Like many of its hemispheric neighbors bracing for the coronavirus pandemic, Cuba is in harm's way. Although the socialist regime boasts world-class physicians and a dedication to health care for all, the reality is more complicated. Covid-19 is anything but an equal opportunity affliction: Companeros with connections or access to dollars have a far better shot at securing medication and loading up on groceries during a lockdown, independent journalist Yoani Sanchez reports.
The island autocracy doesn't have a vaccine for economic misery wrought by a global health emergency. While the outbreak is still incipient (11 confirmed cases and one death as of March 19), fear of contagion is already hurting tourism, Cuba's second largest source of foreign exchange. Cuban economist Pavel Vidal, who teaches at Javeriana University, in Cali, Colombia, estimates that tourist arrivals will fall 8% to 12% this year. Prior global disruptions - 9/11, the SARS and swine flu outbreaks - suggest the blow to tourism in Cuba could far outlast the epidemic, dragging on for 16 months to 18 months, Vidal said.
Yet Cuba may also prove to be one of the rare countries for which the pandemic presents an opportunity. Cuban doctors were among the international first responders in Wuhan to tend to the sick and assist Chinese authorities on the ground. They brought along homemade medication, a variety of interferon used to treat cancer, which Havana claimed helps virus-afflicted patients - and some regime enthusiasts erroneously heralded as a wonder cure. "Cuba in the vanguard. Always Cuba!" Venezuelan President Nicolas Maduro extolled to reporters in Caracas earlier this month.
The island's physicians are also reportedly on their way to Spain and Italy, and to help prepare for an outbreak in Nicaragua.
Cuban physicians were already a global brand. Since the 1960s, waves of its doctors and medical specialists have brought dozens of developing nations welcome care. As recently as 2015, Cubans deployed 37,000 doctors in 77 countries, a study by the University of Pennsylvania's Wharton School found.
This was not altruism. At the height of the international medical missions, in 2013, Cuban doctors sent $10.2 billion back to Havana, according to official government figures. While the haul is much smaller today, medical services are still Cuba's biggest export, kicking in $6.4 billion or 43% of foreign earnings - twice as much as tourism - in 2018.Then came the backlash. As their footprint spread, Cuban medical missions also drew scrutiny. Doctors abroad earned scandalously low salaries - up to 70% of which stayed in government coffers - and were subject to intimidation. Regime minders looked over their shoulders, imposed curfews and restricted contacts with host societies. The program also took a hit when Latin America's Pink Tide of Cuba-friendly leftwing governments was voted out of power. Bolivia, Brazil and Ecuador canceled their contracts with Havana. Some 8,000 physicians left Brazil alone upon the election in 2018 of rightwing populist Jair Bolsonaro, who vowed to gut the program. The economic implosion in Venezuela, until recently one of Cuba's best clients, further shrank Havana's medical meal ticket.
Cuba since then has been scrambling to carve out new markets and replenish the flow of hard currency. Cuban officials are negotiating providing medical services to underserved indigenous communities in Canada. The island's physicians are already in French Guiana and have carried out missions in Saudi Arabia, the Arab Emirates and Qatar. Mexico's President Andres Manuel Lopez Obrador, a socialist, opened the door to Cuban doctors as Brazil shut its own.
The coronavirus pandemic could deepen the trend and even reopen borders: The Brazilian health ministry announced an outbreak contingency plan to hire scores of physicians, including Cubans. "Cuban medical personnel could help countries with poor health care infrastructure do systematic testing and set up emergency facilities to treat patients," said William LeoGrande, a Cuba expert at American University. "When a vaccine becomes available, they could help plan and carry out mass vaccinations - something that's done routinely in Cuba."
As encouraging as that sounds, dispatching planeloads of indentured doctors to fight on the frontlines of a pandemic is bad medicine. "The government tends to see that the best thing for the economy is income that goes directly to the state budget," Vidal told me. The result is inefficient services, scant benefit to the consumer economy and medical wage slaves, so giving the biggest draw in Cuban soft power a bad name. "The Cuban government must change the business model," Vidal said.
Instead of topping up Havana's coffers, Cuba should do right by its doctors and its own brand. "Most of the income must be left to doctors, who could bring wages to Cuba instead, help their families, and encourage the economy by expanding consumption and making investments in the emerging private sector," Vidal said.
With 159 nations (and nearly all of the Americas) facing a deadly illness, the more trained medical personnel on global call, the better. Cuba's flying doctors are well suited to the task. The prognosis for Havana is less clear.
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Margolis is a Bloomberg Opinion columnist covering Latin and South America. He was a reporter for Newsweek and is the author of "The Last New World: The Conquest of the Amazon Frontier."