There is an ongoing emergency; has been going on for a long time and therefore the situation is very serious and uncertain and there is always someone who tries to take advantage of it, even in an unfair way. What is happening in Cuba by the increasingly aggressive and arrogant United States of America ("Yes, take Cuba somehow: take it or release it, I think I can do whatever I want with it"). If in Venezuela it was the military operation Absolute Resolve, conducted on January 3, 2026 with the capture, arrest and deportation of President Nicolás Maduro and his wife Cilia Flores and the agreement with the treasonable vice president Delcy Rodríguez (María Corina Machado, opposition leader and 2025 Nobel Peace Prize laureate, was unwilling to Trump) a Friendly takeover is planned for Cuba. What kind of negotiation is planned, direct and friendly (?), it is impossible to foresee with the current US presidency, that it will be (also) a financial operation, for example in the area of tourism, is much more likely.

In 1962, after the resounding failure of the invasion of Cuba from the Bay of Pigs to overthrow the government of Fidel Castro, with Proclamation 3447 the United States of America initiated and imposed a trade embargo on other countries, economic and financial against Cuba, el bloqueo. A sanction that is maintained with wavering increases at several historical moments, such as the current one, and which the UN General Assembly has never managed to refine.

There are 31 nations that are economically sanctioned by the USA with "variable sanctions programs: some are wide-ranging and geographically oriented (e.g., Cuba, Iran), others are 'targeted' (e.g., anti-terrorism, anti-drug) and focus on specific individuals and entities", illustrates the US Treasury Department itself.

Economic sanctions are thus varied and include financial restrictions, travel bans, and targeted measures used as a tool of political pressure. While the embargo is a sanction that imposes the total or partial blockade of trade with a country (Cuba) and aims to isolate it economically.

Then there is the tariff policy activated in 2025 by the Trump administration, shortly after taking office, which has hit with greater force on 57 countries defined as worst offenders. According to the logic of reciprocity there is a US trade deficit this is due to the fact that tariff barriers (i.e. tariffs) and non-tariff barriers are applied unfairly. So, although it has no basis in economics and interests of 180 countries, on April 2, 2025, Trump issued the PresidentialAction.

There are 33 countries sanctioned by the European Union (23 coincide with those sanctioned by the United States). Within the framework of the common foreign and security policy (CFSP): "Sanctions are an instrument of a diplomatic or economic nature intended to bring about change in activities or policies, such as violations of international law and security, human rights, the rule of law, or democratic principles. Restrictive measures imposed by the EU may be directed against third country governments, non-state entities and natural or legal persons (such as terrorist groups and individual terrorists). They may include arms embargoes, other specific or general trade restrictions (import and export bans), financial restrictions, entry restrictions (visa or travel bans) or other measures that appear appropriate as appropriate.", recites in this regard the page of the Farnesina.

The same impacts of a war

The effectiveness of sanctions is debatable because of the low level of accession by individual countries or for interpretation and management that, in any case, must ensure the interests of individual states.

But sanctions have dramatic adverse health effects. They persist long after the measures are lifted, with casualties comparable to wars. International policy priorities should therefore include the need to reconsider sanctions as a foreign-policy tool, underscoring the importance of moderating their use and seriously considering efforts to reform their structure. What should be done against the US embargo on Cuba, in light of the dramatic outcomes that further escalation in recent months has (also) entailed for the health of the Cuban people.

With the Cuban Revolution of 1959, education and health (public, universal and free) are the two fundamental rights guaranteed to the Cuban people. The embargo, both directly and indirectly, is undermining their guarantee, particularly prevention and health care.

In 1962, life expectancy at birth in Cuba was 64.4 years (in Italy 69.2 years), and reached its peak in 2012 with 78.2 years (in Italy 82.3 years) to then decrease to 73.2 years in 2021 (in Italy 82.9 years): a decline of 7% in 5 years.

Infant mortality in the first five years of life in 1962 was 4.5% of live births (in Italy 4.8%) and reaches 0.62% in 2012 (in Italy 0.38%), rising to 0.83% in 2023 (in Italy 0.28%): an increase of 33% with 151 more deaths in the last decade.

The lowest incidence of cases of tuberculosis in Cuba was recorded in 2021 with 5 cases per 100,000 inhabitants (in Italy 4 per 100,000 inhabitants), in 2024 the cases had risen to 11 per 100,000 inhabitants (in Italy 5 cases per 100,000 inhabitants): more than doubled.

For some months now, infections with chikungunya, dengue and oropouche viruses have become epidemic, and the combined arbovirus caused by the mosquito Aedes aegypti, which has never been endemic in Cuba, has represented a public emergency that could have affected 2.9 million people and caused up to 8,700 deaths. The lack of energy has forced to stop disinfestation and waste collection, and mosquitoes have multiplied to excess with the resulting excessive transmission of infection.

Know how to do it, but can't

A scenario characterized by shortages of primary goods resulting in welfare shortages and a high incidence of disease and mortality. Primary goods for subsistence, but also essential goods to produce, particularly in sectors such as drugs, vaccines and biotechnology where Cuban know-how is competitive with international one. Having state-of-the-art equipment, ensuring technical assistance (including spare parts in case of breakage), and chemical reagents are essential to ensure proper research and health care — all aspects that a strict embargo does not allow.

The Cuban experience in the national production of pharmacies and their impact on access to health not only highlights the pursuit of one of the main objectives of the state (improving the population's health and quality of life), but also the achievement of goals in the field of welfare, industrial technology and intellectual property of national and international importance. An estimated $300 million is needed to import the raw materials needed to produce hundreds of essential medicines. Drug shortages continue to grow, fueling a black market, especially for some expensive and life-saving drugs. Although the essential list of medicaments should be guaranteed to include 651 and comply with World Health Organization guidelines for access (availability and production), many of these (antibiotics, antipyretics, gastrointestinal, respirators), also of low cost and frequent request, are difficult to find both in the hospital and in the territory. 62% of the list (403 products) correspond to drugs that should be produced by the domestic pharmaceutical industry, the remaining 38% is imported. The shortage, which in 2024 was estimated at 70% of demand/needs, could therefore be faced by the recovery of national production.

However, the experience of the past with the US surge in embargo, now more prolonged than ever, and the barriers and deterrents induced by the United States to trade in products: the fear of severe financial penalties and imprisonment of employees of any company involved, the increase in legal fees, the prosecution by the US government for minor and unintentional violations of the Cuban embargo and the subsequent exhortation to the press to spread negative publicity against the pharmaceutical company and its employees, the slowness and complexity of the internal bureaucracy in Cuba… These are all factors that reduce hope, while the reduced participation of international cooperation on the island contain hope.

Dramatic contradictions

One of the areas where the contradictions between scientific capacity and dramatic economic restrictions and sanctions are most apparent is vaccines. Streptococcus pneumoniae represents still one of the leading causes of death in children in the first five years of life globally, with hundreds of thousands of deaths each year, largely preventable through vaccination. However, access to pneumococcal conjugate vaccines remains deeply uneven: in countries with fewer resources, vaccination coverage is often insufficient and millions of children remain exposed to serious infections such as pneumonia, meningitis, and sepsis. This is the context of the Cuban experience with the pneumococcal conjugate vaccine Quimivio, developed by the Instituto Finlay de Vacunas as a scientific and health response to difficulties in accessing commercial vaccines, whose cost can reach hundreds of dollars per dose and is unsustainable for many health systems.

The development of Cuban vaccines takes place, as we have seen, in a particularly complex context determined by the US economic blockade, which limits access to technologies, reagents, scientific equipment and financial channels necessary for biotechnological research. Despite these restrictions, over the years Cuba has built a public innovation system capable of producing vaccines and biological drugs independently. Clinical trials with QuimiVio have involved tens of thousands of young children, and the incidence of invasive pneumococcal infections in children between one and four years old has been dramatically reduced to zero since it was introduced into the national vaccination schedule. This finding demonstrates how public biotechnology research can be a key tool for health sovereignty and equitable access to vaccinations, even in contexts of strong economic and political constraints.

Unfortunately, Cuba (and neighboring countries) are being hit not only by human disasters, but also by natural disasters, some of which are recurrent, others that could be at least partly prevented by limiting their enormous effects on the short- and long-term well-being of the affected populations. It happened last October 29 when, after 24 hours of rain and very intense wind, hurricane Melissa category 3 hit the Cuban provinces of Holguin, Granma, Santiago and Guantanamo. These are the regions, especially the last two, still in strong difficulties after the passage of Hurricane Oscar in 2024 and are among the most impoverished, socially and economically, and where apagones (electricity blackouts) last longer and are more frequent. A hurricane that has caused at least 735,000 people to evacuate and that has shaken the Cuban system. A system that also needs renewal, with the adaptation of popular power to the times and the guarantee of denied rights. For now, the name of hurricane Melissa has been withdrawn and replaced with Mollyda by the World Meteorological Organization — an event that occurs whenever the intensity of a cyclone is such that for the damage caused (deaths and costs) reusing the name would be inappropriate for reasons of sensitivity. Among the most notorious highly destructive hurricanes that led to the withdrawal of their names are Katrina, Sandy and Maria.

The energy strangulation of which the Cuban people are victims "will worsen, if not collapse, if its oil needs are not met", according to United Nations Secretary-General António Guterres, and the Iranian crisis further reduces the chances of getting some help from supportive countries. The serious situation of the health system requires a series of measures to reorganize and rationalize services, offered today in clinics and hospitals without sufficient energy, forced to reduce non-urgent surgeries and strengthen telemedicine, as stated by the Cuban Minister of Health, José Ángel Portal Miranda.

We can only share what the epidemiologist Benedetto Saraceno wrote: «Once again, the health sector is a powerful indicator of a country's progress or regress, and the fact that a high-quality health system like Cuba's is forced to regress should concern anyone who cares about the universal right to health and cure».