Israeli health bill passed

substandard care, said Van III trials AIDS vaccines not for Coverden. The community health centres, mean- : On June 17, after an exhausting day consuch low projected efficacy, and that it while, cannot survive on the low levels of fronting disappointing data and difficult might be unethical, because it would offer reimbursement that the state has negotiateach individual so little probability of benchoices, the AIDS Research Advisory ed with these managed-care plans. Man- : Committee (ARAC) of the US National efit. They were also concerned about the diversion of millions of dollars per year aged-care plans can get by on less because Institute of Allergy and Infectious Disrecommended that NIAID from other projects. Community activists they do not have to meet federal quality eases standards set for the community health researchers not advance two vaccines to opposed the trial, on grounds that the centres and because they have additional large-scale trials, but rather "combine curhigh-risk community has been increasincome from private subscribers. Commurent gpl20 programs with development of ingly disappointed by the mediocre results of other AIDS drug trials, and this study nity health centres, on the other hand, other candidates currently under study", must depend on Medicaid fees for most of and "proceed with expanded clinical trial might squander whatever is left of willingtheir revenue. evaluation when another concept and/or ness to participate in future studies. In its lawsuit, the association contends compelling data from current or other : Other vaccine candidates in the pipeline the Medicaid waivers being granted by the studies are available". In a nod to studies include variations on HIV-envelope proadministration are illegal because Contein, with or without glycosylation, and, pending abroad, where risk/benefit ratios under the heading of "other concepts", gress intended waivers to be used only for often differ substantially, they added, small experimental programmes of short: "This recommendation only applies to live vaccinia and canary pox vectors duration and not as a way to revamp a vaccine trials in the US". Director of expressing one or more HIV proteins. state’s entire Medicaid system. The suit NIAID Anthony Fauci accepted the Attenuated live SIV vaccines have been calls on the court to stop the administrasuccessful in the macaque model, but judgment. tion from approving additional waivers: At issue was the April proposal of the there is doubt whether a live attenuated and to halt the implementation of waivers AIDS Vaccine Working Group to begin HIV vaccine could be approved. that have already been approved. Panel members repeatedly expressed double-blind, placebo-controlled trials, : 4500 or more their desire for studies of the correlates of involving healthy, high-risk Michael McCarthy for two candidate vaccines consubjects, protective immunity, including the relathe recombinant HIV envetive taining gpl20 importance of humoral, cellUS health workers turn to manufactured lope glycoproteins by mediated, and mucosal responses; but Biocine. These Genentech and until there are subjects for study who have by produnions ucts have been shown to be safe and cleared the virus and are resistant to reinin hundred it looks like AIDS vaccinologists several volunfection, Frightened by the rapid changes in the US immunogenic teers. stimulate the of must without a clear picture of the They production operate health-care industry, hospital workers and of antibodies that block in-vitro infection immune response they need to induce. other US health-care personnel are joining blood homoloperipheral leucocytes by unions in increasing numbers, according gous HIV strains. These vaccines have Paul M Rowe to a survey by Management Science Assobeen shown to protect chimrecently ciates Inc, a hospital management consultfrom infection with an intrapanzees ing firm. US hospitals, under pressure venous challenge with homologous HIV from government and private insurers to Israeli health bill (mucosal challenge was not become more efficient, have been However, protective immunity in the into reduce their labour costs by cutting staff On June 15, the Israeli Knesset plenum vitro assay is poor to non-existent against voted to and by trying to take back generous salary pass a national health insurance and benefit packages they gave to nurses field isolates. Also, the chimpanzee model bill, 68 to 0 with 27 abstentions. From the and other employees just a few years ago. is weak, because although chimps can be earliest days of the State, Israeli leaders The survey found that hospital workers in infected with HIV, the infection does not have called for the establishment of unicause immune deficiency. Although simi1993 filed 158 petitions to hold versal health coverage for all citizens but it elections for unionisation, up from just 19an immunodeficiency virus mimics HIV has taken over 40 years and nearly 12 difin 1989, and this year the number of peti- much better, recombinant envelope proferent proposals by half a dozen health tions are expected to jump to 184. :tein vaccines are not highly effective in the ministers to bring the idea to enactment. :: Union organisers have also been helped SIV model. The vote ended 25 hours of debate, there have been 13 cases of Recently most spent on paragraph 71, making pasby a 1991 US Supreme Court decision HIV infection in the recipients of the that allows hospital employees to be dividsage of the law contingent on passage of a ed into eight categories for the purpose of gp 120 vaccines. 1 of these cases has rapidworkers’ organisation tax law, a "stopunionisation, said Ken McDonald of ly progressing disease. Thus, at least some gap" concession to pay for breaking the vaccinees were not protected, nor does the link between health fund and union memManagement Science Associates. Previvaccination necessarily slow the course of there were two ously, only categories: probership (see Lancet June 4, p 1420). fessionals and non-professionals. "The the disease. However, all of these infecOpponents called former health minister tions occurred before the completion of Member of Knesset Haim smaller units are easier to Ramon, now because the employees in one of these the vaccination schedule; outcomes in Histadrut secretary-general elect, a "traithose people receiving all four doses groups tend to have the same concerns tor" for supporting the tax (see Lancet Feb : 12, p 402), since his winning platform was and issues", he said. : remain to be seen. Most panel members felt that the efficabased on severing the tie. Hospital workers are also seeking union of these vaccines might turn out to be cy The Health Minister Dr Ephraim Sneh representation because they want to have 30% or 50% at best. The Vaccine Worka greater voice in the health-care reform predicted that teams from the ministries decisions, said McDonald. He predicted ing Group had concluded that a 30% of health, justice, and finance will have that union enrolment will continue to reduction in transmission would be of sigprepared all the necessary regulations and climb until the debate over health-care . nificant public health benefit, and that that the National Insurance Institute will reform is settled and some stability returns valuable information could be obtained in be ready to collect the health tax by early a large trial; ARAC, however, was conto the health-care industry. October. cerned about confusing the public by conMichael McCarthy ducting a large-scale test of a product of Rachelle H S Fishman

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