Coronavirus Victories May Not Be Enough for Cuba
Health care success could inspire economic change, but the future still looks bleak.
Cuba’s response to the coronavirus pandemic is a useful example of how authoritarian regimes can sometimes handle a crisis better than democracies. This is especially striking considering the country is simultaneously facing a severe economic crisis that predates the coronavirus—but it may not be enough.
The country has so far reported 2,726 cases and 88 deaths from the coronavirus. Lately there have been fewer than five cases detected per day and hundreds of tests have been carried out for every new case detected. Some days no new cases are detected, despite continued mass testing.
Cuba’s health care history, both good and bad, has factored into the effectiveness of its response. Praise should be tempered by the fact that Cuba is a dictatorship and dictatorships sometimes benefit from what the scientist Charles E. Lindblom once called “strong thumbs and no fingers.” Dictatorships can impose lockdowns, curfews, and forced isolation without having to deal directly with a restless citizenry or grumbles in the media.
Cuba has been praised effusively for its health care since the revolution of 1959. Yet contrary to revolutionary hagiography, Cuba’s system was relatively well developed prior to the overthrow of dictator Fulgencio Batista. Cuba had the third lowest infant mortality rate in Latin America (behind Uruguay and Argentina) and one of the highest life expectancies in the 1950s.
Yet most accessible health care under the old regime was concentrated in Cuba’s main cities. As the Cuban-American author Samuel Farber has written in his book Cuba Since the Revolution of 1959: A Critical Assessment, prior to Fidel Castro seizing power “four out of five rural workers could receive medical attention only if they paid for it, and since most of them could not afford it, this meant that the majority of this important group of poor Cubans had no access to medical care.”
Health spending was cut when Raul Castro took over the presidency from his brother Fidel in 2008, but Cuba still has one of the highest doctor-to-patient ratios in the world.
True, there is a vast gulf between the quality of treatment afforded to party insiders, who have access to the best facilities and the latest medicines, and the poor majority, who must sometimes make do with second-rate treatment in dilapidated hospitals, though the same gaps and worse exist throughout the Americas. And there is a saying that Cuba is a good place to be born (infant mortality rates are very low) but an unfortunate place to get cancer, in part because of drug shortages.
During the coronavirus, though, the system’s strengths—widespread monitoring, large numbers of health care workers, and generally strong public trust in hospitals—have come to the fore. One of the most effective measures in Cuba, as in Wuhan, has been centralized quarantine. Cubans showing symptoms of COVID-19 are placed in state-run isolation centres for 14 days, whether they want to go or not. That’s a tough measure, but it’s also a vital one to prevent spread within extended families.
Yet it also recalls one of the cruelest moments in the island’s health care history; until the early 1990s, the Cuban government dealt with HIV/AIDs by testing the entire population and forcing those found to have HIV into monitored and restricted sanitariums, effectively prisons, until they developed AIDS and were moved to hospital.
But Cuba’s acclaimed response to COVID-19 has distracted from the country’s severe economic travails, which are largely a product of a dysfunctional command economy that applies centralised controls to systematically induced shortages. Cuba is in a tight spot. Things are not quite as bad as they were in the 1990s, following the collapse of the Soviet Union and the subsequent loss of about 35 percent of its GDP, but that isn’t to say they are far off.
Raul Castro’s attempt between 2008 and 2015 to liberalise Cuba’s moribund economy and create “un socialismo próspero y sostenible” (a prosperous and sustainable socialism) encountered staunch opposition from Havana’s hard-line Fidelistas. The arrival of Donald Trump in 2016 empowered the faction of the Cuban government that had opposed the rapprochement with the United States during the Obama years.
As is often the case in international affairs, hardliners have empowered hardliners—and the leadership is hardly in a position to lead reform. The average age of the Cuban politburo is now 69 years old, the same as Leonid Brezhnev’s final Politburo as Soviet leader in 1981, often referred to as a “gerontocracy.”
Existing sanctions on Cuba have been tightened by the Trump administration, with several knock-on effects for the island. In April 2019, then-U.S. National Security Advisor John Bolton announced new restrictions on American travel to Cuba as well as the amount of money Cuban Americans could send to relatives on the island.
Since then the Trump administration has added seven Cuban companies to a list of military-run firms with which Americans are prohibited from doing business, including the Cuban partner of Western Union, Fincimex. Shipping companies have also been advised not to transport oil to Cuba.
Rogelio Moreno, a Cuban friend of mine who recently moved from Havana to Argentina to work in a radiotherapy clinic, told me that the living situation in Cuba was already dire before COVID-19. “Sometimes even when you have money you cannot find things to buy,” Rogelio told me. “When a shop does have things, a very long line forms and many people in the line do not get to buy what they want because the goods are sold out quickly.”
Moreover, the coronavirus pandemic has shuttered tourism to Cuba, one of the country’s main sources of hard currency. Cuba had already seen a 23.6 percent drop in number of tourists visiting the island in July 2019 compared to the previous year. This was largely a consequence of the Trump administration’s ban on U.S. cruise ships docking on the island.
But the coronavirus may also provide an opportunity. The Cuban government has in recent days announced another round of economic reforms. As in the past, a precarious economic situation has forced the regime to liberalize. Speaking on Cuban state television on July 2, President Miguel Díaz-Canel announced reforms including an increase in salaries and more autonomy for state-run companies.
Due to its success in combating the coronavirus, Cuba will also soon be welcoming tourists back to the island. However, they will be strictly segregated from locals in a policy reminiscent of the widely hated “tourism apartheid” of the 1990s which saw Cubans excluded from the best hotels and resorts on the island.
The long-term aim of reforms is to unify Cuba’s bizarre dual currency system, where most people are paid in a non-convertible currency worth far less. However, most economists expect currency unification to be highly inflationary; therefore, the government is trying to put more national currency—currently worth around one-twenty-fifth of the country’s convertible peso, which is pegged to the U.S. dollar—into the hands of its beleaguered state workers.
Cuban leaders will be hoping the country’s success in dealing with the pandemic will soften recent economic woes and allow it to avoid suffering a return to the dark days of the 1990s. But despite those victories, as the world spirals into depression, the largest island in the Caribbean—and the region’s longest-standing dictatorship—may well go with it.