Journalist, Diplomat, Entrepreneur & Author

Blood Inquiry

12 December 2017

Senator Wallin rose to call the attention of the Senate to the federal government’s legal obligation to protect and maintain Canada’s voluntary blood system and to examine the issues surrounding commercial, cash- for- blood operations

This past November, we marked the twentieth anniversary of the Krever commission. Judge Horace Krever investigated Canada’s tainted blood scandal after as many as 30,000 Canadians were infected with HIV and hepatitis C through blood transfusions during the 1980s. Families were devastated, children were orphaned and men and women were widowed. It was this country’s most tragic health crisis. It was also preventable.

One of the key recommendations of Judge Krever was to “. . . ensure that blood components and blood products used in Canada are made from the blood and plasma collected from unpaid donors.” Yet today, just two decades later, Canada is once again allowing cash-for-blood, private collection sites.

It’s a problem on so many levels. Who is selling their blood and why? Are we allowing these cash-for-blood operations to set up where they will attract drug users or people whose health may already be compromised? How short is our collective attention span that we have forgotten the deaths, the dire warnings and the promises it would never happen again?

Mike McCarthy, a survivor of the tainted blood crisis — he was infected by U.S. prison blood from Arkansas — says he is just ashamed we are back talking about this, risking it all for no benefit. “I am appalled,” he said, “that we may end up eroding the public system.”

Krever, too, believed that blood should be considered a public resource. Donors should not be paid because paying people to sell their blood introduces risk into our blood supply. Perhaps most concerning is that it makes it very difficult for a country to react if, or when, a new blood-borne crisis breaks out. There is no public accountability for private operators.

In Canada, we have long collected all the blood and plasma we needed through voluntary donations.

But as Michael Decter, an adviser to the Krever commission, a former Deputy Minister of Health in Ontario and an economist, says that allowing plasma “donations” will undercut the volunteer sector. Why give your blood for free if a person next to you is getting paid? Even calling it a donation when you are paid is a misnomer.

The practice of paying people to sell their blood is controversial and allowed in only five countries: The U.S., Germany, the Czech Republic, Austria and Hungary.

Now, the private blood brokers are gaining ground in Canada, even though all major international health organizations, such as the World Health Organization and the International Federation of Red Cross believe that all blood and plasma should be donated voluntarily. In fact, the WHO says countries should aspire to 100 per cent voluntary blood and plasma donation by 2020, and they remain firm in that view today.

And even though we have always been able to collect enough supply from volunteers, we don’t process the needed products in Canada, and so we still purchase virtually all our blood plasma products from the U.S., sourced by individuals who are paid for their blood.

Why do we do that? In the wake of and in response to the Krever inquiry, Canada set up something called Canada Blood Services — a national blood authority. The CBS was supposed to protect and ensure a safe blood supply, a dedicated agency to do what had become not only a life-and-death process but a highly sophisticated one — a responsibility that a locally run Red Cross could no longer manage.

The track record of CBS was a little troubling. CBS seemed at first to support the private, pay-for-blood model, but of late the agency has finally come around, or come back to its original purpose, to ensure a safe blood supply.

A year ago, CBS warned the federal government that voluntary blood donation systems could be at risk if for-profit plasma collection is allowed to expand, and they asked Health Canada to stop licensing the private clinics. Yet despite the warnings, Health Canada continued to give the go-ahead for private, cash-for-blood clinics.

Health Canada and the federal government are signatories to the memorandum of understanding that created CBS. As the regulator of the Canadian blood system they have a legal obligation to protect and maintain our voluntary system.

Health Canada is also authorized by the government to issue the licences for private paid plasma clinics. But they can also say no.

So why did they instead agree to license private collectors when it contravened every fundamental recommendation in the Krever commission?

As a journalist, I have interviewed people over the years who received tainted blood. Many are now dead. So when my home province and Health Canada approved a private clinic run by CPR — Canadian Plasma Resources — in 2016 in Saskatoon, I was troubled and raised questions here in the chamber. The clinic hands out $25 Visa gift cards or people can donate that for a tax receipt. Frequent donors are eligible for bonuses, monthly draws and door prizes; $25 worth of blood and plasma yield products worth $300. But as Kat Lanteigne, co-founder of BloodWatch, says:

Canadian donors are not meant to be a revenue stream for private corporations looking to make a profit.

The company — CPR — was in the news in 2013 when they were set to open three sites in Ontario: one beside a men’s mission in Toronto and another next to a methadone clinic in Hamilton. But in December of 2014, Ontario passed legislation banning cash for blood clinics. Alberta followed suit. Quebec made private collection illegal back in 1994. So the blood brokers moved on to Saskatchewan, New Brunswick and tried in B.C. as well.

Health Canada was informed on numerous occasions that paid-plasma systems harmed voluntary ones, and yet the government continued to say “there was no evidence” of this in other countries.

Well, there is evidence, in Hungary, one of the countries that allows this system. It has lost 20 per cent of its donor base due to private-paid plasma operations.

Health Canada has absolutely no Canadian data on our blood system, so no evidence exists to justify its support for the private blood collection system. All that Health Canada offers up is a three-page position paper, funded by the trade association that lobbies regulators to change the rules so they can open up the clinics, in a document called “The Dublin Consensus.” This is not a recognized academic or research document. It is puzzling why the federal government and some provincial governments choose to abandon Krever’s recommendations and support commercial operators based on such meagre evidence.

Health Canada is not heeding the warnings of CBS and needs to. The “Expert Panel” that Health Canada has convened is made up of at least half Americans, one of whom has shares in the paid plasma industry.

Moreover, there are no recommendations attached to this panel, so its usefulness is in doubt. Will it be used merely to defend the existing position of Health Canada? A report is due in March or April, and that is when Health Canada issues new licences or renews old ones.

The plasma collected by CPR — Canadian Plasma Resources — will not be used for Canadian patients, nor be bought by Canadian Blood Services, so why does Health Canada continue to license a facility that may actually be shrinking our supply?

So what could happen or what should happen? Health Canada should take a pause and rescind licences granted to CPR and agree that no new licences be issued at this time. Health Canada should add the phrase “security of supply” to their regulatory standards, which would mean they cannot approve private clinics in the future as it would undermine our supply. And they could pass a federal version of the Ontario Voluntary Blood Donations Act in order to uphold Krever and protect our voluntary system on a national level.

Those who defend the paid plasma clinics say the Krever recommendations are out of date today, that we can create needed blood products in labs and that safety can now be assured because screening is more rigorous and testing is more accurate. But we can never predict when the next unknown and untested virus will taint blood and kill again.

As Michael Decter put it:

Blood is inherently dirty. We didn’t know what HIV was when it turned up. We didn’t know what Hep-C was when it turned up. I’m a skeptic when they tell me it’s all safe now . . . and that’s not the history of blood where we keep finding new things that cause harm . . . better safe than sorry.

I agree with him. It’s just too big a gamble.