We are on the cusp of a blood plasma therapy against Covid-19. This would mean being able to isolate and concentrate antibodies against the virus to treat people who are sick. Early trials appeared promising and now the NHS is testing the therapy. But this treatment, along with many other plasma therapies for immune deficiencies and rare blood disorders, could all be undermined by global shortages of blood plasma if we don’t begin compensating donors.
The United Kingdom stopped collecting plasma for plasma therapies in 1999 because of the theoretical risk of a transmission of Variant Creutzfeldt–Jakob disease (vCJD or mad cow disease). Now, the NHS have begun collecting plasma for trials against Covid-19. For some time, patient groups, like Primary Immune Deficiency UK, have called for the government to restart plasma collections for other purposes. They argue that we haven’t ever seen a transmission of vCJD, and that the UK’s entire reliance on foreign plasma is a threat to patients.
But this still wouldn’t be enough. No country in the world collects sufficient plasma from uncompensated donors. Prior to the ban on collections, the UK did not, and neither does my home country of Canada. In fact, despite allowing plasma collections, four-fifths of Canada’s blood plasma comes from abroad. In Australia it is over half and New Zealand one-tenth. This is because we all refuse to treat blood plasma donors like heros and compensate them appropriately.
In my paper for the Adam Smith Institute, Bloody Well Pay Them: The case for Voluntary Remunerated Plasma Collections, I argue the United Kingdom, Canada, Australia, and New Zealand should compensate donors for their time and effort. This would ensure a safe and sufficient supply of plasma for life-saving therapies, as well as allow these countries to contribute to the global supply for people in poorer countries that currently cannot afford these treatments.
Canadians, Australians and New Zealanders donate enough blood, but donating plasma is different. It takes about two hours, with 40 minutes of “needle-in” time. A machine separates the yellow-coloured plasma which it keeps from the red and white blood cells which it then returns to you. Not enough people are willing to do that frequently enough to meet our needs in exchange for a biscuit and some milk.
Enough people will do it and will do it frequently enough, however, if properly compensated. The United States allows compensation and so provides more than 70 per cent of the entire world’s plasma supply. If you add Germany, Austria, Hungary, and Czechia, the other countries to permit compensation, these five countries provide nearly nine-tenths of the global supply of plasma for therapies.
It is not like other countries do not pay for blood plasma, they just do so indirectly. Remunerated American plasma is the source material for nearly all of the plasma therapies used by UK patients, and about 80 per cent of Canada’s. Plasma and plasma therapies represent an astonishing 1.6 per cent of total U.S. exports by GDP now America’s 11th largest export.
Compensated donations are even two to four times less expensive than non-compensated donations. Collection centres that offer compensation don’t need fancy and expensive marketing campaigns. They don’t have dozens of people on staff making phone calls to remind donors of their appointments or to encourage donations. If you just offer donors 20 or 30 quid, enough to cover the time and expense involved in donating for most people, then people will donate without any additional prompting. This will prove more effective than images of Health Secretary Matt Hancock sitting in a chair entreating us to donate, as he did earlier this month.
Concerns about safety prompted bans on remuneration in the 1970s and ’80s. It was thought that remuneration played a role in the tainted blood scandal in the UK and US. However, the technology is substantially better than it was back then. Modern testing, and viral removal and inactivation techniques, unavailable in the ’80s, have made this concern no longer applicable. There has not been a transmission of any virus or infection in over 25 years from remunerated plasma.
Besides, you are already using 100 per cent remunerated plasma, Canada is using 80 per cent, and the whole world uses 89 per cent. American plasma isn’t better or safer than Canada’s. It’s just that enough of it is available to meet current world needs, while non-remunerated collections fall further and further behind. There’s no reason to prefer to pay Americans for their plasma when countries could simply permit paying Brits, Canadians, Australians and New Zealanders instead.
Peter M. Jaworski is a Canadian academic at Georgetown University