » ; Diario de Cuba, « Los científicos advierten : el Interferón favorece una infección ‘más grave » de Covid-19 », La Havane, April 29, 2020.

Romy Sánchez is a historian and CNRS researcher at the Institut de Recherches Historiques du Septentrion (IRHiS) of the University of Lille. She received the Prix de thèse IdA award in 2017. (#Thèse180 on-line video -in French)