Canadians need a moratorium on paying for plasma
Canadian Blood Services is one of Canada’s largest national charities funded by taxpayers. Why, did they enter into a P3 with Spanish multinational Grifols, the largest producer of plasma products?
A person donating blood or plasma. Photo credit: Nguyễn Hiệp / Unsplash
On June 8, 2023, Grifols Group entered into an agreement with Canadian Plasma Resources (CPR) a Canadian plasma collector licensed by Health Canada, under which Grifols Group has the right to obtain plasma donated in CPR centres.
The Spanish corporation plans to acquire existing CPR centres by the end of 2025 as well as open five of its own collection centres eventually paying clients for their plasma donations.
Grifols claims this new 15 year agreement will help make Canada self-sufficient for patients depending on lifesaving plasma therapies.
However, not everyone shares Grifols, and Canada Blood Services (CBS), enthusiasm.
Below is an August 17, 2022 article I wrote — a version of which was published on rabble.ca, — outlining why plasma and blood collection should never be privatized and why this public private partnership threatens voluntary blood donation throughout Canada.
The tainted blood crisis from the 1980’s, wiped out almost an entire generation of hemophiliacs – not just in Canada, but around the world.
Few Canadians are aware that hemophiliacs received Factor VIII treatment that was contaminated with the human immunodeficiency virus (HIV) and Hepatitis C. For eight months the Canadian Red Cross Society (CRCS) delayed implementing testing of blood and plasma already in use in the US. For an additional eight months, the CRCS continued knowingly distributing contaminated blood products across Canada.
The tainted blood scandal forced the industry to re-examine mitigating risk to patients. One step was reconsidering the practice of pooling large volumes of blood and plasma from different sources.
Canadian Blood Services (CBS), a federal agency that operates at arms length from the government, replaced the CRCS as Canada’s blood authority in 1998. Quebec chose to establish the Hema-Quebec which operates separate and apart form CBS.
Why then, is CBS holding backroom meetings with Grifols, a Spanish multinational pharmaceutical and chemical manufacturer and the largest worldwide producer of plasma products?
In the works is a deal to broker a private public partnership (P3) to privatize the Canadian plasma supply system. That would make CBS a major stakeholder financially profiting from the harvesting and selling of Canadian plasma.
Canada’s plasma supply faces privatization
According to Kat Lanteigne, co-founder of BloodWatch, “fundamentally, the question is and has always been, should we privatize blood collection in Canada? And, should we be making a profit off of Canadian plasma?”
During an interview with rabble.ca, Lanteigne went on to say, “it’s an unconscionable act because they [CBS] are a charity. And, that’s getting missed in this discussion.”
In fact, CBS is one of Canada’s largest national charities funded by Canadian taxpayers. It’s responsible for the collection of blood and plasma from donors who receive no financial compensation.
Blood is composed red blood cells, white blood cells and platelets. Plasma is the straw-coloured liquid in which these cells are suspended. Think of plasma like chicken broth with very healing proteins in it.
In an interview with rabble.ca, Dr. Michèle Brill-Edwards, semi-retired emergency room physician and former Senior Health Canada regulator, said, “plasma is not just a liquid. It has very valuable proteins that are both financially and medically very valuable.”
According to Brill-Edwards, “financially per ounce, those finished proteins are more valuable than gold and in a medical sense, they’re extremely valuable as well. They’re life-saving in some circumstances.”
In the 1970’s blood collection practices led to the supply becoming contaminated with HIV and Hepatitis C. These viruses were passed on to recipients of contaminated plasma products.
The situation played out in Canada under the direction of the CRCS. An investigation into the tainted blood and plasma supply culminated in the Krever Report (1997) with over 50 recommendations including invoking the Precautionary Principle. That report and its recommendations are still considered the gold standard around the world.
In his recommendations, Justice Horace Krever wrote, “The slowness in taking appropriate measures to prevent the contamination of the blood supply was in large measure the result of the rejection, or at least the non-acceptance, of an important tenet in the philosophy of public health: action to reduce risk should not await scientific certainty. When there was reasonable evidence that serious infection or diseases could be transmitted by blood, the principal actors in the blood supply system in Canada refrained from taking essential preventive measures until causation had been proven with scientific certainty. The result was a national public health disaster.” (Pg. 1049, Vol 3.)
Today, many hemophiliac medications are produced synthetically. Plasma is now used primarily in the treatment of burns, immune disorders, and neurological conditions.
The aggressive, for-profit plasma collection industry has flourished over the years. However, worldwide restrictions are increasingly limiting the expansion of paid collection centers and impacting profits. That’s sending these multi-nationals on a hunt for new populations to exploit.
For profit incentives lead to blood exploitation
The US has the least restrictive plasma regulations of any country. It also has a monopoly on the plasma market because twice-a-week harvesting of plasma from individuals means the US can pool hundreds of thousands of donations at a time.
Compare that with current CBS recommendations limiting plasma donations to once every seven days or Europe where its once every two weeks.
The side effects of plasma collection can include dehydration, weakness, fainting, and blackouts. These adverse effects stem from the use of sodium citrate, an anticoagulant used in plasma harvesting.
Frequent plasma sellers may experience higher rates of lower blood protein levels, increased risk of infection, and liver and kidney problems.
Individuals are paid $30 to $50 per transaction in the US for plasma that will net $300 in the wholesale market and is more valuable than gold when processed. Individuals are incentivized to sell their plasma more frequently and to refer friends.
Promotional materials lead you to believe that individuals are ‘donating’ out of a sense of altruism.
The truth is, the for-profit plasma industry targets racialized and disadvantaged neighbourhoods. They draw from the ever-increasing pool of the those living with chronic poverty and homelessness, as well as university students and middle-class families suffering economic hardship due to the pandemic. Selling plasma often becomes an important source of income that helps people make ends meet.
The US for-profit supply system provides about 75 per cent of the world’s plasma products. Yet, worldwide demand is outstripping the current supply of for-profit plasma proteins.
Brill-Edwards has concerns, “the blood system is a voluntary system and that is obligatory. So, that first system where we take whole blood, that has to be voluntary – it cannot be a paid system. That is our issue today. By cooperating with the paid plasma industry and making that a process across Canada, are we threatening the sustainability of our whole-blood voluntary system?”
Kat Lanteigne agrees that selling plasma is a bad idea. “It is true that there is a challenge with plasma supply around the world because countries were essentially buying cheaper product from an industry that exploits. Eighty per cent of the plasma that is collected in the US is from vulnerable populations, poor and abject poor,” she stated.
Instead, she would like to see plasma collection based on patient need in order to ensure Canada can manage its own supply chain and become self-sufficient.
The Kreever Report recommendations included establishing one national operator to collect blood and plasma on behalf of Canadians. It also recommended blood be deemed a public resource and that access to blood/plasma and blood/plasma products should be free and universal. Safety of the blood and plasma supply is paramount so sufficient amounts should be collected to avoid importation from other countries.
The World Health Organization (WHO) released the guide, Towards 100 per cent voluntary blood donation: a global framework for action (2010), which reinforced the need to make worldwide blood and plasma donations 100 per cent voluntary and set a goal of 2020. WHO also believes every country should be working towards self-sufficiency under a national system.
The for-profit industry gaslights the public into believing the profit driven plasma industry is the only way to reach self-sufficiency. Yet, there is overwhelming agreement that non-profit blood and plasma collection makes for a safer collection system that can meet domestic needs.
For profit plasma a slippery slope to privatization
Lanteigne sees paid plasma collection as the first step on a very slippery slope to the privatization of Canada’s blood supply that will put profits before patient needs in the market-driven environment.
She sees blood brokers taking control of the blood supply making it difficult for the nation, provinces and territories to manage their blood supply while negotiating with a global industry.
Negotiating in the open market becomes increasingly difficult when the supply is impacted by events like the COVID pandemic. The US private plasma industry saw supply dry up when universities began working online. That stressed the US supply chain and impacted profits.
“Fundamentally, what it becomes is a market commodity that is then forced to be negotiated through the eyes of the market and not on patient need,” said Lantiegne.
The US has emerged as the leader in production of plasma proteins including immunoglobulins (IG) used in the treatment of immunodeficiencies and autoimmune disorders.
In Canada, blood products are provided at no cost to patients and have very few restrictions placed on them in terms of use. What is utterly astonishing is the fact that Canada doesn’t track the use of plasma products.
Lanteigne maintains that there needs to be a national digitized system to really keep track of plasma use to ensure patients, whose lives literally depend on these products, are prioritized.
Brill-Edwards goes further stating, “We need the CBS to call a provincial and territorial halt to this mad rush to get more and more plasma when the products that are coming from it are being wildly over used – even as judged by the auditor general of Ontario.”
Germany, Austria, the Czech Republic and Hungary allow private plasma companies to operate, but they must be cost neutral. These centers are also prohibited from incentivizing the process by paying customers to bring friends, issuing prepaid credit cards, or offering trips to frequent donors. Those selling their plasma are limited to one transaction every 14 days.
Countries that ban for-profit plasma collection want to have control over their national supply because plasma is a finite public health resource. They want to ensure safety within the supply chain and maintain control around supply management.
Unbeknownst to most Canadians, negotiations are underway between CBS and Grifols. The multinational corporation has opened a plasma collection site in Winnipeg, purchased a plasma product manufacturing facility in Montreal, and bought out Canadian Plasma Resources business partner in Germany. That sets Grifols up to lead a national takeover of Canada’s plasma collection system.
It’s ironic that the push for privatization is happening at a time when CBS received $20 million in infrastructure funding to open 11 plasma collection centers during the pandemic.
Plasma donations have been extremely robust prompting CBS to schedule the opening of another 11 centers. All donations were made without the need for financial incentives.
Meanwhile, there are plans to add another 24 for-profit plasma centers across Canada. The plasma collected at these sites will be sold on the international market.
Lanteigne points out, “there is nothing that exists in the federal Blood Regulations Act that can deter any of these companies from selling our Canadian plasma abroad for profit.”
But why enter a P3 when there was clear buy-in from the federal government, the provincial and territorial health ministers and the not-for-profit plasma centers were effective and efficient?
Brill-Edwards says, “what we need is for the ministers of health of the provinces and territories that fund the CBS to call a halt to any negotiations that are ongoing with any commercial plasma operators. And during that halt, there needs to be a public discussion about what direction we’re taking. And, there needs to be limits on how much commercial plasma operation can occur in Canada.”
There should be no conflicts of interest in the collection of plasma
She went on to say, “most importantly, there needs to be some conflict-of-interest guidelines put in place – safeguards – so that people who are allowing commercial plasma collection in Canada, CBS board members, are not gaining by allowing that to happen.”
Restricting for-profit plasma collection falls to provincial and territorial governments because Health Canada doesn’t regulate these companies, they just license them.
British Columbia, Ontario and Quebec are the only provinces without for-profit plasma collection centers. In 2014, Ontario unanimously passed the Voluntary Blood Protection Act (VBPA) prohibiting for-profit plasma centers.
A similar piece of legislation was repealed by the Alberta legislature in 2021 when the United Conservative Party (UCP) wanted to welcome for-profit plasma collections centers in order to expand jobs within that private industry. The argument put forth by UPC government was basically, since they do it in the US why not do it here?
Lanteigne acknowledges that the blood and plasma supply for Canadians is a very crucial, finite national health resource. That gives the Minister of Health the authority to take measures to ensure Canadians will not experience shortages.
Unfortunately, this is part of a larger drug deregulation policy that will see Health Canada acquiescing to voluntary regulation of drug companies.
Belgium, the Netherlands, New Zealand and Italy are almost entirely self-sufficient when it comes to plasma derived drugs. Australia is 67 per cent self-sufficient with a fully nationalized plasma collection system. Investment by government, coupled with responsible management and oversight within these countries made this possible in a mere three to five years.
“This is the fight of our life,” said Lanteigne. “It is a finite resource. It needs to be a resource that’s managed responsibly and that is focused solely on patient need and where Canada as a country, as a nation, controls that supply chain.”
BloodWatch has organized a letter writing campaign and is encouraging Ontarians to contact Health Minister Sylvia Jones, their MPP and MP requesting the Ontario VBPA be upheld.
They would also like to see a VBPA adopted in every province and territory which would uphold Justice Krever’s recommendations and establish CBS as the only national blood operator.
Take six minutes to hear from survivors who know exactly why Canada needs a moratorium placed on paying for plasma.
End note: Canadian Health Coalition has stated that, the damage done by the Grifols deal goes well beyond the unacceptable decision to pay Canadians for their plasma. The secrecy and duplicity behind this deal undermine trust in the Canadian Blood Services itself.
Health Ministers are collectively responsible for faithful implementation of their 1998 agreement which created the Canadian Blood Services in the wake of the tainted blood scandal. Canadian Blood Services is a public agency entrusted to operate Canada’s voluntary blood supply system, other than in Quebec, with the safety of Canadians in mind.
The Canadian Health Coalition calls on the ministers to recommit to the voluntary public mandate of the Canadian Blood Services by dismissing the current CEO and Board of CBS, and installing new Directors and CEO to faithfully implement the 1998 agreement protecting the safety of Canadians. Restoring public trust via new leadership is vital to the operation of our voluntary public blood supply.
— In my view, this is clearly another blood, and plasma, disaster just waiting to happen.