Peter Jaworski is an ethics professor at Georgetown University’s McDonough School of Business.
Looking at plasma supply around the world explains why the announcement by Canadian Blood Services to partner with Grifols, a Spanish commercial plasma company that compensates plasma donors, makes so much sense.
No country that bans compensation for blood-plasma donors collects enough plasma to meet their needs. However, five nations that allow it collect more than enough plasma – not only to meet the needs of their own patients, but enough for those in other countries as well.
These permitting countries – Germany, Austria, Hungary, the Czech Republic and the United States – together provide nearly 90 per cent of the plasma used to manufacture therapies such as immunoglobulin, albumin and clotting factors for the world. The U.S. is responsible for more than half, including more than 80 per cent of the plasma needed to make therapies for Canadian patients.
As an ethicist, I sometimes have to remind people that the point of a system of plasma collection is safely and securely meeting the needs of our patient community. It is not to provide us with an opportunity to express our altruism, nor to provide jobs for public-sector unions. The ability to meet the needs of patients is the moral standard by which we should judge our system. And by that standard, most countries, including Canada, are failing.
Patient organizations oppose bans on compensated collections. The Network of Rare Blood Disorder Organizations, made up of the 15 national patient organizations whose membership depends upon therapies made from plasma, have urged repeal of those laws. Alberta listened to them in 2020, repealing their ban, but Ontario, British Columbia and Quebec have not, and still ban compensation for plasma donations.
These patient organizations issued a statement on compensated collection of plasma in 2018, writing: “With no evidence of safety risks, and no evidence of threats to the voluntary collection of blood, compensated collection of plasma can help with the global and Canadian plasma supply shortage, helping to ensure patients can access plasma-derived medicinal products when they need them.”
For years the organization has been urging Canadian Blood Services to create a partnership with private industry that will permit compensated plasma collection in Ontario and B.C. When the Ontario Public Service Employees’ Union cried foul over potentially losing their monopoly on plasma-collection jobs, the patient organization rebuked them, writing: “We urge your union to stop interfering with any discussions that may be taking place to increase domestic plasma collections.”
Quebec’s blood agency, Héma-Quebec, recently claimed it is doing just fine without a private-sector partner, collecting 30 per cent of the plasma the province’s patients needed last year, and on their way to a target of 42-per-cent self-sufficiency. But that means Quebec is currently 70-per-cent dependent on plasma collected in the U.S., and plans to be indefinitely dependent on these imports for nearly 60 per cent of their needs. How is this acceptable?
More recently, former health minister Allan Rock argued we do not need to compensate donors of plasma, saying Australia, New Zealand, Italy, France, Belgium and other EU countries as doing just fine without doing so. They have managed to reach 50- to 90-per-cent self-sufficiency without compensation, he said.
Some of these numbers are disputable – for example, a recent study from the Belgian Health Care Knowledge Centre shows France has only hit 33-per-cent self-sufficiency. But in any case, Italy and France are especially unusual examples to cite. In Italy, you can get a paid day off work to donate plasma. That would count as “payment” and be illegal under Ontario and B.C. laws. France, meanwhile, has a publicly-owned company, LFB, that runs four pay-for-plasma centres in the United States.
But even if we ignore the uncomfortable details, this still means that these countries are dependent on plasma collected in the United States for up to 50 per cent of their needs. How are these low expectations tolerable? And why is paying Americans to donate plasma so much better than paying Canadians?
Mr. Rock describes pay-for-plasma as “notoriously exploitative,” but this charge doesn’t stand up to scrutiny. To make it stick, you have to show that there is too much risk for too little reward, or that there is an unfair division of the benefits. But this isn’t the case. Giving plasma isn’t risky, and in return the donor gets the benefit of knowing they helped save lives, plus nearly 30 per cent of the total revenue per litre of plasma, or $50 for the 60 to 90 minutes it takes.
Meanwhile, in Ontario and Quebec, everybody from the phlebotomists to the administrators get paid for plasma donations, except for the donors. If $50 is too little or unfair, how much worse is $0?
Alberta prioritized patients and repealed the Voluntary Blood Donations Act in 2020, allowing payments for plasma. By 2024, the province will collect more than 100 per cent of the plasma needed by its patient community. It is Alberta that is doing just fine – not Quebec, and none of the countries Mr. Rock mentioned.
Héma-Quebec and Mr. Rock are asking patients to accept low expectations so that we avoid compensating Canadians while continuing to compensate American donors. We should refuse. Instead, we should have policies in each of our provinces that allow for more than 100-per-cent collections, as in Alberta.
This would not only ensure against supply disruptions for our patients, it will also allow us to assist countries with plasma-collection deficits – such as Australia, New Zealand, Belgium, Italy and France – in meeting the needs of their patient communities as well.
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