Vaccinal chronicity: immunotherapy, primary care, and the temporal remaking of lung cancer’s patienthood in Cuba

Abstract

The Cuban biotechnology industry is producing cancer immunotherapy, in particular, therapeutic vaccines that actively stimulate the immune system to stabilise the tumour. These products aim to transform metastatic malignancies into a chronic disease. Since 2010, this therapeutic concept has been integrated within a public health experiment, consisting of the large distribution of immunotherapies, including in primary healthcare centres, to enhance access and assess its effectiveness on a wider population of patients. Such experimental intervention, consisting of post-marketing clinical trials, has focused only on lung cancer, one of the most widespread and lethal cancers on the island. Combining interviews with ethnographic observations focusing on care performed by professionals, patients, and their relatives, this paper analyses the experience of lung cancer chronicity under this type of immunotherapy in Cuba. It shows how a certain form of continuity is made between prophylactic and therapeutic vaccination to shape a new temporality of cancer care, through the integration within primary care, constant access to biotechnology, and multiple care practices directed to strengthen the immunotherapy’s efficacy. If vaccinal chronicity remains fragile due to its experimental dimension and the fact that long-term survivorship is still an exceptional phenomenon, lung cancer patienthood is deeply transformed through a shared effort of the people and the state to provide more stable, meaningful, and inclusive care.

Keywords:

• Primary healthcare
• lung cancer
• chronicity
• Cuba
• immunotherapy

Acknowledgements

I am particularly grateful to the people who helped me to improve the different versions of the paper, especially Cinzia Greco, Ilana Löwy, and Fatima Elfitouri. I also acknowledge the anonymous reviewers who provided me with insightful comments to better articulate and focus my argument. I would also like to thank the Cuban colleagues who supported my research project. I am particularly grateful to the patients, their close relatives and the healthcare professionals who agreed to participate in my research.

Ethical approval

This project was approved by both my home institution (at the level of the INSERM CEEI-IRB, France) and the ethical committee at INOR (Cuba).

Disclosure statement

No potential conflict of interest was reported by the author.

Funding

This work was supported by the Institut National Du Cancer (INCa) and EHESS Paris [PhD scholarship]; and the Institut Francilien Recherche Innovation Société (IFRIS) [Mobility grant].

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Notes

1 Mostly with firms based in the Global South, but also, in the case of CIM, in Canada or with a US cancer institute during the Obama administration – which was marked by historical steps toward the restoration of Cuba-US diplomatic relations (Evans et al. 2018).

2 This duality between the convertible peso (indexed on the dollar) and national peso (worth less than 24 times) was in vigor until 1^st of January 2021 when monetary unification was realized.

3 On one hand, epidermal growth factor (EGF) and its receptor; a specific ganglioside on the other.

4 All the names are pseudonyms, yet reflecting gender.

5 The name of the rationing card enabling every citizen to access highly subsidized food.