Cuba's Cancer Hope

Cuba’s Cancer Hope

PBS Airdate: April 1, 2020

NARRATOR: One in three Americans will be diagnosed with cancer in their lifetime.

SYLVIA RICE (Cancer Patient): I, I have cancer?

RYAN SWITZER (Cancer Patient): Like getting hit by a truck.

GEORGE KEAYS (Cancer Patient): The PET scan showed that I had eight metastases in the chest.

YOUSUF ZAFAR (Medical Oncologist, Duke University): I become anxious, because their options become more and more limited.

NARRATOR: Some take matters into their own hands…

GEORGE KEAYS: You know, I’m not trying to break the law. But I’m also not going to die.

NARRATOR: …even if it’s illegal to get treatment where they’re going: Cuba.

CANDACE JOHNSON (President and Chief Executive Officer, Roswell Park): Wow. In Cuba. Jeez.

KUNLE ODUNSI (Deputy Director, Roswell Park): What could come out of Cuba that we don’t already know?

NARRATOR: How did a small nation, cut off from modern medical technology, become a world player in cancer science?

JOHN KIRK (Latin American Studies, Dalhousie University): Cuba was forced to think outside the box.

NARRATOR: Castro had a vision.

KELVIN LEE (Cancer Immunologist, Roswell Park): If there’s a two percent chance that the science is right, we need to be there.

There’s nothing in the United States.

NARRATOR: Can scientists whose countries are political adversaries now work together to fight cancer?

AGUSTÍN LAGE DÁVILA (Former Director, Center of Molecular Immunology): If you are isolated, you are dead, in science. Cooperation is everything.

DOCTOR ANABELY GARCIA (Georges Keays’ Havana Medical Team Chief): Mosquito.

GEORGE KEAYS: Yeah.

WILLIAM “BILL” BLANCHET (Boulder Internal Medicine): We added the Cuban vaccine, and his cancer gets smaller and disappears.

NARRATOR: Cuba’s Cancer Hope…

ANABELY GARCIA: Don’t cry.

NARRATOR: …right now, on NOVA.

GEORGE KEAYS: Life isn’t meant to be fair; it’s meant to be lived.

NARRATOR: George Keays has always loved the outdoors. He’s 67 years old.

GEORGE KEAYS: I was very active: runner, swimmer, loved mountain sports, skiing, snowboarding and that kind of thing.

NARRATOR: Today, he’s preparing for an unusual trip. It’s a matter of life or death. George has Stage 4 lung cancer.

GEORGE KEAYS: So, this was really kind of a shock. Something like this put a crimp in your style.

NARRATOR: This isn’t George’s first encounter with the deadly disease.

GEORGE KEAYS: My wife was diagnosed years ago. And my daughter was 10 and my other daughter was 20. And then she passed away when they were 14 and 24. It was tragic, you know, they were very, very close to their mom.

NARRATOR: One in three Americans will have cancer in their lifetime. It’s one of the leading causes of death, worldwide.

SYLVIA RICE: When I first received the diagnosis of Stage 4 pancreatic cancer, I was like, “Huh? I, I have cancer?” Like, “Other people have cancer. I don’t have cancer. What are you talking about?”

RYAN SWITZER: It was definitely like getting hit by a truck; unexpected, for sure.

TANYA FRITZ (Cancer Patient): I said, “Did you just drop the bombshell on me that I think you did?” And I think that’s when it finally clicked. And he said yes.

MARYAM HATAMI (Cancer Patient): I’m about to be 35 in two weeks. It’s been two years that I’m living with metastatic breast cancer at Stage 4.

NARRATOR: There are more than 100 different types of cancer. In the U.S., they kill an estimated 600,000 people a year. The havoc cancer wreaks on patients and families is devastating.

ANA MARIA SALAZAR (Cancer Patient): My mom passed from breast cancer, and my dad had passed because of lung cancer. So, for me, “cancer” was “death.”

RYAN SWITZER: There was a period between Christmas and New Year’s where I didn’t get out of bed for that entire period, you know? My one daughter came in and said, “Hey, Dad? Are you ever going to come play with me again?”

GEORGE KEAYS: You go from being very healthy, suddenly, “Well, you have six months to live.” It hit my daughters very, very hard. My oldest daughter said, “I just love you so much.”

NARRATOR: When George was diagnosed, he discovered patients like him, where lung cancer metastasizes throughout the body, often don’t live much longer than a year. That was four years ago.

George is convinced what’s helping him stay alive is a new treatment that goes beyond the radiation and chemo he’s received. It’s actually a lung cancer vaccine. It’s one of a new wave of treatments that are transforming some cancers from a death sentence into a chronic condition, like diabetes or high blood pressure.

ELIZABETH JAFFEE (Medical Oncologist, Johns Hopkins University): We’re really in a scientific revolution, particularly when it comes to cancer research, because there are a number of patients with deadly cancers, we can turn them into chronic diseases where they’re living years.

NARRATOR: But the cancer vaccine George is receiving is not available in the U.S. In fact, it’s against the law for him to go where he’s been going for this cutting-edge treatment.

GEORGE KEAYS: You know, I’m not trying to break the law, I’m not. But I’m also not going to die.

NARRATOR: To fill his prescription, George has to fly 2,000 miles, to Cuba. But why is George risking a trip to Cuba, when some of the most advanced cancer medicine in the world is back in the U.S.? What could a small communist nation, embargoed by the U.S. for over 50 years, bring to the fight against cancer?

Cuba’s advances in cancer treatment are largely unknown to most Americans.

KELVIN LEE: I think everyone here thought that Cuba was stuck in I Love Lucy days, you know? The 1950s, old cars, can’t possibly be any good science going on.

KUNLE ODUNSI: I mean, certainly I did not know about what was going on. Kind of, you know, what could come out of Cuba that we don’t already know?

NARRATOR: Cuba is a small country with big contradictions. Even though the island is impoverished, it continues to provide free healthcare to all its citizens.

One of them is Marta Reymo. She shares her small apartment in Havana with her family, including her grandson.

MARTA REYMO (Cancer Patient): (Translated from Spanish) Yes, yes, I smoked. But, like a year before I got the disease, I quit smoking. Why? Because I had a sister who had the same thing I have today. And when she had cancer and the doctor talked about smoking and such, I quit too. But, well, the damage was already done.

NARRATOR: The popularity of Cuba’s famous cigars and cigarettes, contributes to lung cancer being the deadliest cancer here, as it is in the U.S.

Sometime in 2009, Marta just wasn’t feeling like herself.

MARTA REYMO: (Translated from Spanish) I went in for my X-ray and an ultrasound, and I had a C.T. scan. After all the tests, they told me that I had a growth in my right lung.

NARRATOR: Like George Keays, she was diagnosed with inoperable Stage 4 lung cancer.

MARTA REYMO: (Translated from Spanish) Saying that disease, I thought the worst. I thought I was going to die.

NARRATOR: Not only did Marta lose her sister to lung cancer, but Marta’s daughter, who is a nurse, lost her husband, as well.

MARTA FERRAN (Daughter of Marta Reymo): (Translated from Spanish) My husband died six months before this, from the same disease, and now I have to face the situation again with my mother. It was really hard for me, very difficult.

NARRATOR: Marta’s lung cancer began the way all cancers do.

YOUSUF ZAFAR: Cancer is our own body going awry, starting with a single cell in our body that stops listening to the signals to stop growing or stop behaving in a certain way. And when that cell stops listening to those signals, it starts growing out of control, and it turns into cancer.

NARRATOR: The bloodstream becomes cancer’s highway to reach other organs.

SYLVIA RICE: And so then she says, “You have it in multiple areas of your body. It’s already spread. It’s in your ovary, it’s in your liver, it’s in your pancreas, and you’ve got a couple areas in your lungs.

MARYAM HATAMI: One day, when I was working, I heard something, like, breaking. And they took me to the emergency room, took the pictures, and it showed a fracture in my spine. The cancer made that.

NARRATOR: Historically in the fight against cancer, treatment options have been surgery, radiation and chemotherapy.

In addition to these, Marta’s found another option. For 10 years she’s been taking a cancer vaccine called CIMAvax-EGF®. Cuban clinical trials show that it extends life by three to five months, on average. And about 15 percent of patients, including Marta, have survived five years or more.

CIMAvax is one of a class of new drugs that activates the immune system to fight cancer. They’re called “immunotherapies.”

KELVIN LEE: Immunotherapy, broadly, is essentially using the immune system to fight human disease.

NARRATOR: Our immune system protects us from infection and disease by identifying foreign threats like bacteria or viruses that are dangerous to the body. When a threat is identified, immune cells, like killer T cells, are signaled to attack and destroy. But it was only in the last few decades that scientists realized they could use the immune system to not only attack foreign invaders, but also attack cancer.

MARTA REYMO: (Translated from Spanish): I feel that after all these meds, I have gotten my life back. I’ve been getting treatment for 10 years now.

NARRATOR: Marta’s daughter works the dayshift as a nurse. At night, she helps organize her mother’s care. Most of the medicines distributed to patients like Marta are manufactured in Cuba.

MARTA FERRAN: (Translated from Spanish) We have been able to extend her life and quality of life. That’s the most important thing.

NARRATOR: The CIMAvax cancer vaccine Marta’s taking is now used to treat thousands of patients in Cuba and other countries.

How is it possible for a country as poor and isolated as Cuba to come up with cutting-edge medicines like this? Cuba’s unique approach to medical research stretches back 60 years, to the time of the Cuban revolution…

1959: Fidel Castro, a former lawyer, leads a revolution that overthrows the Cuban government.

FIDEL CASTRO (Leader of Cuba, 1959-2008/Film Clip): (Translated from Spanish) The spirit of our revolution. Homeland or death, we shall prevail!

NARRATOR: The revolution establishes a one-party communist state with Castro as its authoritarian leader.

JUAN VELA VALDÉS (Cuban Minister of Higher Education): It was not only a change of government. It was mainly a change of economic, political and social structure of the country.

NARRATOR: Medical science is at the heart of Castro’s vision.

FIDEL CASTRO (Film Clip): (Translated from Spanish) The future of this country must necessarily be a future of men of science.

JOHN KIRK: He was a person who clearly was obsessed with public health and education. In 1960, the year one of the revolution, he talked about the need for, for science in Cuba. So, from the very beginning, he saw science as an opportunity to bring Cuba kicking and screaming into the modern era. He claimed, on several occasions, that access to healthcare was the most fundamental human right that existed in the world.

NARRATOR: Castro promises free health care, a promise later written into the new constitution. But as the new government nationalizes business, confiscates private wealth and tears lives apart, many professionals, including doctors, flee the country.

JOHN KIRK: If you were part of the white, urban, middle class in Havana, you had everything to lose by staying. Most of the doctors decided that it was in their best interest to, to leave.

NARRATOR: Juan Vela Valdés was minister of higher education.

JUAN VELA VALDÉS: In 1958, we had 6,500 physicians in our country. From ’59 to ’62, in three years, half of the doctors flew away from our country.

NARRATOR: Cuba has to rebuild the healthcare system from the ground up. Castro establishes new universities, clinics and medical schools across the island. And he sends thousands of medical students and doctors abroad to study at some of the top medical universities in the developed world.

AGUSTÍN LAGE: During the ’60s and the ’70s, many people were sent abroad to study science. I spent two and a half years in Paris.

NARRATOR: Agustín Lage was later chosen to be the first director for the Center of Molecular Immunology, one of Cuba’s leading biopharma research centers.

AGUSTÍN LAGE: Getting training in biochemistry and cancer biology, my supervisor is Luc Montagnier, discoverer of the AIDS virus.

NARRATOR: When they return to Cuba, many of these students and doctors are tasked with building the country’s new public health service, the difficulty heightened by political tensions and economic isolation.

JOHN F. KENNEDY (President of the United States, 1960-963/Address to the Media April 20, 1961/Film Clip): The forces of communism are not to be underestimated in Cuba or anywhere else in the world.

NARRATOR: In 1962, at the height of the Cold War, President Kennedy announces an expanded trade embargo against Cuba. Today, Cubans call it el Bloqueo, “the Blockade.” The American embargo would include hospital equipment, medical supplies and even ordinary antibiotics.

JOHN KIRK: As a result, Cuba was forced to think outside the box, particularly in terms of medical research. One of the things that that allowed it to do was to start producing its own medicines.

NARRATOR: Castro develops a self-sustaining medical sector to manufacture medicines for Cuba’s public health service. Throughout his regime, Castro continues to emphasize the importance of human capital and science as Cuba’s future.

FIDEL CASTRO (Film Clip): (Translated from Spanish) Science and the production of science must be first in the national economy. But due to the scarce resources, especially energy resources in our country, we have to develop the production of intelligence. That will be our place in the world. There will be no other.

NARRATOR: Today, Cuba reports health statistics that rival the U.S., but some researchers caution these may be unreliable due to manipulated data. Free medical care for ordinary Cubans is provided, often at clinics with scarce equipment or serviced by physicians who drive cabs to make ends meet.

That’s not the case at La Pradera. It was designed to attract international patients, who pay in hard currency.

GEORGE KEAYS: So, we’re going to turn here.

NARRATOR: For nearly two years George Keays has been coming here for treatment and rest. Everyone knows George.

GEORGE KEAYS: Mi madre de Cuba, my mother in Cuba.

GEORGE KEAYS: It was March of 2015, and I went for an annual physical with my primary care doctor. He said, at that time, you know, your cough looks kind of like maybe an allergic cough. But the cough was getting worse and so ordered a CAT scan.

And I remember I left the office, and the doctor called me, “Get back in here. You have a growth in your lung.”

So, then I went for a full body PET scan to determine how far this had spread. It showed that I had eight metastases in the chest along the lymph nodes, one in the shoulder, and it had spread to my brain. So, I had a brain tumor as well.

NARRATOR: Lung cancer is the leading cause of cancer deaths worldwide, more than 1.6 million each year. More than breast, colon and prostate cancers combined.

BILL BLANCHET: Here is a reconstructed CAT scan. This is the metastasis…

NARRATOR: One reason lung cancer is so deadly is that often, by the time there are symptoms like coughing, back pain or difficulty breathing, the disease has already spread.

BILL BLANCHET: …the large tumor here.

NARRATOR: This was distressing news for George, a non-smoker. His lung cancer cells had been growing undetected for years.

GEORGE KEAYS: At that point, you know, the prognosis was pretty grim, less than two years, probably less than a year.

MARY REID (Epidemiologist, Roswell Park): Late stage lung cancer progresses very quickly. Historically there hasn’t really been much to do other than try chemotherapy, try radiation, try some maybe targeted therapy, and then, keep people comfortable until they die.

GEORGE KEAYS: I had had 15 radiation treatments in the clinical trial program and one radiation treatment to the brain; I was taking gene therapy. And then cancer mutates, it basically starts to get smart about what you’re, what you’re treating it with.

NARRATOR: Watching the news one evening, George learns about new treatments emerging in Cuba.

NEWS REPORT: A lung cancer vaccine, developed in Cuba…

GEORGE KEAYS: I actually saw it on television, where people from Roswell Cancer Center, in New York, went to Cuba, and they were looking at alternative treatments.

NARRATOR: His research convinces him the Cuban drugs might help him more than what is available in the U.S. George wants in. His doctor urges him to call Havana.

GEORGE KEAYS: And they said, “Yeah, we think that, you know, you, you could, you could come down here, and see if a vaccine might work.

NARRATOR: Immunotherapies, including Cuba’s cancer vaccines, are a medical breakthrough. For years, scientists believed the immune system could not attack cancer cells, because, unlike an invading virus or bacteria, they are considered to be part of us.

KELVIN LEE: Cancers are really 99 percent you. They’re 99 percent normal, so the immune system largely sees them as normal.

NARRATOR: Even into the 1980s, researchers who believe they can harness the immune system against cancer are considered renegades.

OLIVERA FINN (Cancer Immunologist, University of Pittsburgh): I was a graduate student in the late ’70s, at Stanford. People were suspicious of the ability to actually provoke an immune response against the cancer cells. We’re saying we can do something against cancer, and everybody’s sort of laughing, right?

NARRATOR: But it turns out the immune system does fight cancer. The battle begins as soon as normal cells mutate into cancer cells.

KELVIN LEE: Long before anybody knows that they have cancer, there’s this ongoing war of the immune system trying to control the cancer and the cancer trying to escape.

NARRATOR: If the cancer learns how to mask itself from the immune system, it can gain the upper hand and grow.

KELVIN LEE: So, by the time the cancer actually grows large enough to be detected by our normal tests, it’s already figured out how to get away from the immune system.

NARRATOR: But finally, researchers learned how cancer masks itself. And in 2018, Tasuku Honjo and James Allison won the Nobel Prize for discovering how to unmask cancer and let the immune system do its job.

This is how it works.

KUNLE ODUNSI: When you and I get an infection, usually the immune system revs up, but at some point, the immune system has to stop and rest.

NARRATOR: The body has natural mechanisms that stop the immune system so it won’t damage ordinary cells. These are called checkpoints.

KUNLE OUNSI: But it turns out that these same mechanisms that tell the immune system to stop, have been hijacked in cancer. The cancer is sending a signal to the immune system to stop.

NARRATOR: Honjo and Allison figured out how to turn the immune system back on. Their discoveries led to checkpoint inhibitors, drugs that can turn cancer’s signal off. Now the immune system can recognize the cancer and attack.

ELIZABETH JAFFEE: It took 30 years of understanding the immune system, before we could understand how to make the immune system recognize cancer.

NARRATOR: How did scientists learn to use the immune system as a weapon against cancer? For Cuba, and the rest of the world, it all starts with interferon.

NEWS ANCHOR MONTAGE: A substance known as interferon…

…the body produces interferon in minute amounts…

…the body’s natural first line of defense against viral infection.

NARRATOR: In the 1980s, interferon was a science sensation, the first breakthrough drug made from the body’s own immune cells with the potential to fight cancer.

KELVIN LEE: Interferon is a major defense mechanism the body uses when it is infected with a virus or has a cancer growing in it.

NARRATOR: Interferon can prevent viral infection from spreading and signals immune cells to attack the virus.

OLIVERA FINN: Interferon was our very first immunotherapeutic drug that could be made in large quantities.

NARRATOR: In 1980, renowned American oncologist Randolph Lee Clark visits Cuba and tells Castro about interferon.

LUIS HERRERA MARTÍNEZ (Scientific and Commercial Advisor to BioCubaFarma President): (Translated from Spanish) Doctor Clark explained to Fidel that interferon was one of the promising drugs for cancer treatment. That’s what drove him to want to make interferon.

NARRATOR: Castro sends doctors first to study with Clark, in Texas, and then to Helsinki, Finland, where they learn how to purify interferon from white blood cells. When they return to Havana, the doctors are taken straight to a house refitted with a new laboratory, House 149. Castro gives them a simple instruction: make interferon for Cuba.

LUIS HERRERA: They worked constantly every day until 10 or 11 o’clock at night. Fidel came here almost every day, just making questions. It was very, very, very intensive.

NARRATOR: It takes scientists in other countries as long as a year to replicate the purification process. The Cuban doctors master it in 42 days.

But around the same time, a new technology, first developed in California, is gaining ground worldwide: genetic engineering. Castro sends Luis Herrera to Europe to investigate.

LUIS HERRERA: I remained in Europe some time getting that information. I came back and I met Fidel, and then he started to make questions concerning genetic engineering.

NARRATOR: The genetic engineering process Herrera brings back to Cuba is transforming science across the globe.

In the laboratory, scientists remove a section of D.N.A. from a human cell that codes for a specific protein. They then insert that D.N.A. into the D.N.A. of a bacterial cell. As the bacteria replicates, it carries the code for the human protein in its own D.N.A.

AGUSTÍN LAGE: You can put the bacteria in a fermenter and you have millions of flasks of interferon.

NARRATOR: It turned out interferon only works against a few cancers, but the process of making interferon took immunotherapy science to a new level. Genetic engineering started a new approach to fighting cancer around the world and in Cuba.

By this time, Castro’s ambitions were clear.

JUAN VELA VALDÉS: That’s the first time I heard him to say that we can become a medical power.

LUIS HERRERA: That was the beginning of the whole biotechnology development in Cuba.

NARRATOR: Cuba would go on to build a world class biotech industry. Research, development, quality control and distribution are all the responsibility of one government agency, BioCubaFarma.

OLIVERA FINN: They are a small country, the communication is much quicker and faster. They can immediately make a drug available to all the patients who qualify for that drug and immediately collect the data on a large number of patients.

NARRATOR: Cuba’s 30-plus biopharma facilities hold over 2,000 international patents for drugs and processes in use around the world. But the trade embargo makes all these treatments unavailable in the U.S., like Vaxira®, the cancer vaccine George Keays has been taking for nearly two years.

GEORGE KEAYS: I get one to two calls a week from people who have heard about me, have heard that I’m coming here, and ask questions, like, “Where do you get the vaccine? How, how’d it work for you?” You know? I think there are some people for whom this might not work, but I think there are a lot of people for whom this can be beneficial.

NARRATOR: But now American patients could be on their way to having access to Cuban cancer treatments legally. And it all started with a cold call to Roswell Park Comprehensive Cancer Center in Buffalo, New York.

KUNLE ODUNSI: I was sitting in my office and my secretary came to me and said, “There is a telephone call for you from someone who is from Cuba.” When I picked up the phone, what she talked about was the fact that they have some innovative approaches in Cuba that she would like to discuss with Roswell Park.

I have to tell you, my initial response was skeptical.

So, my first question is, “Why are you talking to us?” And she talked about the fact that this is one of the few institutions in the United States where the discoveries in Cuba could be taken to the next level and make sure it benefits a wide range of patients, not only in Cuba, but across the world.

NARRATOR: Eventually, the researcher from Cuba’s Center of Molecular Immunology, or C.I.M., is invited to make a presentation on the lung cancer vaccine CIMAvax-EGF, the same vaccine that Marta Reymo has been taking.

It is a standing room only event.

CANDACE JOHNSON: Well, I think, scientists, we’re all a little crazy. And so, we all, we all want to hear something really interesting. It sparked curiosity of how it came to be. And so, that was what I recall from it, is, “Wow. In Cuba. Jeez.”

NARRATOR: Cancer vaccines are already in development around the world, but what surprises Roswell Park researchers is the science that makes this vaccine work.

KELVIN LEE: They had thrown out the first chapter of any basic immunology textbook to actually accomplish the science.

NARRATOR: Cuban scientists claim to have found a new way to fight cancer, by first getting the immune system to do something it’s never supposed to do: attack a healthy human protein.

The research Cuba presents at Roswell Park goes back to 1981. A young scientist named Rolando Pérez is investigating epidermal growth factor or E.G.F. It’s a natural protein in the body that tells cells to multiply. Pérez is one of many scientists around the world trying to understand the role E.G.F. might play in cancer.

ROLANDO PÉREZ RODRÍGUEZ (Director of Science and Innovation, BioCubaFarma):

(Translated from Spanish) We wanted to know whether human breast tumors were dependent on E.G.F. for their growth. What we found was a high expression of E.G.F. receptors in about 50 percent of tumors.

NARRATOR: A receptor is a protein molecule on the cell’s outer surface. When an E.G.F. protein connects with an E.G.F. receptor on the cell’s surface, the protein sends a signal to grow and multiply.

ROLANDO PÉREZ: (Translated from Spanish) It was really a surprise to find that there were tumors which had a high dependence on E.G.F.

NARRATOR: At Roswell Park, researchers show how live cancer cells use E.G.F. to grow into the beginnings of a tumor mass.

KELVIN LEE: In the culture that has epidermal growth factor, you can see a layer of lung cancer cells that, over time, are dividing and growing and getting bigger and bigger. In the culture that has the lung cancer cells but has been depleted of E.G.F., you can see that the lung cancer cells have, in fact, stopped growing.

NARRATOR: Pérez’s research points out some tumor cells have thousands more E.G.F. receptors than healthy cells. To prevent cancer from using E.G.F. to grow, the Cubans came up with a novel idea: starve the tumor by removing E.G.F. from the equation. To do this, they would have to vaccinate the body against E.G.F. and convince the immune system this normal human protein is a threat. But it wouldn’t be easy.

AGUSTÍN LAGE: If you vaccinate a human being with human E.G.F. nothing happens, because the immune system interprets that this is self.

NARRATOR: A typical vaccine includes a weakened dose of the virus or bacteria being targeted. Once it’s injected into the body, the immune system produces antibodies that attach to the invader and attract other immune cells to destroy it. Memory cells remember it, in case it comes back again.

To get the body to recognize E.G.F. as a threat, Cuban scientists attached a protein from the meningitis bacteria to the E.G.F. protein.

AGUSTÍN LAGE: So, then the invention was to link human E.G.F. with a protein that is coming from a bacteria, from the meningitis bacteria, by the way. And as the bacteria protein is there, then the immune system interprets “this is non-self and dangerous.”

NARRATOR: The attached bacterial molecule causes the immune system to see all E.G.F. as a threat. Antibodies signal immune cells to eliminate the E.G.F. The idea is to starve lung cancer cells of something they depend on to multiply, but leave enough E.G.F. in the body for ordinary cells to function.

As it turns out, CIMAvax is most effective for lung cancer patients like Marta, who already have high levels of E.G.F. in their blood.

AGUSTÍN LAGE: You are making a trick to the immune system, no? You trick the immune system, because you present something “self” as if it were “non-self.”

NARRATOR: When Roswell Park researchers learn the science behind CIMAvax, many are convinced it could be a game changer. They urge president and C.E.O. Candace Johnson, to consider the possibility of a partnership.

CANDACE JOHNSON: It was really a couple of individuals that decided to really press this. And let’s, let’s see what we can do. Let’s reach out to these folks in Havana and see if we can establish some sort of relationship with them.

NARRATOR: Then in 2014…

BARACK OBAMA (President of the United States, 2009—2017, Statement by the President on Cuba Policy Changes, December 17, 2014/Film Clip): Good afternoon.

NARRATOR: …history opens a door.

PRESIDENT BARACK OBAMA (Statement by the President on Cuba Policy Changes, December 17, 2014/Film Clip): Today, the United States of America is changing its relationship with the people of Cuba.

NARRATOR: President Obama begins normalizing relations with Cuba, and New York Governor Andrew Cuomo leads a trade delegation to Havana.

CANDACE JOHNSON: So, the governor wanted to take a group of leaders from around the state, and he chose me. I could bring one person, and I took Dr. Lee. So here we all go into Cuba, we’re only there for 36 hours, and Dr. Lee and I decided that this was an opportunity to really do this.

NARRATOR: Roswell Park scientists believe Cuba’s CIMAvax could add to the arsenal of weapons available for cancer patients. The Cubans hope for access to research data from Roswell Park and even technologies that could improve their immunology drugs.

ERNESTO CHICO (Chief Executive Officer, Innovative Immunotherapy Alliance): We have limited resources because of we are in a poor country. We have also limited resources because the best and the most efficient technology are usually coming from the U.S. And we don’t have access to that.

NARRATOR: One example is this American-made flow cytometer. It suspends samples in a fluid and whisks them through multiple lasers, one cell at a time. Tens of thousands of cells’ characteristics are rapidly analyzed. In the U.S., the device is the standard for advanced research and clinical trials.

JOSEPH TARIO, JR. (Laboratory Supervisor, Roswell Park): So, in this case, we’re measuring the T cells in the patient’s blood, in order to determine what type of T cells are present.

NARRATOR: One department at Roswell Park has over 20 of these expensive machines. The data they could yield for Cuban research would be invaluable. There are only two such devices at C.I.M. One is broken.

ZAIMA MAZORRA HERRERA (Researcher, Center of Molecular Immunology): We had this equipment broke for one year, because we had to send the equipment to Germany. If this equipment has more than 10 percent of the American component, we can’t buy.

NARRATOR: Despite these limitations, Cuban science makes important strides, even as American discoveries in immunology treatment continue to lead the world. For Roswell Park, a partnership with Cuba could allow them to combine C.I.M.’s cancer vaccine with immunotherapy treatments already available, like checkpoint inhibitors.

ELIZABETH JAFFEE: What we’re realizing now is that you have to combine immunotherapy agents, so we’re seeing studies that are testing vaccine with immune checkpoint agents.

NARRATOR: At Johns Hopkins Kimmel Cancer Center in Baltimore, Bruce Toma is being treated for Stage 4 pancreatic cancer.

TRIAL DOCTOR: One more.

NARRATOR: He’s participating in a clinical trial combining checkpoint inhibitors with a cancer vaccine developed by Dr. Elizabeth Jaffee.

BRUCE TOMA: This is how good your work has done. Nobody can believe…

ELIZABETH JAFFEE: It’s, it’s so good.

BRUCE TOMA: …that I’m Stage 4 metastasized pancreatic cancer.

ELIZABETH JAFFEE: So, I don’t know how much of your scans you’ve seen.

BRUCE TOMA: First one.

ELIZABETH JAFFEE: The first one. So, what we’re really excited about is that you had all of this tumor here in the peritoneum.

BRUCE TOMA: Mm-hmm.

ELIZABETH JAFFEE: Your most recent scan, there’s nothing there. We can’t detect it. It’s totally gone.

BRUCE TOMA: Oh, wow, yes. I can see the difference.

NARRATOR: Immunotherapies are incredibly expensive, and not everyone has the same success as Bruce. And we don’t know why.

YOUSUF ZAFAR: If we can understand why certain patients do benefit from immunotherapy while others don’t benefit from treatment, we can make great leaps forward in our cancer treatment.

TRIAL DOCTOR: Anything else going on? Any headaches or…

NARRATOR: But for now, many patients, no matter what therapies they are receiving, will likely reach a point when they run out of treatment options.

YOUSUF ZAFAR: As their cancer grows and the treatment that I’m giving them fails, I become anxious, because with every step, their options become more and more limited.

STACEY BURRELL (Daughter of the late Kathy Wolf): Mum, she took the scissors and she started just chopping off her own hair. I’ll never forget it. My sister and I just stood there just awestruck. It was a very emotional experience.

BERNIE WOLF: (Widower of the late Kathy Wolf): And Kathy was willing to try anything. And it was tough on her when they, when they said, “That’s it, there is no more,” and, “Treatment would only make you worse.” But Kathy held the doctor’s hand and said, “I understand.”

MARYAM HATAMI: They say usually it’s three years, the time. I’m exactly at third year. The doctor said I have one more year to live.

ANABELY GARCIA: It’s no pain, because the needle is so thin, mosquito.

GEORGE KEAYS: Yeah.

NARRATOR: At La Pradera, oncologists administer George’s Vaxira prescription.

George’s doctor and close friend Dr. William Blanchet is in Havana to lend support.

BILL BLANCHET: The cancer was growing, the cancer markers were getting bigger on this agent. His oncologist increased the dosage; the cancer continued to get bigger. We added the Vaxira, and his cancer gets smaller. And so, on the three-year anniversary of being diagnosed with horrible Stage 4 lung cancer, this guy runs a 10K run, and puts an offer down on a house. Those are things that people three years into Stage 4 lung cancer tend not to do.

NARRATOR: But George is not cured. Cancer continues to be a daily struggle. In addition to Vaxira, he’s undergoing a number of treatments in the U.S. Despite this, his doctors recently discovered a new metastasis in his liver.

GEORGE KEAYS: It’s a hell of a thing to have to take a risk with, you know, your, your wellbeing that you, you, that somebody could say, “Well, you’re breaking the law.”

NARRATOR: But could Cuban drugs like Vaxira become available in the U.S.?

AGUSTÍN LAGE: In science, cooperation is everything. So, if you are isolated you are dead, in science.

KELVIN LEE: Our legal department was saying, “How are we going to do this? Is this going to be worth it?” And I said, “If there’s a two percent chance that the science is right, we need to be there.”

NARRATOR: Cuba and Roswell Park come to an agreement to cooperate. In 2016, CIMAvax becomes the first Cuban drug ever approved by the F.D.A. for clinical trial in the U.S. At Roswell Park, it’s being combined with a checkpoint inhibitor, nivolumab, that could make CIMAvax even more effective.

GRACE K. DY (Medical Oncologist, Roswell Park): And the flip side is the way CIMAvax works, it may make nivolumab work better, as well. Think of it like, “Can one plus one equal to five?” So that’s the ultimate goal of testing.

NARRATOR: Two years later, Cuba’s Center of Molecular Immunology and Roswell Park double down on their partnership and make history again.

NEWS ANCHOR: The president and C.E.O. of Roswell Park announced the first ever biotech joint venture between the United States and Cuba.

CANDACE JOHNSON: We did it!

NARRATOR: The two agree to build a new biotech facility in Cuba, dedicated to cancer drugs, jointly owned by Roswell Park and C.I.M.

ERNESTO CHICO: Eventually, we will build factories, and at some point of time we will reach the medical community in Cuba and the U.S. with new medicines for the people.

NARRATOR: The embargo will continue to be one of the biggest challenges for the Roswell Park-C.I.M. research partnership. Even after the F.D.A. approved clinical trials in 2016, Roswell Park worried the embargo would make it almost impossible to ship CIMAvax safely from Havana to Buffalo. So, they tried a test run, with water in a temperature-controlled box.

KELVIN LEE: So, it actually got from Havana to Canadian customs; and the F.D.A. was expecting it because we told them that it would come. Got to U.S. customs, apparently if you’re on the embargo list in the United States, your country is not in the electronic database. So, the box went back to Canada, sat there for, I think, two days. So, the box is good for holding temperature for 72 hours.

NARRATOR: Nearly 200 hours after being packaged in Cuba, the box arrived in Buffalo. The real vaccine would have been destroyed.

These kinds of challenges are critical to overcome for the research partnership to succeed. Both sides are convinced it’s worth it.

AGUSTÍN LAGE: The data that we have are good.

KELVIN LEE: And there is nothing in the United States.

MARY REID: It’s a precedent-setting event. You know, these are American scientists working so closely with Cuban scientists. They are presenting us with very novel drugs. CIMAvax has the potential to work as a vaccine to prevent lung cancer formation, and that has a substantial public health implication.

AGUSTÍN LAGE: I hope, I really hope that this won’t be stopped, because this is cancer treatment and these are American citizens being treated by cancer vaccines manufactured here in this small country.

NARRATOR: Even as political tensions rise between their two countries, Cuban and American scientists continue on in the hopes of improving cancer treatment and one day finding a cure.

KELVIN LEE: If we work together to raise the quality of the life of our peoples, that will bring us together. Science is going to move relationships forward. The promise of lifting the burden of cancer in all peoples is going to move the relationship forward.

SYLVIA RICE: I’m handling it, and I want to keep going, because I have things that I want to do, I have things I want to see. I have things I want to complete with my children.

MARYAM HATAMI: I’m so lucky that I see things, that I feel things on my skin, and I don’t want to lose it. I want to live my life the fullest.

GEORGE KEAYS: If I can’t walk, I’ll be on my knees. If I can’t be on my knees, I’ll crawl. But I’ll continually try to get back up. And that will be my life.

ANABELY GARCIA: How do you feel today?

GEORGE KEAYS: Very good, very good. No pain.

NARRATOR: Before going home, George meets once more with Dr. Anabely Garcia, chief of his Havana medical team.

ANABELY GARCIA: And, here, we put in the date that you receive. You have vaccines until August. Okay?

GEORGE KEAYS: Yes, that’s right.

ANABELY GARCIA: We wait for you next May or June. Oh, no, no, no, no, no. Don’t cry.

GEORGE KEAYS: Thank you. I’ll see you again in May.

ANABELY GARCIA: Yes, of course.

BILL BLANCHET: Hasta luego!

GEORGE KEAYS: One of the things you learn is to live in the moment. I may not be here in six months, I don’t know.

CAPTION: George continues treatment for recurring tumors in his lungs, liver and brain and other health issues. A shortage of Vaxira in Cuba has prevented him from filling his prescription.

Marta Reymo reports she is in good health and remains cancer free.

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