"Shane Smith:" "This week on Vice:" "The amazing medical breakthroughs that are happening in Cuba." "Kelvin Lee:" "You go from this discernible tumor, and then after the vaccine, that's all cleared out." "It's really quite dramatic." "Gianna Toboni:" "This hospital treats people with diabetes, and they have a new drug that could eliminate 70% of the diabetes-related amputations." "Smith:" "And then, the ecological threat to one of the world's most popular foods." "Isobel Yeung:" "How long has this been infected for, do you think?" "MAN:" "Months." "Once you see it, you're really very, very late." "(theme song playing)" "Yeung:" "Go, go, go!" "Refugee:" "We are not animals!" "In 2016," "Barack Obama became the first sitting U.S. president to visit Cuba in nearly 90 years." "I have come here to bury the last remnant of the Cold War in the Americas." "Smith:" "The shift towards normalizing ties between the two countries saw the loosening of trade and travel restrictions." "But what many people don't know, is that the thaw in relations could also allow Americans access to hitherto inaccessible Cuban medicines that may transform the treatment of some of our most widespread and harmful diseases." "♪ ♪" "(Dr. Sara Gonzalez speaking Spanish)" "(both speaking Spanish)" "It's so funny the doctor walked in just, you know, less than a minute ago, and she's already taken the... the baby's heartbeat." "Dr. Sara Gonzalez is a family doctor in this Havana neighborhood." "She and her team walk door to door to check in on her patients." "(speaking Spanish)" "Toboni:" "These neighborhood doctors are central to the Cuban healthcare system." "Ay, yi, yi, yi, yi." "Toboni:" "Checking in door to door allows doctors to focus on preventive medicine by catching and treating diseases earlier, keeping costs low, and contributing to longevity." "(Gonzalez speaking Spanish)" "(speaking Spanish)" "Toboni:" "Life expectancy here matches that of the U.S., while Cuba spends less than a tenth of what we spend on healthcare per capita." "(speaks Spanish)" "(speaks Spanish)" "(laughs)" "(horn honks)" "Toboni:" "While most of Cuba may look like it's stuck in the 1950s, their medicine is not." "(Professor speaking Spanish)" "Toboni:" "Cuba boasts more doctors per capita than anyone else in the world." "Their infant mortality rate is better than the U.S., and when the Ebola crisis broke out in 2014, they sent more doctors to Africa than any other nation." "As a small Communist country, their healthcare system was built out of necessity." "First, the 1963 trade embargo restricted Cuba from importing medicines from the U.S., and then in the early '90s, their economic isolation worsened with the collapse of the Soviet Union." "These unique conditions furthered the need to develop their own advancements, driving them to the forefront of medical innovation and inexpensive treatments." "This hospital treats people with diabetes, and they have a new drug that they're administering called Heberprot, and the reason it's a really great drug is because based on clinical trials, they say it could eliminate" "70% of the diabetes-related amputations." "Toboni:" "Diabetes is a serious epidemic in Cuba, just like in the U.S., but doctors here have created a new, highly effective treatment that manages one of the disease's most dangerous complications:" "Foot ulcers." "(speaking English)" "Toboni:" "Dr. Jose Fernandez Montequin is a diabetes specialist." "Can you just explain what's happening today?" "(speaking English)" "Toboni:" "Heberprot-P is injected around the site of the ulcer, stimulating tissue growth so the foot can start to heal." "(speaking Spanish)" "Toboni:" "Hundreds of thousands of patients in more than 20 countries have avoided losing limbs, and in some cases, their lives, thanks to Heberprot-P." "When someone receives an amputation, how does that affect their life expectancy?" "(speaks English)" "So this treatment isn't just preventing amputations, it's actually saving lives." "(speaks English)" "Toboni:" "Despite this drug's impressive results, the U.S., a country with 30 million people living with diabetes, is the one place that won't accept it due to its own longstanding trade embargo." "And it's not just medicines." "All Cuban products have been banned for more than 50 years, including their most famous exports:" "Sugar and cigars." "Toboni:" "We're at a tobacco farm a couple hours outside of Havana." "Cigars are, obviously, a huge part of Cuban tradition, but partly because of that popularity, there have been a lot of issues related to that, uh, with public health." "Lung cancer is the number one cancer killer in the world." "In the U.S. alone, there are almost a quarter of a million new cases annually." "Half of those diagnosed die within one year." "But there's a new treatment here in Cuba that doctors say could be life-changing for many lung cancer patients." "We're here to meet a family." "Their dad has had lung cancer for a while, and is on CimaVax, a lung cancer vaccine." " (Toboni speaks Spanish)" " Orelve:" "Hola." "Toboni:" "Orelve Sanchez took part in early clinical trials of CimaVax." "After being diagnosed with stage four lung cancer, he was told he would not live more than a year." "What was going through your mind when you got that diagnosis?" "(speaks Spanish)" "(speaks Spanish)" "When were you diagnosed with lung cancer?" "(speaks Spanish)" "Do you think your husband would be sitting here with us if it wasn't for the vaccine?" "(speaks Spanish)" "Toboni:" "Orelve has survived more than ten years on CimaVax." "It's also worked for thousands of patients whose cancer fits a specific makeup." "About 20% of the patient population naturally has high concentrations of a protein known as "epidermal growth factor,"" "or EGF, which feeds the cancer." "CimaVax triggers the immune system to target the EGF and stunt the tumor's growth." "While it isn't designed as a cure, or used as a preventative vaccine, it effectively manages the cancerous cells." "CimaVax was developed at the Center for Molecular Immunology." "Dr. Tania Crombet is the director of clinical research there." "How many patients here have been treated with CimaVax?" "(speaks English)" "And how has it worked?" "(speaks English)" "Toboni:" "That means that these patients, against all odds, have survived the biggest cancer killer by taking this vaccine." "♪ ♪" "These results have caught the attention of cancer researchers worldwide." "This is Dr. Kelvin Lee." "He's the first doctor to attempt to bring this treatment to the U.S." "Toboni:" "So, what brings you down to Cuba?" "So, we have been working with the Center for Molecular Immunology in Havana to bring that cancer vaccine up into" "Roswell Park in western New York and Buffalo to do clinical studies of it, and to also to do additional research in trying to understand how it works, what's the best way to deploy it, what are the other potentials." "♪ ♪" "Toboni:" "Dr. Lee and the researchers at CIM have been collaborating together for a few years." "Good to see you!" "How are you?" "Toboni:" "Before most drugs can be used in the U.S., they must undergo clinical trials for FDA approval, and for Cuban drugs, there are even more obstacles." "Before a trial can be approved, the U.S. Treasury Department must grant an exemption from the trade embargo." "I remember when we first came back from in 2012," "I was telling our legal team..." "They said it was complicated, and, you know," ""This hasn't been done before," ""and, you know, there are all these federal agencies to go through."" "I said, "You know, if there's a 20% chance," ""just a 20% chance that what the CIM is doing" ""is going... is real?" ""This is going to fundamentally impact human health." ""We need to be there." "We need to do this."" "(Dr. Elia Neninger speaking English)" " So they start there?" " Yes." "Exact." "Toboni:" "Dr. Elia Neninger is an oncologist who's been treating patients with the vaccine for about a decade." "Magaly Gomez was diagnosed with advanced lung cancer one year ago." "Have you ever seen a patient receive CimaVax?" "No, this is the first." "This is great." "Toboni:" "CimaVax is administered once a month." "The patient receives four injections, one in each arm and leg." "Toboni:" "How successful has CimaVax been?" " For her?" "For her." " For her." "(Neninger speaking English)" "Lee:" "The tumors are smaller." "Lee:" "That's quite remarkable that you go from this... where she has, you know, a clearly... you know, a discernible tumor, and you can't see the..." " the vasculature." " Neninger:" "Uh-huh." "Uh, and then after the vaccine, that... that's gone, you can see a vasculature." "That's all cleared out!" "That's amazing!" "Toboni:" "So that was originally advanced lung cancer." "Yeah, Three-B." "Uh..." " Three-B is inoperable." " Neninger:" "Three-B." "But that's actually a pretty remarkable response just on chest X-rays." "It's really... it's really quite dramatic." "Toboni:" "To hear some firsthand accounts," "Dr. Lee visited with a group of CimaVax patients who have responded particularly well to treatment." "They all have high EGF levels, and were given less than a year to live." "Magaly has been taking CimaVax for six months." "Yolanda has survived with it for four years, and Marta, for eight years." "How has the treatment been?" "(speaking Spanish)" "And yourself?" "(speaking Spanish)" "(Martina continues in Spanish)" "(Yolanda speaks Spanish)" "Toboni:" "A year ago, a promising treatment like CimaVax would never have been sent here to the U.S., but last October, due to the thawing relationship between nations, a historic decision was made to allow the first clinical trial" "of a Cuban drug on U.S. soil." "We followed Dr. Crombet from Havana to Buffalo as she joined Dr. Lee for the start of the trial." "Lee:" "Hi!" "How are you?" " My friend." " How have you been?" "We're gonna start the trial today." " First patient will get vaccinated today." " Crombet:" "Yes." "We have our expert from Cuba who's vaccinated" " more patients than anybody, uh..." " Crombet:" "Oh, no." "(Crombet speaking English)" "And we are starting that team today." "Lee:" "The exciting thing about CimaVax is whether or not you could use it in other cancers, that utilize EGF like colon cancer, head and neck cancer, maybe breast cancer, prostate cancer." "(speaks English)" "Toboni:" "Scientists here are looking not only to replicate Cuba's results, but to test CimaVax for use as a traditional vaccine in high-risk patients." "So, the idea there is to use CimaVax to prevent lung cancer in patients that have a high risk of getting lung cancer." "So, high-risk smokers." "Uh, that's millions of people worldwide." "Toboni:" "Lung cancer and diabetes are only the beginning." "There's the potential for a whole range of innovative Cuban drugs for breast, neck, and even brain cancer to make their way to the U.S." "With political differences between the two countries pushed aside, doctors can share in medical breakthroughs, and patients here may start to benefit from Cuba's low-cost and effective treatments." "We're hoping that those novel vaccines and treatments can actually come for clinical trials, and development in the United States using the same path." "So, we are on the first step on a very big journey, hopefully, that will be very exciting." "In season three of "Vice,"" "correspondent Isobel Yeung investigated how the world's agricultural systems are threatened by what is known as monoculture, the widespread cultivation of a single type of crop." "Man:" "The same gene is being used almost worldwide." "If one of those families should develop susceptibility to a new disease, we'd be in real trouble." "Now, a similar practice may be threatening the existence of one of the world's most popular fruits." "Yeung:" "Ouch." "♪ ♪" "Ow." "We've come here to the birthplace of the Cavendish banana, possibly the most important fruit in the world, eaten by billions of us every single year." "We're here in the very depths of the English countryside." "♪ ♪" "We're here in Chatsworth House in England, which is mostly known for its stunning landscapes and gardens, for over five centuries of British aristocracy, and, of course, for being the birthplace of the Cavendish banana." "Every banana that's grown, almost around the world today, is a Cavendish banana, and because they don't produce seed, it's the same genetic material in every plant, and so, pretty much, every banana that's eaten around the world" "started their journey here in the 1830s as the Cavendish dwarf banana." " (snapping)" " Yeung:" "Hey!" "Yeung:" "Not having seeds means you can munch your way through Cavendish bananas without chipping your teeth, but it also means that they're sterile, and can only be grown by replanting identical offshoots." "Porter:" "They came in through China, we think through Mauritius, and they arrived in this country, and the sixth Duke cultivated them, got them to flower and fruit, realized their potential as a food crop, and from there they turned it into a commercial crop" "that they started to export, and that's when we all started to enjoy them on the supermarket shelf." "So essentially the hundreds of billions of bananas that we consume are all direct clones of these bananas here?" " Yes." " Yes." "Cool!" "♪ I'm Chiquita Banana ♪" "♪ And I've come to say ♪" "♪ Bananas have to ripen in a certain way ♪" "Yeung:" "This quirky-looking yellow fruit was once unknown to the west, but after a massive marketing campaign, and an even bigger production plan, it's now one of America's most consumed fresh fruits." "The banana business model is the cheapest fruit in the supermarket." "Yeung:" "Author Dan Koeppel, or Dan, the Banana Man, explained how that all became possible." "Consider that a banana gets shipped thousands of miles, goes bad really fast." "How is it possible that a banana can be so cheap?" "Well, you gotta control the things you can control, which are labor and land, and so when the banana industry started, an essential part of their business model was to make sure that they didn't pay anything, basically," "for workers, and they didn't pay anything for land." "How did they do that?" "Military force." "Koeppel:" "So, over and over again, the banana companies took over countries..." "Guatemala, Honduras," "Nicaragua, Colombia, all over Latin America... in order to make sure their business model of cheap bananas was preserved, and this led to insane, horrible amounts of bloodshed, genocide, and the birth of the term "Banana Republic,"" "which meant a country that wasn't controlled by its native people, but by American banana companies." "I mean, it's kind of shaped a lot of countries, and even whole continents." "Oh, yeah, the very makeup of Latin America would not be the same if not for bananas." "Yeung:" "Now countries like Costa Rica are dominated not just by a single crop, but by a single clone, creating one of the world's biggest monocultures." "♪ Day O ♪" "♪ Day O ♪" "♪ Daylight come and me wan' ♪" "♪ Go home ♪" "♪ Work all night on a drink of rum ♪" "We're in a massive banana plantation in Costa Rica." "Here in Latin America is where the majority of our bananas in the U.S. actually come from." "♪ Daylight come and me wan' go home ♪" "If we have brown bananas, the consumer just rejects them right out, so every single stage of this process has to be calculated to a "T."" "♪ It's six foot ♪" "♪ Seven foot ♪" "♪ Eight foot bunch ♪" "Ugh!" "So, on every single one of these bunches, you have about 150 bananas." "That's a lot of bananas they've got to harvest every day, and an operation this big needs an equally large work force." "(worker speaking Spanish)" "(speaking Spanish)" "(continues in Spanish)" "Thousands and thousands of Cavendish bananas have been harvested just down here, and now we're making our way to the packing station where they're gonna be shipped all the way across the world." "The size of this plant is enormous." "You've got 8,000 boxes being filled every single day, full to the brim with bananas, that's happening 365 days of the year, so they're pretty busy." "The scale and speed at which these bananas are cultivated, packed, and shipped is only possible because of the use of this one clone of banana." "Yeung:" "How did we get to rely so heavily on just this one crop?" "(speaks English)" "Yeung:" "Agricultural expert Dr. Luis Pocasangre explained that this is the problem with monocultures." "They're all susceptible to the same diseases, which can spread like wildfire." "(Pocasangre speaking English)" "Yeung:" "This cancer is known as TR4, a strain of Panama Disease, and it's devastating banana crops around the world." "Koeppel:" "Panama Disease is a fungus, it's called fusarium wilt, and it spreads very quickly." "It can destroy an entire country's crop in four years." "It doesn't just kill the bananas." "It makes it impossible to grow bananas in that place again." "Yeung:" "Ground zero for the spread of this disease is the Philippines, the second largest banana supplier in the world." "Bananas are central to the Filipino economy, accounting for nearly 90% of all exported fruit." " So, this all used to be bananas here?" " Yes." "Kema:" "You know here on the edge, you see quite a number of plants that are yellowing." "So, essentially these are all infected with the Panama Disease." "Yeung:" "Gert Kema is a plant pathologist, who works with banana corporations as well as small farmers to monitor and contain the spread of TR4." "That's infected." "Over there, you see?" "Right." "I can assure you that many of the plants that are here around that still look pretty good, most likely, they're infected too." " Really?" " Yes." "Yeung:" "How long has this been infected for, do you think?" "Kema:" "Few months." "Once you see it, since this takes months, you're really very, very late, and the farmer does everything he can to kill those plants, but it's not stopping the disease." "That's essentially what's going on." "Yeung:" "Farmers here are frantically trying to stop the spread by chopping down the plants, covering them with flammable rice hull, and burning the pile." "This entire landscape is dotted with rice hull fires." "You can see they're spraying disinfectant and trying to quarantine the plant, but, I mean, these people have been walking all over this area." "I've been walking all over this area." "There's no disinfectant around the farm, only at the very entrance, so, it's so hard to contain this disease." "Yeung:" "With containment nearly impossible, small-time farmers are left with the difficult choice of how much land they're willing to sacrifice in order to contain the spread." "(Manuel Rotersos speaking English)" "In total, how many workers have you had to lay off?" "(speaking English)" "Yeung:" "This is just one plantation of hundreds in the region." "Thousands more acres of banana crops have been affected, and the disease is spreading quickly." "(Kema speaking English)" "(speaking English)" "(Kema speaking) monoculture is a bad thing." "It's not just a bad thing because it means we only get one banana, and there are many more that taste good." "Monoculture's a bad thing because it's an environmental disaster." "It's a cultural and social disaster." "It requires the transformation of forests into factories." "I'd say the chances of the Cavendish banana crop being devastated by Panama Disease are 100%." "The question is:" "Will there be a replacement?" "And will it be a replacement that repeats the monoculture and repeats the mistake?" "Or will it be part of a sort of arsenal of varietal bananas?" "Yeung:" "The reason he's so confident that this will happen, is because it's actually happened before." "Over 50 years ago, the entire banana industry was almost wiped out by the original strain of this fungus." "The original banana that gave birth to the banana industry was a different breed." " This banana was called the Gros Michel." " Yeung:" "Mm-hmm." "Koeppel:" "It was a bigger banana than the one we have now." "It tasted better, in every way, it was a better banana, except it was susceptible to this disease." "And by 1960, it was what we call commercially, or functionally, extinct." "Yeung:" "To replace it, they needed a banana that looked like the Gros Michel, which they'd been marketing for about half a century." "There was only one option:" "The somewhat inferior-tasting, but aesthetically similar, Cavendish banana." "Koeppel:" "They invent bagging and boxing." "They invent ripening rooms." "They come up with all these ways to make the Cavendish work, and they gamble that people aren't gonna care that it tastes bad, and that's what happened, and the Cavendish becomes our banana, and the Gros Michel, and the lesson of the Gros Michel" "is totally forgotten." "Yeung:" "An entire global monoculture has been built around exporting this one inferior banana, which could suffer the same fate as the Gros Michel." "Even though worldwide, there are around 1,000 different types of bananas." "This is a Cavendish that when it ripens, it doesn't turn yellow." "Yeung:" "Mmm, cheers." "It's better than the... the Cavendish, but this is not the one that is exported." "The market is used to..." " a yellow banana." " Yeung:" "Mmm!" "It does feel weird eating a green banana." "Mmm." " What's this?" " Fhia 17." "Molina:" "It's the product of hybridization." " Yeung:" "Mm-hmm." " Moderately resistant to TR4." "So why is this one not used?" " Because the taste is no good." " Shame." "Yeung:" "What about this one?" "This one looks funny." "That doesn't affect the pulp, see?" "But nobody will buy them because they judge it by the skin." "Yeung:" "Yeah, it's not very appealing, is it?" "Molina:" "Because with consumers, like America, for instance, you buy with your eyes." "Yeung:" "As the industry continues to rely on the one most marketable banana, the risk of this massive monoculture being wiped out by disease is ramping up." "TR4 has now spread all across Asia, to the Middle East and then to Africa." "Back in Latin America, one botanist," "Dr. Juan Aguilar, is the banana's best hope at survival." "We went to Honduras where he, and his team of scientists, are inventing new breeds in the hopes of finding a marketable, disease-resistant banana." "The pollinator is the person who make sex with banana." " Why do you need to do that?" " For example:" "I am resistant to cancer, and you is not resistant to cancer." "We need to make love." "Make sex to get the son who maybe will be resistant to cancer." "Molina:" "This is the sperm." "Huh?" "This is the... the male flower." "If you put your finger, you feel... that the female is sticky." "This female is ready to make sex..." " today." "Only today." " Okay." "So, these little guys are completely resistant to TR4." "What they've got to do now is isolate this one resistant trait, and put it into the Cavendish, so crossbreed it." "The problem is that could be a really, really long, laborious process." "Yeung:" "These bananas are incapable of sexually reproducing on their own." "So, Aguilar's doing it for them." "Three months after pollination, these bananas are harvested, peeled and squashed." "By Aguilar's own estimates, it takes about 12,000 bananas to find a single seed." "Once they find a seed, it's grown to see what traits it carries, before being crossbred multiple times to create the hybrid they're after." "It's kind of worrisome if this is one of the most viable solutions for our TR4 problem worldwide." "They've been going for decades, and they still haven't found a TR4 resistant Cavendish, and who knows how many more decades they're gonna be going for before they do find one." "Yeung:" "While Aguilar continues his search for that ultimate, golden, disease-resistant banana, its future as a monoculture crop poses a bigger question about our agricultural systems." "By demanding the cheapest, most uniform products in our lunch boxes, we don't just run the risk of losing the almighty banana, but also the biodiversity of life on Earth." "(Molina speaking English)" "I'll save the bananas for you." "(speaks English)" "♪ ♪"