Eduardo López-Collazo proposes a universal public healthcare system, compatible with the private sector – more or less along the lines of the Spanish model
14ymedio, Yunior García Aguilera, Madrid, 6 June 2026 / Eduardo López-Collazo belongs to that rare breed of scientists who are not content to observe the world from the laboratory. A nuclear physicist by initial training, with a doctorate in Pharmacy from the Complutense University of Madrid and a researcher in fields including immunology, sepsis, cancer and immune response, he has built a distinguished career in Spain within the field of biomedicine.
For many years he directed the Health Research Institute at La Paz University Hospital in Madrid, one of the benchmark institutions of the Spanish healthcare system. But his trajectory does not end with science. López-Collazo has also been a science communicator, columnist, cultural critic and author of books in which he tackles difficult subjects – cancer, HIV, pandemics – in prose capable of making the complex accessible to a general readership.
Born in Cuba and resident in Spain since the 1990s, he looks at the Island from the distance of exile, but also with the precision of a scientist and the sensibility of a writer.
A patient who became infected, the infection progressed to sepsis, and from there transitioned to a shock state in which the entire system has collapsed.
Question. If Cuba were a sick organism, what would its diagnosis be today?
Answer. Good question – I love analogies. I would say it is a patient in multi-organ failure. A patient who became infected, the infection progressed to sepsis, and from there transitioned to a shock state in which the entire system has collapsed. I would like to find another figure to describe it – one with a better prognosis – but I cannot find one. And it is a complicated situation because, with the resources currently available, there is nothing truly effective against septic shock. I say this from first-hand knowledge. Sepsis and its complications have been, alongside metastasis, one of my main lines of research ever since I left the metaphorical Island – nearly three decades ago now.
Question. As a scientist, what concerns you most about a transition: the lack of resources, the lack of talent and consensus, or the lack of method?
Answer. I believe everything plays a part, but if I had to single out one cause, I would point to the lack of method. Both in science and in art – two fields that have far more in common than we generally care to admit – method is essential. Cuba has lived with its back turned to it; that is to say, turned away from the tool that makes it possible to identify an error, acknowledge it and correct it. Of course, the lack of resources is crucial. So too is the loss of talent, today scattered largely throughout the diaspora. And, regrettably, that diaspora does not appear to have reached any great consensus; nor do I see any within the Island itself. continue reading
“The talk of a medical powerhouse was propaganda with some grains of truth and a great many holes.”
Question.For decades Cuba was presented as a medical powerhouse. How much of that narrative was real, and how much was propaganda?
Answer. I want to believe that a number of public health programmes were set up on the Island that did work. Vaccination, the family doctors and nurses scheme, epidemiological surveillance – these are good examples, difficult to deny. There were also attempts to introduce cutting-edge technology, but in that area the failures were considerable, because as a rule everything is coloured by ideology. When that happens, it all goes down the drain – can I say down the drain? We see the same thing in Spain and in many other places. Either way, the talk of a medical powerhouse was propaganda with some grains of truth and a great many holes.
As I answer you, a vivid scene comes back to me. I am from a town called Jovellanos, in Matanzas, but I did my university studies and then stayed on to live in Havana. It was at the height of the HIV/AIDS pandemic, while attempts were being made to contain the spread of the virus by methods that were, to put it mildly, rather unorthodox, when I saw that at the laboratory of the Jovellanos hospital they were pricking patients with the same lancet that, between one patient and the next, they would dip in alcohol. I remember I kicked up a tremendous fuss – and they listened to me because “he comes from Havana.”
In short: the narrative was inflated until partial virtues were turned into national myth. Cuba had good doctors; it did not have the perfect system it sold to the world.
Question.What should be the healthcare priority for a Cuba in transition: hospitals, primary care, medicines, doctors’ salaries, training, or statistical transparency?
Answer. You’re making this difficult for me. Let me think for a few seconds… The priority must be transparency. Yes, transparency. Without reliable data, nothing can be rebuilt. After that, and with equal urgency, come medicines, salaries, hospitals and primary care. But the first thing is to know the truth: how many people are falling ill, how many are dying, what is lacking and who is accountable.
“Cuba needs a universal public system, and if you press me, a mixed one with a strong public foundation.”
Question.What healthcare model might work for Cuba: a universal public system, a mixed system, a decentralised one, or would something entirely bespoke need to be designed?
Answer. I know that a large part of the diaspora is expecting me to say: private. But no – that would be a serious mistake. Cuba needs a universal public system, and if you press me, a mixed one with a strong public foundation. More or less along the lines of the Spanish model. What I am clear about is that it cannot be opaque, nor militarised. Public does not mean absolute state control. It must be decentralised, open to evaluation, compatible with regulated private initiatives and underpinned by robust primary care.
Question. Should scientists, doctors, artists and intellectuals take up public office during a transition, or should they remain as a critical conscience?
Answer. Some will need to take office and others should remain as a critical conscience. I will be among the latter, and from a distance – I’ll say it plainly, so we can spare ourselves a follow-up question (laughter). A transition cannot be left solely in the hands of recycled bureaucrats. But nor is it wise to turn every intellectual into a minister. I believe that lucidity is also a service that can be rendered from outside power.
Question. What risks do you see in a rapid opening-up of Cuba’s scientific sector: brain drain, opaque privatisation, technological dependence, capture by foreign interests, or the continuation of old structures under new names?
Answer. Allow me to put inverted commas around “Cuba’s scientific sector.” It is something rather anecdotal within the Island today. There are no longer centres of excellence doing science, and the scientists who have not yet left the country are worried about having electricity, not about interferon signalling pathways or the unification of the laws of physics.
At a certain point in history – I am talking about the late 1980s – there was a flowering of scientific infrastructure that is, by today, obsolete. Nor does a rigorously trained replacement generation exist. Many things would need to be picked up almost from scratch, and experience shows that science and its offshoots are never a priority for those who bring about the kind of social change the Island now needs.
Question. Can artistic sensibility improve the way a scientist observes, questions, imagines and makes sense of life?
Answer. At last you’re letting me out of the scientific straitjacket. I was beginning to think it wouldn’t happen – that once you’ve been pigeonholed there’s no way to let people see the other facets.
Look, I don’t see the division between art and science; to me it’s a continuum. In fact, I research with a very artistic vision, and when I write fiction or do dance criticism I make great use of the scientific method – without that diminishing beauty in the slightest; quite the contrary.
I’ve told the story several times that one of my great laboratory projects took shape during the pas de deux in the second act of Swan Lake, in a production I saw at the Teatro Real in Madrid. I’ll just add, as an aside, that when I was getting close to having seen that ballet a thousand times, I stopped counting.
I’m not sure I’m making myself clear: without fiction, without dance – classical or contemporary – without cinema, without visiting galleries and museums… I would not be the scientist I am.
To conclude: art trains a different way of seeing. A scientist without imagination only measures; one with sensibility also suspects, connects and doubts. Science needs data, but it also needs beauty in order to formulate good questions. I always tell my university students that there are few things more beautiful than Maxwell’s equations. They are simple, concrete and only four. With them, the whole of electromagnetism is described. Pure beauty, comparable to the Sistine Chapel, the David or the Mona Lisa. And if we move on to quantum physics, relativity, or the theory of cell fusion to explain metastasis – well, that’s where we enter the territory of the sublime.
“I learned early that I had to camouflage my homosexuality, wrap it in newspaper, tuck it into a pocket and not let it show too much.”
Question. In a democratic Cuba, what place should sexual freedoms, family diversity and equality before the law occupy within the project of national reconstruction?
Answer. I am grateful for the question, because these things need to be said out loud. I am openly gay – I think at this point that is hardly a scoop – but I always remember that when I was very young, I must have been around ten, I wrote a sentence in my diary that still haunts me: “I will be myself later.” Later. Like someone who hides a suitcase under the bed to open it once the hurricane has passed.
I was born in a town, on an Island, and under a regime where anything out of the ordinary was punished. I learned early that I had to camouflage my homosexuality, wrap it in newspaper, tuck it into a pocket and not let it show too much. Otherwise, you didn’t even make it to the corner. Literally.
Question. Do you believe that a country which created forced labour camps for homosexuals is as tolerant today as it tries to project itself to the world?
Answer. I am told things have changed on the Island. Perhaps. A little. Just enough for some people to get a photograph taken. The truth is that Cuba continues to be a profoundly homophobic country, and the average Cuban – even the most educated, the most progressive, the most inclined to quote Lezama, that writer almost nobody has actually read – after the third rum, drags that particular deadweight along.
I notice it on the few occasions I find myself around people from the Island. On certain faces you can still read it, clear as day: “Fine, but don’t take it too far with the gay business.” I’ve also heard: “He’s gay, but the guy’s a genius at what he does.” The “but” as a safe-conduct pass. As if professional success earns you a temporary reprieve. As if excellence somehow compensates for the deviation. How generous!
That is why I consider it essential that any country aspiring to call itself free must have full freedom as its foundation – including sexual diversity. Without that, it excludes an enormous part of its own people. And no system, no party, no transition, no national project will have my endorsement if it intends to leave this matter for later.
Because we already know what “later” looks like.
I once sent a friend packing – a friend who was telling me, in all seriousness, that first many other things needed to be resolved before talking about LGBT rights. Of course. She had been born with those rights already in place. For her, they could wait. For us, they cannot. No one can spend an entire lifetime queuing to have the right to exist.
“Cuba needs memory so as not to repeat the harm, tolerance to integrate differences, and control mechanisms to prevent political inflammation from destroying the social fabric.”
Question. You have spent years studying the immune response. How can Cuba defend its future without turning the transition into another form of self-destruction?
Answer. Like the immune system: Cuba must defend itself without attacking itself. It needs memory so as not to repeat the harm, tolerance to integrate differences, and control mechanisms to prevent political inflammation from destroying the social fabric.
On that note, I recently published an essay entitled The Limits of Democracy in which, with the help of a neurologist friend, Pepe Castillo, we explain democracy through the lens of science. It would do no harm for those who are going to build democracy in Cuba to read it.
Question. What would be, for you, an unmistakable sign that Cuba has begun to heal?
Answer. A good sign would be that people are no longer afraid. I experienced that myself when I left in the 1990s – suddenly I stopped being afraid to talk about my plans, to criticise what was wrong, to talk about my dreams, to kiss my boyfriend in the street, and a long list of other freedoms. You know what? In recent times I have started to feel afraid again – afraid to be myself in certain places – and that means something troubling is afoot…
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This piece was produced in collaboration with Cuba Siglo 21 as part of the project “Cuba: Stabilise and Develop.”
Translated by GH
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