Stung by the Pope and Health Studies, Congress Mulls a Policy Change for Cuba

Long-standing public and political contention over the effects of the United States' economic embargo on the health of the Cuban people appears to be approaching a watershed. The proponents of a change in U.S. policy base their arguments on the results of scientific research over recent years that indicate the embargo has contributed to unhealthy shortages of food and medicine in Cuba. In both houses of Congress, bills are being considered that would exempt from the embargo the sale of food to Cuba, and would eliminate current licensing requirements for the sale of medicines or other medical supplies and equipment. Federal government spokespersons deny the validity of the research findings and assert that any shortages of medical supplies for everyday citizens are attributable to the policies of the Fidel Castro regime rather than to the U.S. embargo. A hearing on May 7 in Washington, D.C., of the subcommittee on trade of the House Ways and Means Committee to discuss U.S. economic policy toward Cuba drew many of the main figures on either side of this heartfelt debate. The following report provides an overview of the issue. When Pope John Paul II left Cuba on January 25, his departure address at Jose Marti Airport in Havana included a final chastisement of both the Cuban and U.S. governments for their feud of almost four decades. He decried "the suffering caused by material and moral poverty, the roots of which may be found, among other things, in unjust inequalities, in limitations to fundamental freedoms, in depersonalization and the discouragement of individuals, and in oppressive economic measures, unjust and ethically unacceptable, imposed from outside the country." The following month, President Bill Clinton responded to concerns highlighted during the Pope's visit by announcing several "actions" to lessen the burden of the embargo on the Cuban people. Among them was restoration of direct humanitarian charter flights carrying food and medical goods to the island. These flights had been halted in 1996, after Cuban fighter planes in international airspace shot down two civilian U.S.-registered airplanes flown by members of the Miami-based exile group, Brothers to the Rescue, killing three American citizens and a permanent resident. Clinton also said permission would be reinstated for visits and transfer of funds from Cuban Americans to relatives on the island, and steps would be taken to "streamline"the licensing process for sale of medicines to Cuba. CUBA QUESTION: Two proposed federal bills would exempt the sale of food and medical goods from the U.S. embargo against Cuba, but a strong lobby is aligned against a policy change. "Tourist pharmacies and hospitals in Cuba are filled with modern medicine, but Castro denies the Cuban people access to all of these," said one of the legislators who spoke at the May 7 hearing on Capitol Hill, Ileana Ros-Lehtinen (R-Fla.), whose Miami district includes a large Cuban American constituency. Several Miami-based activist groups, such as the Cuban American National Foundation, have been influential proponents of the embargo. "Medicine is used as a tool of torture by the Castro regime to force the people into submission. Dissident doctors are arrested for helping those left to suffer by the regime," Ros-Lehtinen told the hearing. Another viewpoint offered at the hearing typifies the divisions of opinion concerning medical supplies to Cuba. "Opponents say, 'Won't the Cuban government just divert food and medicine to so-called medical tourism? How can we be sure these goods will really get to the Cuban people?' That argument is patently absurd," declared William M. Paparian, Cuba Relief Project coordinator of the international relief agency, Operation U.S.A., which is shipping medical supplies and equipment to the island. "We can't control what the Cuban government does, but we can act with moral decency ourselves." The U.S. has applied sanctions for foreign policy purposes 104 times since World War II, 61 of which were between 1993 and 1996, according to the President's Export Council. In the major embargoes since World War II, including those against North Korea, Vietnam, South Africa, Chile, El Salvador, the Soviet Union, Haiti, Iraq, and the former Yugoslavia, medicines and food were allowed to serve the basic needs of the people. Cuba is the exception. Sanctions against Cuba date back to 1960, the year after Fidel Castro took power, when then-President Dwight D. Eisenhower banned U.S. exports to the island, except for food and medical supplies. In September of 1961, five months after the Bay of Pigs invasion, the Foreign Assistance Act authorized a total embargo on trade with Cuba. The effects of the embargo were mitigated by an estimated $5 billion to $6 billion in annual subsidies from the former Soviet Union until its collapse in the early 1990s, which plunged the island into a "special period" of energy blackouts, food ration cards, and crippled public transportation. In October of 1992, George Bush signed the Cuban Democracy Act (CDA), significantly tightening the embargo by decreeing that any foreign ship visiting Cuba would not be allowed to enter U.S. ports for six months. The only loophole for providing food, medical supplies, or other goods by sea was to send them through a third country and then ship them to Cuba, thus increasing costs. The law cut off another avenue of supply by prohibiting subsidiaries of U.S. companies based in other countries from trading with Cuba. Opinions, conflicting "facts," and passionate exchanges characterized the May 7 hearing of the House Ways and Means Committee's subcommittee on trade to discuss U.S. economic policy toward Cuba. Following are excerpts from statements by some of the speakers: Robert Menendez (R-N.J.): "The U.S. has licensed nearly every request for commercial sales of medicine and medical supplies to Cuba and commercial travel to Cuba for this purpose--to date, 50 of 53 requests... . There is ample evidence that Castro not only has access to medicine, medical supplies, and food, but that these resources are routinely diverted for export or to Cuba's growing pleasure and medical tourism industries." John Joseph Moakley (D-Mass.): "Breakthrough medicines that combat cancer and AIDS are not available, doctors reuse disposable gloves until they break, pacemakers for heart patients are virtually impossible to find, extreme shortages in kidney dialysis machines keep patients from receiving treatments, and in the children's cancer wards, they go without nausea suppressants for children receiving chemotherapy." Michael Ranneberger, coordinator for Cuban affairs, U.S. Department of State: "Since the passage of the CDA (Cuban Democracy Act) in 1992, over $2 billion in humanitarian donations has been licensed, including nearly $275 million for medicines and medical equipment, and $13 million in food. The United States is the largest donor of humanitarian assistance to Cuba." Esteban E. Torres (D-Calif.): "Just look at the record: covert invasions, assassination attempts, commando activities, nuclear threats, beatings, jailing, human rights violations, embargoes on food, medicine, travel, alienation of our allies, all in the name of wanting to bring democracy to the Cuban people. It isn't working. It isn't moral and it does not bring credit to a country that prides itself as being humane and fair." John S. Kavulich II, business association president, U.S.-Cuba Trade and Economic Council Inc.: "Since the visit of the Pope... there has been an exponential increase in the number of United States companies requesting information about Cuba." Lincoln Diaz-Balart (R-Fla.): "We are witnessing an intensification of efforts to save the tyranny of Castro in the face of the inevitability of the tyrant's death in the coming years and the unwillingness of the Cuban people to remain indefinitely oppressed. The most dangerous recent development in that campaign to preserve the apartheid economic slave system in Cuba even after the tyrant's disappearance is the participation and cooperation of a sector of international and American capital ... .That capitalist sector has hired lobbyists to work against the embargo on Castro in the United States Congress." Michael Barnes, business coalition representative, USA Engage: "Helms-Burton [the Cuban Democracy Act] is cited [by Fidel Castro] as proof that the U.S. wants to destroy Cuba. It has become an effective rallying point for the Cuban government. The exploitation of Helms-Burton has been so successful that several political dissidents we met referred to it as 'the Helms-Burton-Castro Act.'" Craig L. Fuller, bipartisan citizen's group cochairman, Americans for Humanitarian Trade with Cuba: "It was my privilege to travel to over 60 countries while serving as a member of the White House staff during the Reagan administration, including the four years I served as chief of staff to Vice President Bush. During that time, while I rarely saw embargoes work, I never saw a situation where we denied people the opportunity to purchase food and medical supplies." The CDA allowed licensing of medical sales only if on-site inspections in Cuba were conducted by the manufacturers to ensure that the goods would be used for their intended purpose, and not for reexport, for the "medical tourism" industry serving foreigners with hard currency, for torture of Castro's opponents, or for biotechnological research. Two months after the bill's passage, the United Nations General Assembly voted 59-3 to end the unilateral embargo, with only Israel and Romania supporting America, but the outcome had no effect. In 1992 and 1993, Cuba experienced an epidemic of optic and peripheral neuropathy. There were no fatalities, but more than 50,000 people variously suffered sight impairment, deafness, pain and loss of sensation in the extremities, and a spinal disorder that impaired walking and bladder control. Studies by Cuban scientists indicated that dietary deficiencies were the root of the problem (Ministry of Public Health of Cuba et al., Morbidity and Mortality Weekly Report, 43:183-92, 1994). A humanitarian mission was mounted by the Pan American Health Organization, the regional office of the World Health Organization. Coordinator of the mission was Gustavo C. Roman, then-chief of neuroepidemiology at the National Institutes of Health, who worked in Cuba from May to September of 1993. Distribution of donated B group vitamins to Cuba's entire population of about 11 million began in May, and most of the afflicted people recovered by year's end. In September of 1993, an optic neuropathy field study initiated by the Pan American Health Organization was conducted by a 153-person team comprising Cuban scientists, Roman, and investigators from the Centers for Disease Control and Prevention, the Food and Drug Administration, and Emory University. "The deteriorating economic situation in Cuba may have set the stage for this epidemic," the resulting paper stated. "Although we cannot assign a definite cause to this epidemic, our findings suggest that its occurrence was linked to a deterioration in diet" (Cuba Neuropathy Field Investigation Team et al, New England Journal of Medicine, 333:1176-82, 1995). Roman sent requests to the American Medical Association, the American College of Physicians, and various neurologic societies worldwide to appeal for a lifting of the embargo on humanitarian grounds, even as Sen. Jesse Helms (R-N.C.) introduced the Cuban Liberty and Democratic Solidarity Act--also known as the Libertad Act and the Helms-Burton Act--which would codify the embargo for the first time since its inception in the 1960s and making it modifiable only by an Act of Congress. In February of 1996, the proposed legislation got an emotional boost when the two civilian U.S.-registered airplanes were shot down by the Cuban military. Helms-Burton was passed the next month. The same year, Anthony F. Kirkpatrick, an assistant professor of anesthesiology at the University of South Florida College of Medicine, published articles in the Journal of the American Medical Association (A.F. Kirkpatrick, JAMA, 275:1633-7, 1996) and Lancet that examined the effect of the 1992 Cuban Democracy Act licensing procedures on medicine and medical equipment supplies in Cuba. He noted that such requirements as on-site inspections carried penalties for violations of up to $1 million per case for corporations and prison terms up to 10 years for individuals. "The number of companies granted U.S. licenses to sell to Cuba has fallen to less than 4 percent of pre-CDA levels," he wrote (A.F. Kirkpatrick, Lancet, 348:1489-91, 1996). Another stern rebuke of America's policy on Cuba came with the release in March last year of a 300-page report titled Denial of Food and Medicine: The Impact of the U.S. Embargo on the Health and Nutrition in Cuba from the Washington, D.C.-based American Association for World Health, which serves as the U.S. office for the Pan American Health Organization and the World Health Organization. Among the activities in this year-long investigation by a nine-member multidisciplinary research team were: a survey of 12 American medical and pharmaceutical companies about the effects of the embargo on their dealings with Cuba; on-site visits to 46 Cuban facilities; and interviews with 160 medical professionals, aid agency representatives, government officials, and others. "Since 1992, the number of unmet medical needs--patients going without essential drugs or doctors performing medical procedures without adequate equipment--has sharply accelerated," the report stated. "A humanitarian catastrophe has been averted only because the Cuban government has maintained a high level of budgetary support for a health care system designed to deliver primary and preventive health care to all of its citizens." The report said the embargo was contributing to four major health problems: malnutrition, especially among pregnant women; poor water quality, due to lack of treatment chemicals and spare parts, leading to rising incidences of such waterborne diseases as typhoid fever, dysentery, and viral hepatitis; poor access to medical information, due to travel restrictions, currency regulations, and shipping difficulties; and undersupplies of drugs and medical equipment, including access to only 889 of the almost 1,300 medicines available to Cuban physicians prior to 1992, and no access to about half the new drugs appearing since then. "Such an embargo appears to violate the most basic international charters and conventions governing human rights," the report declared. In May of 1997, the Department of State released a lengthy press statement that began, "There is a large body of misinformation and outright disinformation about the present state of health care in Cuba, including the false accusation that it is U.S. policy to deny medicine or medical supplies and equipment to the Cuban people." It argued that health care for the average Cuban had deteriorated because Castro deprived them of basic medical needs, while developing a health service available only to the Cuban elite, foreign "medical tourists," and others who could pay in hard currency. The statement also said the U.S. had approved 36 of 38 license requests for commercial sales of medical goods to Cuba since 1992. These licensing numbers were investigated by Kirkpatrick at the request of Rep. Esteban Torres (D-Calif.), who introduced the House legislation currently being considered. In response to Kirkpatrick's queries, the State Department revised its total license figure from 36 to 31. But using the Freedom of Information Act and other avenues, Kirkpatrick's analysis found that just eight licenses were for bona fide commercial sales of medical goods to Cuba, issued to foreign-based subsidiaries of three companies. The other licenses were unrelated to direct sales to Cuba, such as sales to aid groups that would donate the goods, or permits to travel to the island to explore commercial potential. There is little doubt that biomedical and other biotechnology facilities have been well-funded by the Castro regime. An American Association for the Advancement of Science (AAAS) mission visited more than a dozen Cuban scientific institutions from June 29 to July 4, 1997. The three participants were led by Rita Colwell, chair emeritus of the AAAS board of directors, president of the University of Maryland Biotechnology Institute, and currently President Clinton's nominee for the next director of the National Science Foundation. Accompanying her were Richard Getzinger, director of the AAAS office of international programs, and consultant Martin Prochnik. "In contrast to obvious difficulties in the rest of the economy," said a summary of Colwell's subsequent report, "the biotechnology facilities were new, relatively lavishly constructed, well equipped and competently staffed. Almost all had photographs of visits by President Castro, indicating his personal interest and support. We were told that over one billion U.S. dollars had been invested in this field to date." Hospital supplies might be a different case. At the House subcommittee hearing on May 7, W. Bradford Gray, a board of directors member of the Medical Device Manufacturers' Association, a national trade group, reported on a March meeting with Castro and a tour of Cuban health care facilities with a delegation of business executives. "Although Cuban physicians are well-trained by international standards, they do not have the modern medical equipment and supplies necessary to treat effectively many diseases and conditions," he said. "With a few exceptions, the vast majority of the Cuban people have not benefited from the last four decades of American advances in therapeutic and diagnostic products." The Senate bill now being considered, The Cuban Women and Children Humanitarian Relief Act (S1391), was introduced last November by seven senators led by Christopher Dodd (D-Conn.) and John Warner (R-Va.). It is expected to have a smoother ride through committees than the House bill, the Cuban Humanitarian Trade Act (HR1951), introduced last June. The latter bill has bipartisan backing from 122 members but has been referred to the Committee on International Relations, which has been sympathetic to the Cuban American pro-embargo lobby. Both bills would remove restrictions on sales of medical supplies and food but the Senate legislation merely authorizes the president to do so, rather than carrying the House bill's stronger phrasing as a mandate. A vote on either proposed act could occur in June or July.

Stung by the Pope and Health Studies, Congress Mulls a Policy Change for Cuba

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