Vivir En Cronicidad: Terminal Living through Cuban Cancer Vaccines

ABSTRACT

I examine in this article a movement in Cuba known as cronicidad (chronicity), to reimagine advanced cancer as a normal social experience. In Cuba, cronicidad is particularly visible through treatments called therapeutic vaccines designed to slow the growth of tumors. I explore how cronicidad becomes possible through the Cuban socialist integration of biotechnology and public health. Drawing from interviews with and observations of Cuban cancer researchers and clinicians involved with a novel lung cancer vaccine, I argue that cronicidad differs from chronicity as an area of anthropological inquiry in its emplacement of advanced cancer within routine care in Cuba’s socialist biomedical system.

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EL RESUMEN

Examino un movimiento en Cuba para re-imaginar cáncer avanzado como una experiencia normal conocido como cronicidad. En Cuba, cronicidad es particularmente visible por tratamientos denominados vacunas terapéuticas diseñadas para retardar el crecimiento de tumores. Exploro como cronicidad se pone posible por la integración de biotecnología y salud pública del sistema socialista cubana. Partiendo de entrevistas y observaciones de investigadores y clínicos cubanos involucrados en el uso de una vacuna novedosa contra cáncer, sostengo que la cronicidad difiere de las discusiones de enfermedades crónicas analizados dentro de antropología en su colocación de cáncer avanzado dentro de cuidado rutina en el sistema de salud en Cuba.

KEYWORDS:

• Cuba
• cancer
• charismatic
• chronic disease
• socialism
• vaccines

Acknowledgments

To the diverse group of Cuban interlocutors inside and outside of the biomedical sector: thank you for sharing your experience and insight. Appreciation to Drs. Kelvin Lee, Mary Reid, and Deborah Erwin at Roswell Park Cancer Institute. Gratitude to Ian Whitmarsh, Galen Joseph, Karina Vasilevska-Das, Gabriel Coren, Melissa Salm, Zahra Hayat, and Julia Sizek for their feedback on early drafts of this article. I am grateful for the suggestions from the guest editors, in particular, Ignacia Arteaga and Sahra Gibbon, as well as the guidance of Medical Anthropology Outgoing Editor Lenore Manderson, Interim Editor Ayo Wahlberg, Incoming Co-editor James Staples, and Managing Editor Victoria Team.

Notes

1. Phase I through III clinical trials are underway in the US and the UK (Weissenbacher 2017; clinicaltrials.gov, 2020).

2. The idea of the “normal social,” is a short-hand tangentially related to Victor Turner’s distinction from the liminal phase in the ritual process (1967).

3. Specific types of leukemia are named chronic, including Chronic Myeloid Leukemia, a slow-growing blood cancer notable for its susceptibility to suppression by targeted therapies like Gleevac. Sunder-Rajan (2017) details the legal battle in India over Novartis’s patent protection laws.

4. A tumor is simply a solid mass of abnormal cells and may be benign or malignant. Cancer is similarly a notoriously imprecise term, and yet, incredibly evocative and communicative. I use tumor here as a synecdoche for cancerous cells in general.

5. The original two research questions posed were (1) how do the Cuban conditions of biopharmaceutical innovation influence its entry into global circulation; and (2) how does the counter-current movement of Cimavax from marginalized spaces toward sites considered global centers of research and development affect how we think about where knowledge can be produced?

6. While Finlay is recognized for this discovery in Cuba, in the US credit it given to Walter Reed.

7. Despite several in-person introductions to Dr. Lage, he never responded to requests for an interview. While I had several conversations with Dr. Crombet-Ramos, she was not able to schedule an interview due to extensive travel. It is possible that concurrent diplomatic tensions and the high-stakes clinical trial partnership with RPCI may have rendered the subject too sensitive for these high-profile figures.

8. The nature and specificity of allocation of profits from these sales was a subject of occasional scorn by some of my interlocutors, who judged local dilapidated facilities as evidence of official corruption and misuse of funds intended for health and research.

9. The “immortal” HeLa cells are the most famous example of the contested boundary between the human and tumor (Skloot, 2010).

10. Arteaga et al. (2019) discuss how disease stratification of cancer patients both engenders and entrenches inequities in healthcare access and delivery.

Additional information

Funding

This research was supported in part by the National Science Foundation [Doctoral Dissertation Research Improvement Grant] and the Social Science Research Council [Dissertation Proposal Development Fellowship] and approved by the University of California San Francisco Committee on Human Research #16-191017.

Notes on contributors

Naomi C. Schoenfeld

Naomi C. Schoenfeld is Affiliate Faculty at the University of California San Francisco. She is a medical anthropologist and public health nurse practitioner. Her research explores the intersection of pharmaceutical innovation and (post)socialism in Cuba. Her clinical work is with marginalized communities in San Francisco.