By Joshuah Bearman

It's kind of difficult to identify Mike Davis' precise
profession. A Google search turns up many descriptions: public
intellectual, iconoclast, American social commentator, sociographer,
scientist historian, old-time Commie, one-time big-rig driver. Whatever it
may be, the defining characteristic of Davis is that he stays in no single
discipline, preferring to combine them all, from urban theory to economic
history to paleoseismology, to build a fresh perspective on whatever
subject he has chosen for scrutiny. His first book, "City of Quartz" --
originally rejected as his history thesis -- lifted the veil on the Los
Angeles power structure to reveal that racism, elitism and class struggle
were embedded into the social architecture for preserving the ruling-class
status quo, which is perhaps an overly simplistic way of describing a very
complex book. The book, which came out in 1990, was well timed. "City of
Quartz" also presaged the social unrest that erupted in 1992, earning Davis
a strange status of modern-day prophet and making the book required reading
in classrooms nationwide.

In 1998, "Ecology of Fear" continued Davis' critique of Los Angeles but
added a new component: natural disaster. The book described the doom-laden
geography of the city itself -- the flood plains, the fire zones, the
earthquake faults -- and described the dangers those disasters represent,
both on their own and when amplified by the worst disaster of them all:
suburbanization. But he was not content to stay in Los Angeles.

Davis used part of his MacArthur Award funding to take one of his children
to Greenland to see the melting Arctic with their own eyes. His books
"Under the Perfect Sun," "Late Victorian Holocausts" and "Dead Cities"
widen the geography and range of topics of Davis' interdisciplinary
investigation. His latest book goes global. "The Monster at Our Door: The
Global Threat of Avian Flu" looks at the potential for an avian flu
pandemic, but goes beyond the usual "killer bug" narrative by focusing on
the intersection of epidemiology, globalization and the chronic poverty of
the developing world.

What follows is my recent conversation with Davis, a man who named one of his own daughters Cassandra, after the one skeptic who said, "Maybe we
shouldn't bring that wooden horse inside the walls of Troy."

Q: Your latest book, about the avian flu, is very topical these days. So
let's start there. We'll get everybody good and scared. Let's start with
the basics. You were working on the topic a few years ago, before it was a
big news story. How did you get interested in epidemiology?

A: This little book, "The Monster at Our Door," is a spinoff of another
project called "Planet of Slums," and a chapter in it called "Slum
Ecology." I was doing some research on population densities in the slums of
very large, very poor cities like Mumbai [India], Kinshasa [Congo] and so
on. As I accumulated data and compared it with the major slums of the 19th
century -- the Lower East Side of New York, the East End of London -- it
became clear that today's third-world slums are an order of magnitude
larger than 19th century slums and even denser than the Lower East Side of
our great-grandparents' time, and so I had to ask a question: What does
this mean for the transmission of disease?

Q: It's a Victorian relapse.

A: Well, we have a billion people on Earth by the official reckoning of the
United Nations, living under dense, sprawled conditions in swamps with
appalling conditions of sanitation. And in so many countries the public
health infrastructure has been damaged by the International Monetary Fund
and structural adjustment policies from the 1980s that forced hundreds of
thousands of health workers in Africa and Latin America to immigrate. Now,
so many urban people have no access to even elementary healthcare. In other
words, it is indeed the Victorian world, writ large.

Q: How does the avian flu fit in?

A: I decided, then, to take a contagious disease -- an emerging disease --
and think a little bit about what that would mean in terms of today's
megaslums as incubators of disease. Avian flu was my choice, and I was
somewhat stunned to discover that slums haven't really been factored in.
Because, quite honestly, 98 percent of the debate that's occurring about
avian flu and other possible epidemics and pandemics is simply richer
people in the richer countries selfishly worrying about their own health.
No one had thought about how global poverty creates a perfect medium to
spread the disease.

Q: Meaning, we're only worried about whether it will show up on our shores.

A: The sudden concern about avian flu is because Americans are finally
realizing that it is a disease that won't respect borders or the barriers
that separate the lives of the rich from the poor. According to estimates
by the Bush administration, up to 2 million or more Americans could die of
avian flu. And Americans, of course, have been left naked and largely
unprotected by the brilliant policies of this administration, which, for
example, immediately after its election put "abstinence education" on a
much higher priority than influenza -- despite the fact that influenza,
even in its normal, seasonal form, kills 35,000 or 40,000 Americans every
year, a disproportionate number of those being elderly African-American people.

After September 11th, the defense agenda also got sidetracked by a lot of
protection against biological weapons that are a much more distant danger
than an avian flu pandemic.

When the administration decided that biowarfare was the great priority,
they spent billions protecting us from Ebola fever and anthrax and
smallpox. That was partly because of Washington's new emphasis on
bioterrorism and the idea that Saddam Hussein had bioweapons, all of which
was part of the pretext for invading Iraq. It was only late in the day that
the administration suddenly embraced what the World Health Organization and
others have been saying since the avian flu first leapt from birds to
humans in 1997 in Hong Kong -- that this virus represents a real risk of
being as deadly as the 1918 pandemic.

Q: Which was extremely deadly.

A: It was the most single deadly event in human history, killing somewhere
between 40 and 100 million people.

Avian flu is a big news story now, and there's been a lot of reporting on
it, but still little context. Your approach to thinking about the deep
ecology of disease is unique. You describe the social conditions that
provide tinder for a pandemic spark: the livestock revolution, the
agro-industrial poultry production and so on. How is the stage set for a
potential pandemic?

I'll start with an anecdote. A few years ago I took my son to East
Greenland. The East Greenlanders were the last population in the Northern
Hemisphere to meet Europeans. In fact, two Danish naval lieutenants who
finally managed to get up the treacherous coats of East Greenland were
really expecting to meet Vikings, not Inuit. This was at a time when the
germ theory of disease already existed in embryonic form, thanks to Koch
and Pasteur. And so the East Greenlanders were intensely studied. At point
of contact, they were a lean people, eating 98-99 percent seal meat. They
had no infectious disease apart from the cold. Their health condition was
probably the primordial condition of humans in the 90 percent of our
history when we were hunter-gatherers. Then, there were no large
concentrations of human beings -- or, more importantly, large enough
concentrations of human beings living side by side with large enough
concentrations of animals to allow animal viruses or bacteria to jump to
humans and assume a chronic or epidemic form.

It was as if the Danish scientists in the 1890s studying East Greenlanders
looked back through 10,000 years of human history, before the era
infectious diseases -- because most infectious diseases came through the
domestication of mammals and birds. That kind of disease is a product of
dense populations or urbanization or large-scale agricultural society.

Q: That's what creates "disease transitions"?

A: Yes. It seems that diseases have emerged in fairly abrupt fashion, in
what historians of disease call disease transitions. When the Mongols
created their wonderful Eurasian world empire and made commerce between the
Yellow Sea and the Atlantic possible, they also created a pathway for
diseases like the Black Death to reach Europe. Every major step in the
biological unification of the human race brings a massacre of populations.
The European arrival in the New World led to the deaths of 90 percent of
the population there. Those were disease transitions. And there's broad
agreement amongst historians of disease that we're living through a fourth
disease transition.

Q: Resulting from economic and social globalization.

A: Fifteen years ago, an anthology of infectious disease studies was
published warning that globalization would bring back old diseases in more
virulent forms and lead to the emergence of novel, new diseases. There are
various reasons: changing barriers between human and wild animal
populations, integrated commerce and the absence of a counterpart
investment in global public health. A few years later, Laurie Garrett wrote
a Pulitzer Prize-winning book, "The Coming Plague," much to the same effect.

Q: Why is China the geographic origin of these coming plagues?

A: In the past, it was believed that almost all influenza originates in
South China, where there's this highly successful, extraordinarily
productive agriculture that mixes domestic birds with pigs and fish and
human beings. It's an ideal crucible for bird diseases passing to mammals
and ultimately to humans.

A widening crucible, as China expands, urbanizes, industrializes its
agriculture --

A little footnote here: Since the 1980s, 200 million people have left the
Chinese countryside for Chinese cities. In less than a decade, China has
added more people to its cities than did all of Europe in the 19th century,
the so-called age of industrial revolution and city building. These people
in the cities are demanding more protein, and that demand is being met with
chicken. Chicken is now the second major protein after pork, which it will
soon replace -- if Avian flu doesn't scare everybody off chicken, that is.

This has created unprecedented concentrations of poultry. In Southeast
Asia, a lot of the chicken is manufactured by a huge company based in
Thailand called CP, which has created an enormous, multinational
factory-farming poultry operation. CP, incidentally, was involved in
covering up the outbreak of avian flu in Thailand, and it even shipped sick
chickens to Europe for sale. So you have these factors: an integrated,
industrialized system of poultry production that looks more like the
continuous flow of an oil plant than anything looking like animal
husbandry; the fantastic rise in demand for animal protein; the increasing
concentrations of people in larger and larger cities, many of them poor.
Across Southeast Asia, the huge poultry farms sit side by side with small
poultry farms, wild birds and human populations.

It seems like these factors clear a wide open path for new disease. Massive
industrialized poultry provides a medium for the flu to move from a rare
disease among wild migrating birds to the chronic, recurring bird epidemic
that it has become. Since the disease mutates so adeptly, it then jumped
species. And then it's a matter of time before a few more mutations or a
combination with human influenza makes it communicative between people.

It is an unprecedented phenomenon. This is happening not only in Asia. Two
years ago, a different strain of avian flu jumped to people in Holland,
killing a veterinarian with very similar symptoms as those in Southeast
Asia. Last year, the same thing happened in British Columbia. People got
sick but nobody died. What's happening, essentially, is that we have
changed the ecology of influenza. We provide food for its survival and
evolution. Each time it moves into a new niche, H5N1 jumps another species
barrier that was believed to be insuperable. Cats didn't get influenza.
They do now: This thing killed most of the tigers in the Bangkok zoo. And
every time it moves geographically or crosses species, it diversifies the
opportunities to change itself into a form that would spread in the same
way ordinary flu does.

And unlike SARS, which caused a huge world scare in 2003, avian flu would
be very difficult to quarantine. Because a person with SARS is contagious
while also symptomatic, whereas with the flu, you're contagious before you
actually get sick.

And this means that flu can, because it spreads easily as a respiratory
infection, avoid almost any barrier put in its path. It's already on the
move. Avian flu is in Russia, and arriving at the gates of Europe. More
disturbing, the disease has almost certainly migrated with infected wild
birds to the great lakes of East Africa. There, it essentially goes off the
radar screen because there is no surveillance system. Countries like
Ethiopia won't even discuss the issue with the World Health Organization.
Countries like Uganda and Tanzania would love to be able to monitor avian
flu, but they don't have the means to do it whatsoever. So right now, this
disease with its vast potential to become the second great plague of
globalization after AIDS/HIV just submerged, and when it reappears, it may
be too late.

Q: So in addition to the lack of defensive medicine, the missing public
health defenses in the Third World represent a breach in the walls.

A: No one in Washington has proposed funding resources that would allow
East Africans to match the level of surveillance that Southeast Asia has.
And while all this has been happening, the basic work of defending humanity
against infectious disease, which involves continual development of new
antibiotics, vaccines and antivirals, has been totally abdicated by the
pharmaceutical giants. Those companies have no interest in making
antibiotics or vaccines or antivirals because they are unprofitable.
Infectious diseases don't create lifelong, expensive demand for medicines
the way that chronic conditions like diabetes or heart disease do. Nor are
they as profitable as culturally defined illnesses like erectile
dysfunction, the darling of the pharmaceutical industry. There is one drug
for diabetes that earns more than the revenue from all vaccines and
antivirals put together.

Q: Should the government be stepping in? Bush's recently announced plan
earmarks money for this kind of research -- not enough, and it's about
time, but is that a step in the right direction?

A: There's a few of us old enough to remember that, for instance, the
influenza vaccine was originally developed by Jonas Salk for the U.S. Army
in the Second World War. It was manufactured by the federal government,
which used to actually make drugs, but no more. The Bush administration has
now offered billions of dollars in subsidies to [Big] Pharma, which strikes
me as inherently ridiculous. The most that any politician in Washington,
Democrat or Republican, can think of doing apparently is to lay billions of
dollars in guaranteed profits at the feet of the pharmaceutical companies,
to waive all questions of liability for the vaccines and products, and then
beg them to produce these vaccines and antivirals. The old-fashioned
socialist in me wonders, Why shouldn't the federal government, in
association with the public universities that produce most of the raw
research that gets turned into these products, not produce lifelong
medicines for free -- as a human right?

Some people ask why we should worry about a disease for which we know of
fewer than 200 human cases. When we live in a world where millions of
children die each year of diarrhea, malaria and even a lack of clean water,
isn't this a fantastically rare disease?

And some people ask whether Bush's invocation of the avian flu wasn't just
a plot to give money to the drug companies and divert attention from other
issues. It is a reasonable question. The reason there should be real alarm
is simply the experience of 1918. That was an influenza almost entirely
novel to the human immune system, and it killed about 2 percent of
humanity. Likewise, H5N1 is entirely new. And, more startling, researchers
recently reconstructed the genome of the 1918 influenza and brought the
virus itself to life for study, and they discovered that it was also a bird
flu that jumped species, just like the emergence of the H5N1 avian flu of 1997.

Let's talk a bit about the public health issue. The public health
infrastructure in the United States is suffering. We've seen the HMO
revolution reduce the number of beds, and it's very clear, as we saw in
Toronto with SARS, that in the case of even a small, localized outbreak,
our public health system would be overwhelmed instantly. As a policy
matter, massive public health revitalization ought to be at the top of the
agenda. One of the things I kept wondering last year when I was covering
the presidential campaign was why the Democratic side never equated all the
resources spent on Iraq with the missed opportunities to make a sort of
national security preparedness effort. The $200 billion thrown at Iraq
could have been so much more efficiently spent on the public health
infrastructure. As politics, it seems to be a no-brainer, a twofer: Invest
at home, and address national security at the same time.

Q: You talk about this a little bit in the book -- how the amount spent on
these kinds of public health preparedness in the last three years was a
just couple of billion dollars, less than we spend in 10 days in Iraq. Even
before September 11th, everybody in the security sector was talking about
how the biggest single thing we could do defensive-wise was to rebuild the
public health infrastructure. But people really balked at the price tag:
$40 billion. Now we've spent hundreds of billions in Iraq. With that kind
of money, we could rebuild the entire public health system from the ground
up. We could make the whole country like Switzerland, with transformer
mountains that turn into hospitals, robots dispensing vaccines, everyone
equipped and trained with lifesaving techniques. So I'm asking you to
address the clear politics of the avian flu.

A: That's true, and more. The politics of public health anywhere begin with
nutrition, and even right here in California we have a shockingly large
number of children who go to bed hungry every night. We have malnourished
children and malnourished adults. Fifteen percent of the children in Los
Angeles have suffered from malnutrition. If the first level of public
health is nutrition, the second level is basic immunization. Immunizations
and vaccines should be an absolute human right in this country, freely
available to everybody. The third level is our local health facilities,
which have been closed by the thousands across the United States in the
recent years. The fourth level is hospitals and, above all, intensive-care
facilities. Think about what would happen in the case of pandemic
influenza, where you need to hospitalize an enormous number of people in
intensive care and some degree of isolation. Los Angeles has lost something
like 17 percent of its hospital beds since the year 2000, largely due to
HMOs, which operate on the "just in time" system of closing hospitals,
getting rid of hospital beds and raising the profit margins -- as if
epidemics, and surges in intensive-care cases, will never occur.

Q: Wasn't there a spike in normal influenza a few years ago that swamped
the capacity of hospitals, private and public, in Los Angeles County?

A: That case is used now in textbooks. It's a real crisis. In San Diego,
just after Katrina, they wanted to bring in 150 people from Louisiana with
serious health conditions and offer them beds as a kind of gesture. Then
they discovered those hospital beds didn't exist in San Diego County! In
many ways, we're worse off than we were in 1918, when the country had a
greater surge capacity and more hospital beds per capita than now.

It's absolutely incredible that the first-responder capabilities haven't
been totally refurbished since September 11th.

Another dimension is that you need a community response, and what's most
effective is giving people actual roles. As in the natural disaster
planning in Japan, where there's an equivalent of the citizens alert. In
San Francisco, the city identifies block by block anybody who has medical,
engineering or law enforcement skills -- anything that would be useful in a
disaster. This is because San Francisco has counted on being isolated by
another earthquake for a matter of days with no outside aid. They've dealt
with this by trying to create a grass-roots network, so everybody who has a
skill is prepositioned and knows how to use it. That seems to make more
sense than hoarding toilet paper and water and waiting to be dug out of the
rubble, as we're told now.

The greatest danger, of course, in any pandemic is fear. Even if it wasn't
that deadly we'd all be so scared that society would disintegrate. It's
surprising how thin the veneer of civilization is.

That's what happens when you're left in a passive role -- when you're told
you have no civic responsibilities; you know, it's each person for
themselves, run to the hills, try and get some Tamiflu and hide it, keep it
for your family. There's an atomization of society. That's what we have
instead of the kind of civic solidarity that would exist if people had
roles and if resources were available in communities on an equal basis.

Q: Why, if this is all so obvious, and if you have so many medical
professionals and good people trying to shout about this at the top of
their lungs, why hasn't it improved? Why has this not translated into any
kind of effective political protest or political action?

A: This brings us back to the absence in the country of a real opposition
party. There's no political force capable of mounting serious battles on
behalf of most of the basic issues for people in this country and abroad.
John Kerry had every opportunity during the election to tack George Bush to
the wall over the question of his failure to prepare for a pandemic
influenza. It's an absolutely logical thing to do, particularly because the
election was taking place in the middle of a flu crisis -- one of the two
major vaccine suppliers collapsed in the fall of 2004.

When the Democrats do make noises, it seems the terms are framed by the
Republicans.

That's why no one questions, for instance, the need to give away billions
of dollars to the drug companies to get antivirals.

Let me try to end my endless riff with this. Roche is the pharmaceutical
company with the patent, and therefore monopoly, on producing the antiviral
medicine Tamiflu. It can save your life, and it's all made in a single
plant in Switzerland. If you line up to buy it from Roche, like the Bush
administration's doing, you stand in line for two or three years to get it.
And then there won't be enough anyway. The administration is ordering 2
million courses. That's less than 1 percent of the population. This
extremely limited supply sets up a "Sophie's choice" -- who will get this
in an emergency?

Why are we waiting around? There's absolutely nothing to prevent the
president of the United States from saying that the health of Americans
overrides everything else, and we're going to start making Tamiflu and
we'll have supplies in six months. It can be done, but it will never
happen. And there's not, as far as I know, a single Democrat who is talking
about this. Where is everybody? This is millions of people we're talking
about. Wouldn't real leadership do something?

>>Comment by Richard Fidler

The above interview with Davis is very interesting and relevant. It's
too bad Davis embraces the theory of state capitalism; his
analysis would have been even more compelling if he had explored
what the Cuban workers state has achieved in researching and
preventing epidemics through a combination of state resources,
massive public health initiatives, community involvement and above
all political will.

The following is an extract I scanned from "Development within
Underdevelopment? New Trends in Cuban Medicine" (Havana, 1998) by
Ernesto Mario Bravo, a professor in Havana's College of Medical
Sciences. Born in Argentina, Dr. Bravo has lived in Cuba since
1963. He has published and lectured widely and in recent years has
been involved in promoting exchanges between scientists from Cuba
and North America.

The book is a fascinating overview of the development of Cuban
medicine from the guerrilla field hospitals in the Sierra Maestra
to today's exemplary public health system, recognized
internationally as one of the best in the world. The main focus,
however, is on the problems and challenges of developing science
and technology in an underdeveloped workers state. Referring to
the lack of models, Dr. Bravo says "none of the socialist
countries of the period had found a way to bring about a
successful scientific and technical revolution, and they were
lagging behind other industrialized countries, especially in
modern biotechnology. Therefore, an original solution had to be
found that would be appropriate to Cuba's reality at the time."

What this has meant in practice is explained through extensive
interviews with leading scientists in the biotechnology program.
Among the interesting features of the program they describe is how
sophisticated research is conducted in close collaboration with
the extensive system of public health clinics throughout Cuba. As
Dr. Concepción Campa Huergo, president of the Finlay Institute and
head of the team that obtained the Cuban vaccine against
miningococcal meningitis, puts it: "... the Ministry of Public
Health provides health coverage even in the most isolated places
in Cuba, guaranteeing follow-up and vigilance when a massive field
study is applied, with hundreds of thousands of voluteers - the
Cuban people, who support and have absolute trust in their
health-care system and scientific development and who know that
that development isn't aimed at making anybody rich."

The following is excerpted from the book's final chapter, on "Cuba's
Future in Modern Biomedicine". Endnotes omitted. -- Richard

* * *

Scientific Potential for the Development of Cuban Biotechnology

As explained in the preceding chapters, profound changes were made
in Cuba's economic and social structures beginning in 1959. Those
transformations injected strength and dynamism in the scientific,
technological and production infrastructures-a process in which
the socialist government played a key role.

The interaction among the participating factors was especially
fluid in the case of biotechnology. The scientific and
technological structure for which the foundations were laid at the
very beginning of these changes contributed to this.

Cuba has amassed an important scientific and technological
potential.

The national education system consists of a group of subsystems
for each level and type of teaching. In a country of 11 million
inhabitants, 2,344,200 students were enrolled in 13,900 schools
during the 1996-97 school year, and there were 256,000 teachers.
Seven percent of the students were in higher education. In 1997,
Cuba had the highest number of teachers per capita in the world.

Special high schools emphasizing the sciences were created in
1981. Entrance is limited, teachers are rigorously selected and
the level of studies is very demanding, all of which should
produce good researchers in the future.

More than 30,000 people work in Cuba's 153 research centers and in
the research and development areas of its most important
enterprises. Forty-seven percent of them are women, more than 8000
of whom are university graduates, including 5338 researchers.

In 1997, there were 5231 Ph.D.s, nearly 13 percent of them in the
biomedical sciences. There are around 24,000 university professors
for the more than 130,000 university students, and they devote
part of their time to research in diverse areas of science and
technology?

For every million inhabitants, Cuba has 1369 scientists and
engineers working full time in research and development.

There are 3000 science clubs, with over 30,000 members, in Cuba's
high schools. In addition, the Young Technicians' Brigades have
more than 12,190 members, and the Association of Inventors and
innovators has more than 340,690.

The Cuban Government spends 1.15 percent of its Gross National
Product on research and development. The budget for current
expenses for science and technology is 1.7 percent of the GNP --
three times as much as a decade ago.

More than 100 scientific societies are active in the country, 57
of them related to medicine. In 1997, 155 scientific journals were
published, in many specialties.

The national scientific and technical information system has 600
information centers. The system includes a computerized
information exchange and electronic mail network. In 1997, it
obtained access to INTERNET.

The Productive Structure of Cuban Biotechnology

Interferon served as the model product for Cuban biotechnology. At
first -- in 1981-- natural IFN was produced from human leukocytes.
This product was named Leuferón and was marketed by enterprises
connected with the Ministry of Public Health.

It soon became evident that the demand for the product couldn't be
met with the leukocytes obtained from the country's blood banks,
and it was decided to produce it by genetic engineering. In the
CIB [Biological Research Center], created in 1981, IFN was
produced through recombinant DNA in a process that spanned the
entire production cycle: research, development, industrialization
and marketing.

The CIGB [Center for Genetic Engineering and Biotechnology] was
created in 1986. By mid-1997, its researchers and those of the
CIB, working together, had obtained more than 200 products. The
CIGB occupies an area of 72,000 sq. metres. Its eight-story main
building has 43,200 sq. metres of laboratories and a 8000 sq.
metres production plant, with a microplant and various production
areas, including fermentation, recovery, purification and
preparation of materials and culture media, a process-control
laboratory and a building for auxiliary systems.

The CIGB also covers the complete production cycle, following the
U.S. FS-209D classification norms. Its researchers are working not
only with recombinant DNA but also on the transgenesis of
vegetable and animal cells, the generation of monoclonal
antibodies, chemical syntheses of biomolecules and other
state-of-the-art technologies.

The CIGB is a vanguard bioscientific institution, a vast
research-productive complex with advanced equipment. It has eight
departments: research, quality control, teaching, information,
production, economics, engineering and services.

The Research Department has several divisions: pharmaceutical
products, vaccines, immunotechnology and diagnoses, technological
development, industrial biotechnology, preclinical and clinical
studies, plant biotechnology, genetics of mammalian cells, a
chemical and physics division, and automatization.

A firm called Heber Biotec, S.A., was founded to market these
products. As a result of these efforts, Cuba is now

one of the three countries in the world with the greatest clinical
experience in the use of natural and recombinant IFN (antiviral
and anticancer agents), which is produced in Cuba under the
Heberón brand;

one of the three countries in the world that produce recombinant
EGF (a cicatrizing agent), marketed as Hebermín;

the only country that produces recombinant streptokinase (a
thrombolytic agent) commercially; it is patented under the name of
Heberquinasa, in more than 20 countries; and

one of the three countries in the world to develop and produce a
recombinant hepatitis B vaccine commercially (Cuba's vaccine is
named Heberbiovac); a diagnostic system for hepatitis C has also
been created.

Heber Biotec, S.A., has seven lines of products: Heberfarma
(pharmaceutical products), Hebertec (enzymes and industrial
processes), Heberlab (reagents for molecular biology
laboratories), Hebermab (monoclonal antibodies), Heberdiag
(diagnostic kits), Hebervet (veterinary products), Hebersoft
(computer software) .

Heber Biotec's sales quintupled between 1992 and 1996.

The CIGB was founded directly by the Council of State of Cuba.
When, in 1981, UNIDO [United Nations Industrial Development
Organization] decided to create a center of excellence for the
transfer of biotechnology to developing countries, Cuba bid for
the seat of the center, but it was awarded to India. The Cuban
Government then decided to create its own center, for which it
earmarked a considerable sum in convertible currency.

Around 1000 people-700 of them researchers and scientists-were
working in the CIGB in 1997. Their average age was 29. The CIGB is
one of the largest scientific centers of its kind anywhere in the
world.

The CIGB has created two new affiliated biotechnology centers in
Camagüey Province and in Sancti Spiritus Province.

A group has also been formed in the CIGB to work on developing
basic research; this is extremely significant.

As explained earlier, the Cuban Government has insisted that the
country's research centers produce useful results, both to meet
national needs and to bring in foreign currency.

The CIGB has been a model for the country's scientific development
in many ways, from its workers' dedication to science to its
elimination of bureaucracy and its linking of science with
production.

However, Cuba's biotechnological structure isn't built on the
CIGB, alone. Other first rate institutions, such as CENIC
[National Scientific Research Center], the Finlay Institute, the
IPK [Pedro Kouri Institute of Tropical Medicine] and the Center
for Molecular Immunology, are developing genetic engineering;
monoclonal antibodies and other modern technologies. Several of
those centers are both meeting national needs and competing on the
international market.

During the 6th Cuban Congress of Biotechnology, held in December
1997, Dr. Albert Sasson, special adviser of the Director of
UNESCO, praised Cuba's advances in biotechnology and said that the
dedication of Cuban researchers and the Cuban Government's
commitment to and support for the work made him confident that
this sphere would have a bright future.

The Prospects for Cuban Biomedicine

It was a real achievement for an underdeveloped country such as
Cuba to create a biotechnological structure that not only met the
country's internal needs but also broke into the international
market with some of its products.

Cuba's situation was considerably complicated by the collapse of
the European socialist camp, with which it had been closely
related. This forced the country to introduce a "special period in
times of peace" in order to confront its new economic
difficulties. And, as Vice-President Lage said, "This adversely
affected the normal functioning of the Cuban health system."

Internationally, the prosperous countries of the European
Community and the United States are weighed down by economic
problems and are engage in a fierce struggle to control markets.
Meanwhile, the countries of the former socialist community --
Cuba's trading partners -- are undergoing serious economic
distress, and the "emerging" countries are struggling hard to
renegotiate their foreign debts to creditor banks.

The U.S. Government has ratified the continuation of its economic
blockade against Cuba, a hangover of the cold war. In April 1992,
President George Bush stated that the "trade embargo" also
included hindering the development of biotechnology in Cuba.

The biotechnological market is dominated to an ever greater extent
by tt international consortia that insist on respecting patents
and maintain growing secrecy concerning technological know-how.

What are the prospects, then, for Cuban biomedicine? Internally,
to develop a first-rate biomedical program (with emphasis on
biotechnology) based on cellular and molecular biology,
biochemistry, genetics, immuno ogy and pharmacology.

Only by doing this can it improve on what is produced elsewhere
and, above all, obtain original products that can be patented.

Projects should be coordinated with other Latin-American and
"emerging" countries, and Cuba should establish the closest
possible contacts with laboratories in the developed world that
are interested in carrying out mutually beneficial joint projects.
It should boldly enter the biotechnological market of both
developed and underdeveloped countries, including members of the
former socialist camp and the present-day socialist countries.

A cable from ANSA, an Italian news agency, dated April 19, 1997,
reported on this:

"The Observer, a British weekly, stated that Cuban medicines may
be placed on the British and Canadian markets in the year 2000,
thanks to the biotechnological advances that are taking place in
Cuba. Production agreements were signed with Canadian firms
recently. The medicines of particular interest to investors
include a new version of streptokinase, for heart attacks, and
erg3mab, an anticancer drug which may revolutionize the treatment
of tumors. The publication stated that York Medical, a new
Canadian company, signed an extensive agreement with the
biotechnological institutions in Havana to market Cuba's medical
inventions in the West. Meanwhile, a vaccine against cholera and
another against leprosy are being developed in the Western
Scientific Complex near Havana. Likewise, a vaccine against
meningitis B -- the only one sold anywhere in the world-has been
developed in the Finlay Institute, in the Cuban capital."

By making enormous efforts, Cuba, an underdeveloped country, has
managed to raise its scientific level high enough to incorporate
the biological revolution. Its planned economy, that placed
priority on its development, which it considered strategic; the
creation of a solid educational-scientific-technological
infrastructure; government leadership that pushed ahead with
considerable daring, linking the scientific and technological
infrastructure with production; and the tremendous efforts,
intelligence and devotion of its scientists, imbued with a spirit
of love for their country and of solidarity with other peoples,
were all important factors in this.

In the future, all of these factors should become even more
dynamic, allowing Cuba to continue to overcome all the stumbling
blocks in its path and to become a power in biomedicine -- thus,
paradoxically, achieving development within underdevelopment.