Perspectives in Health Magazine The Magazine of the Pan American Health Organization Volume 8, Number 2, 2003

The Pedro Kourí Institute, founded in 1937, has evolved into a world-class player in the global fight against tropical and infectious diseases.

A turnoff at kilometer 6 of Havana's Novia del Mediodía ("Noontime Bride") highway leads through the gates of the Pedro Kourí Institute of Tropical Medicine (IPK), one of Cuba's institutional crown jewels. Inside the modern 10-building complex, the island's top medical scientists carry out research in more than a dozen fields, from biotechnology to treatment of HIV/AIDS.

In his office, the institute's director, Gustavo P. Kourí, receives a visitor with a smile that brightens his chiseled face. On the wall behind him are myriad international and national commendations received by him and his institute over the years, including his most recent prized possession, a medal from the Vatican.

Kourí wears his white lab jacket like a family coat of arms. Continuing the work of his father, the late Pedro Kourí, he has transformed the 66-year-old institute into not only Cuba's leading research and treatment center in tropical medicine and infectious diseases, but also a leading player in these fields worldwide.

In the process, Kourí has acquired his own impressive international credentials. He is director of the Pan American Health Organization (PAHO)/World Health Organization (WHO) Collaborating Center for Research and Training in Medical Malacology and Biological Control of Vectors and Intermediate Hosts, one of three PAHO/WHO collaborating centers that are housed at IPK. He is a member of the Joint Coordinating Board of the Special Program for Research and Training in Tropical Diseases and a member of the Council of the International Society of Infectious Diseases. He also served on PAHO's Centennial Advisory Board in 2002, the year the organization celebrated its 100th anniversary.

What motivates him? "My country, my institute, my family, my people," he says.

A family affair
The Kourís' battle against tropical diseases began in 1937 when Pedro Kourí created the Institute of Tropical Medicine at the University of Havana. For 20 years, the institute's work focused on Cuba's most worrisome parasitic diseases: malaria, Bancroftian filariasis, hepatic fascioliasis, amoebiasis and other intestinal parasites. Students from the United States, Latin America and other regions came for training in tropical medicine and research. Pedro Kourí represented Cuba at various national and international congresses, including the Third World Congress on Microbiology, held in New York in 1939, where he announced his discovery of a new parasite, Inermicapsifer cubensis. He developed new methods for diagnosing and treating parasitic diseases, presenting these in his four-volume publication, Lessons on Parasitology and Tropical Medicine.

Gustavo was an admiring witness to such accomplishments. "I was very close to my father," he says. "Even as a boy, I worked with my father. As a teenager, I continued and worked with him at the institute."

When Fidel Castro's revolution triumphed, the elder Kourí took the sweeping changes in stride, according to his son. "There was no contradiction with the revolution," recalls Gustavo. "My father and most of his colleagues reacted very favorably. He was of very poor origin and was always focused on the diseases of the poor, so he had a very advanced feeling in relation to socialism."

Following in his father's footsteps, Gustavo Kourí has cultivated international ties while helping his own country conquer its most threatening infectious diseases. (Photos by Annemarie Christensen)

It seemed natural that Gustavo Kourí would follow in his father's footsteps, entering medical school and graduating in 1962. He was trained in surgery and pathology and did his medical internship in parasitology. He also spent a year at Minas del Frio in the Sierra Maestra for his clinical rural practice in general medicine.

It was in the mountains that he met Castro, two years after the revolution. Kourí was stationed at a school for primary and secondary teachers. During the conflict, the site had served as a military base under the command of the legendary Che Guevara, and it had a 20-bed hospital used by the revolutionaries. Castro, now president as well as comandante, showed up one evening and spent four hours talking with Kourí and the other medical staff-intraining. They discussed the merits of Cuba's rural hospital program, and Castro left the young doctors and nurses with the feeling that he had complete confidence in their work.

After his stint in the mountains, Kourí decided to relicense in microbiology, but in 1965 Castro announced the formation of the National Center for Scientific Research. "It was the first big scientific institute [in Cuba]," Kourí says. Eager to hone his research skills, he joined a team of a dozen colleagues who got the center up and going.

"We called ourselves the 12 crazy doctors," he recalls. They spent two years studying basic sciences, including physics and math, to prepare themselves for research. Kourí was named vice-director of the center in 1968. Twelve years and three posts later he landed at Cuba's Ministry of Higher Education as national director for research and postgraduate studies.

An institute reborn
Meanwhile, the small but impressive institute Pedro Kourí had founded went into decline after his death in 1964. For more than a decade, it carried on with just 14 staff working in a 1,000-square-meter facility. Gustavo recalls that it suffered from a "lack of leadership" and the fact that Cuba's public health system was deteriorating and "resources were being directed to more serious problems."

In 1979, however, the Cuban government decided to support the institute's activities, incorporating it into the Ministry of Health and recruiting the younger Kourí as director.

Among the Kourí Institute's current projects are a recombinant dengue vaccine and one for HIV/AIDS. The Institute conducts evaluation and clinical trials for all Cuban vaccines and is in charge of control and evaluation of antiretroviral treatment for HIV/AIDS.

"We started a second phase with full support from our government and decided to bring the institute to the highest scientific level in the shortest possible time," says Kourí, adding proudly: "This task was given to me directly by our President."

The new Kourí Institute cultivated scientific relationships with countries and international organizations around the world, including in the United States. Support from the Special Program for Research and Training in Tropical Diseases (TDR), of the United Nations Development Program (UNDP), the World Bank and WHO, was critical to the institute's retooling. TDR provided training, research and project grants and helped the institute establish exchange relationships with other scientific centers around the world.

Today the Pedro Kourí Institute for Tropical Medicine comprises 52,000 square meters and 700 employees and is Cuba's leading research and training center in infectious diseases, as well as a major player in international efforts to control tropical diseases. Many of the national laboratories of Cuba are housed at the institute, along with the island's only tertiary AIDS clinic and research center. It continues to receive support from TDR as well as Canada, France, Spain, Belgium, the European Union and the Wellcome Trust, among others.

While the institute originally limited its work to parasitology and tropical medicine, it now addresses infectious diseases in general, with projects in more than a dozen research fields. These range from sexually transmitted diseases and infections in immunodepressed patients to strategies for the control of the disease-bearing mosquito Aedes aegypti.

IPK is in charge of evaluation and clinical trials for all Cuban vaccines, "which is very relevant work for our biotechnology industry because we determine the effectiveness of our products," Kourí says. Among the vaccines the institute is developing or preparing to test are a recombinant dengue vaccine and a vaccine for HIV/AIDS. IPK is also in charge of the control and evaluation of antiretroviral treatment for HIV/AIDS, which the government provides free of charge to those who are infected. (As part of Cuba's public health system, the Kourí Institute provides its services free of charge to Cuban nationals.)

In addition, the institute has a medical residency program and master's and Ph.D. programs in virology, bacteriology, parasitology, vector control, epidemiology and infectious diseases.

Kourí takes equal pride in-if not explicit credit for-Cuba's overall health achievements, many of which could not have occurred without his institute's contributions. They roll off his tongue like the names of his children: "Cuba was the first country in the Americas to eliminate polio. Vaccines against 13 infectious diseases have been developed, and so the incidence is very low. Typhoid is 0.1 percent, TB is 7.8 percent, tetanus is zero, and bacterial meningitis is 0.3 percent. Malaria is completely eradicated, and dengue outbreaks have all stopped. And AIDS is under control."

Having largely conquered its own most threatening infectious diseases-thanks in significant part to the work of IPK-Cuba has more recently taken on the role of providing assistance in this area to other developing countries. As with other national health pursuits, Kourí's institute is deeply involved in this.

Continuing in the tradition of his father, Kourí says he is especially proud of the institute's teaching function. Since 1980, it has trained more than 20,000 students, some 1,800 of them foreigners from 72 countries.

"IPK is respected throughout Latin America and beyond," says Paul Farmer, professor of medical anthropology at Harvard Medical School. "With a comparatively tiny budget-less than the budget, say, of a single large research hospital at Harvard-IPK has conducted important basic science research, helped develop novel vaccines, trained thousands of researchers from Cuba and from around the world, and developed ties with researchers in the United States, too. Gustavo Kourí has provided the leadership for all of this."

International ties
The Kourí Institute has developed research and educational exchange ties with a number of academic institutions in the United States, including Cornell, Harvard, North Carolina, Princeton and Yale universities. The most significant of these is with the David Rockefeller Center for Latin American Studies at Harvard. Since the center's inception in 1994, one of its priorities has been to reestablish and expand ties with Cuban scholars and institutions. Through its Cuba Program, the center has fostered collaboration between Cuban counterpart institutions and the Harvard Medical School, the Harvard School of Public Health, the John F. Kennedy School of Government and even the Graduate School of Design.

Harvard Medical School had strong ties to the Kourí Institute even before the revolution. That relationship dissipated following Castro's rise to power and the institute's decline. But in 1998, John David, professor emeritus of tropical medicine in the Department of Immunology and Infectious Diseases at the Harvard School of Public Health, wrote to Gustavo Kourí suggesting ways of strengthening research ties between the two institutions. Kourí replied with an invitation.

After playing a key role in the fight against Cuba's most threatening diseases, the Kourí Institute has more recently directed its energies toward infectious diseases such as TB, dengue and malaria-those that most threaten the world's poor.

"I went there to see if we could have exchanges between faculty and students, and within a year we started having scientists from there come to the Harvard School of Public Health," David says. Harvard students and faculty have also traveled to Cuba, and the two institutions have jointly sponsored conferences and workshops on dengue, immunology and health reform, among other topics.

David adds: "Our relationships have been quite separate from dissidents. The autocracy has not affected our relationships."

The Kourí Institute has even developed relationships within U.S. government circles. Gary Clark, chief of the Dengue Branch of the U.S. Centers for Disease Control and Prevention, has known Kourí for more than a decade and participates in IPK courses on dengue fever. He notes that such collaborative ventures are important to researchers in Cuba and the United States, as well as other countries.

"It's an opportunity to meet people with the same interests," says Clark. "Through Dr. Kourí's leadership and the course-currently coming up on the eighth one-we have 14 to 16 years of efforts to bring researchers together. About 50, 75 people come [to] do special laboratories... It's an opportunity to meet people with the same interests."

Harvard's Farmer observes that much more than "pure research" is at stake in these collaborations: "The IPK has singled out a number of ranking infectious threats, including TB, dengue, malaria and HIV. Comparatively speaking, these are not ranking threats within Cuba. But these diseases constitute huge problems for the poor world." There is no effective vaccine for any of them, and they are the leading infectious diseases in the world today, he says.

Kourí also views his mission in these larger terms. "Considering the risk of introduction of exotic diseases in Cuba, our government decided to strengthen the institute and increase our surveillance. But at the same time, our president declared that this center was not only for Cuba, but also for humanity."

For Farmer, IPK represents an opportunity not to be missed.

"Harvard Medical School and the Harvard School of Public Health may well constitute the world's largest universitybased medical research complex," he explains. "If we were to join forces with one of the developing world's premier research institutions to develop new tools to control or treat these plagues, it would be, as Shakespeare put it, ‘a consummation devoutly to be wish'd.'"

Annmarie Christensen is director of publications at the Global Health Council in Vermont,USA. She reported this story while visiting Cuba for the council in April.

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