“Sobering” message sent out from United Nations Earth Summit

THE LANCET

POLICY AND PEOPLE

“Sobering” message sent out from United Nations Earth Summit

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he 5-day Earth Summit, a follow-up to the much-touted summit in Rio de Janeiro in 1992, took place at UN Headquarters in New York last week. During the proceedings, an expert panel assembled by WHO discussed not only the links between environment and health, but also the often-ignored relation between health and sustainable economic development, specifically, how best to incorporate specific health issues into the future programme of the UN Commission on Sustainable

Development. This was done in light of findings published the previous week in a WHO assessment report Health and Environment in Sustainable Development Five Years After the Earth Summit (see Lancet, June 28, p 1896). The summit included a special session of the General Assembly at which 22 heads of state and 20 heads of government spoke. Noting the failure to adopt a political statement in the final programme document, and the fact that overall international assistance to develop-

ing countries has actually declined since 1992, despite promises made at Rio to the contrary, Rizali Ismail (Malaysia), president of the General Assembly, praised the efforts of participants. Some European countries have increased their assistance since 1992. But Rizali Ismail also declared that “absence of political will” and “inability to extend politically in the long-haul process” were “sobering”. Robert Ivker, Josh Hamilton

Kuwait’s health system charges look set to dissuade foreign workers efore the Gulf war, Kuwait’s oil revenue guaranteed a high standard of living for its citizens and good public services. Large numbers of foreign workers were attracted to the country, to supply specialist skills needed by the economy but also to undertake the tasks which Kuwaitis no longer needed to do themselves. This situation changed with the Gulf War. The devastation of the country during the war has taken its toll on the economy, and the government is now scrutinising public expenditure much more carefully, including health-service spending. One of the proposals currently being considered to reduce government expenditure, is that health care should continue to be free for Kuwaitis but that foreign workers should make a contribution to their health care. A study undertaken by the four major providers of private insurancesuggested the introduction of a sliding scale of contributions. Foreign

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workers would pay approximately 30% of the cost of treatment in the first year, rising to 100% over 5 years. However, the government turned down this proposal, claiming that it involved them in too much expenditure at the outset. Instead, they have made it clear that they are looking for a method by which foreign workers can realistically be required to cover their own healthcare costs throughout their stay in the country. The insurance companies have been asked to provide alternative proposals to the Health Committee of the Kuwait parliament. According to Ahmad Shamlaan, deputy director of the Kuwait Insurance Company, there will be two main proposals put before the Parliamentary Health Committee. The first of these is simply to require non-Kuwaitis to pay the cost of any medical treatment. The second is to impose a compulsory health insurance on all foreigners. The report from the insurance

companies examines which of these alternatives would be the easiest to implement. Linked with these proposals is an examination of the government’s suggestion that government funded hospitals would be available only to Kuwaiti citizens, and that foreign workers would be required to use private hospitals only. The cost of this is currently being assessed, but the insurance companies have expressed concern that the country’s five private hospitals and 140 consultant clinics would not be able to cope with the demand from nearly 600 000 foreign nationals. If approved, a boom in hospital building can be predicted. However, over the past few years the salaries of foreign workers have been dropping and if health-care costs start to soar, it is likely that the number of foreign workers in Kuwait will soon begin to diminish Peter Kandela

Canada makes vaccine biotech investment anada’s federal government will sink Can$60 million into the largest biotechnology investment ever made in the country. It will join Pasteur Merieux Connaught Canada in a $350-million, 10-year programme to develop therapeutic vaccines against cancers. The Toronto firm, a subsidiary Pasteur Merieux Serums et Vaccins, is seeking to develop vaccines to treat bladder, lung, prostate, cervical, breast, ovarian, colorectal, and skin cancers. Under the deal, Ottawa will collect a small percentage of royalties from

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gross revenues earned from the sale of vaccines. Industry minister, John Manley, who projected that the vaccines sales could top $10 billion in their first decade, said Ottawa could garner a 20% return on its investment before the royalty arrangement expires in the year 2017. “Let me be clear that this is no subsidy”, Manley told reporters on June 25. “This is no loan or grant.We expect to earn all that money back, and more, once these vaccines are successfully on the global market. I expect to make a profit.”

Pasteur Merieux officials said the firm is also seeking to bring other partners into the venture. It is now negotiating with Edmonton-based Biomira Inc, another vaccine manufacturer, about a possible role. The firm is also hoping as much as $25 million can be raised from the University of Toronto, the Clinical Research Centre in Montreal, the National Cancer Institute, the British Columbia Cancer Agency, and the Alberta Research Council. Wayne Kondro

Vol 350 • July 5, 1997