Blood supply donors and privateers.

I get a regular phone call that I won’t answer. I know what the caller wants and I’m not willing to get into a discussion about why I don’t want to talk to them. The caller? Canadian Blood Service (CBS), an organization whose sole mission is to collect blood donations to meet the health needs of Canadians, a huge, vital service that depends on volunteers like me.

Last year, I got a nice little certificate from the Canadian Blood Service honouring me for my “generosity and commitment to helping others” in recognition of the 50 blood donations I’ve made over the last decade or so. The bargain always felt good: as a donor, I give them a pint of the red stuff, “the gift of life,” and, in return, I get some juice and a few cookies. But, for now, I’ve taken a hiatus. Let’s call it a one-man boycott.

In Canada, over the last few decades, we’ve seen the slow privatization of many things related to healthcare. Each time, when the moneylenders are let into the temple, a little bit of our public healthcare system dies. We are now seeing the beginnings of the privatization of our blood supply. Not quite blood, per se, but a component of blood: plasma. Plasma is the clear, yellowish liquid part of blood that remains after you’ve removed the red and white blood cells and platelets. Plasma is essential for delivering proteins for blood clotting and fighting diseases. It helps treat hemophilia, shock and trauma. It is also made into products, such as drugs to treat bleeding disorders and immune deficiencies. And that’s what has the moneylenders mighty interested.

An Iran-based pharmaceutical company called Canadian Plasma Resources has already set up plasma donation centres in New Brunswick and Saskatchewan and they want to set up more. The argument they give is that Canada needs to move towards self-sufficiency in blood products. Canada is currently 100% self-sufficient in fresh plasma, however, for the stuff needed to make plasma-based drug products, we currently import about 70% of those products from the US. The key difference between Canadian Plasma Resources (CPR) and the Canadian Blood Services is the plasma folks are a for-profit company and they pay donors to donate their plasma, which you can do about every two weeks. Once you’ve passed the initial screening, every donation you make will earn you a $50 VISA-card type reward. The company then turns that plasma around and makes plasma-based pharmaceuticals out of it, which they can then sell to other countries or back to Canadians. Sounds good, right?

There are many reasons some think allowing for-profit plasma donations in Canada is just plain wrong. In fact, it is indefensible. We’ve just celebrated the 20th anniversary of the Krever Inquiry on Canada’s notorious tainted blood scandal where over 2,000 Canadians contracted AIDs and another 30,000 or so got Hepatitis C from tainted blood. That report was a damning indictment of the way blood was screened and distributed in Canada and showed how good, old government incompetence, ass-covering and unaccountability conspired to kill and injure Canadians. But what have we learned? One of the key recommendations of the Krever report was that Canada should maintain a volunteer-only blood system in order to have a safe and guaranteed supply of blood and blood products.

Yet 20 years later, we see the Canadian government granting licenses to a private company so they can expand their private plasma drug business. In November, a shocking, in-depth article in Maclean’s magazine drew heavily from an 800-page freedom-of-information request and showed the extent to which our regulator – Health Canada – is trying to open the doors to the moneylenders. That article, examining correspondence between CBS and Health Canada, clearly showed Health Canada has been colluding with this company and essentially helping them establish their private blood donation clinics in Canada. Some provinces have responded by banning for-profit private blood donation clinics (Quebec, Ontario and Alberta so far), but that hasn’t stopped the other provinces from being courted.

Many people have argued that the for-profit system won’t be as safe as the purely voluntary system we have now, a position staunchly defended by the Canadian Blood Service, which maintains the blood Canadians voluntarily donate is so thoroughly screened, another tainted blood scandal is highly unlikely. Even though the level of blood screening is more thorough than perhaps 20 years ago, the safety of our blood supply is not the biggest issue. The bigger danger is that the volunteer aspect of our blood supply now has to compete with for-profit companies that pay donors.

The CBS already collects plasma and has seven voluntary donor plasma collection sites, but how long will they last when they have to compete against a private company setting up clinics near universities, luring students who need a few bucks? Adrienne Silnicki with the Canadian Health Coalition told me, “We have evidence that, in Saskatoon, CBS has seen a reduction in donations from their target demographic 17-24 year olds.” In other words, the worry that for-profit clinics will steal blood that volunteers would otherwise donate is justified.

CBS, in a letter to Maclean’s magazine, cited the example of Hungary which has seen its voluntary service drop off after the for-profit plasma organizations set up shop.

Publicly, the CBS has warned Health Canada and provincial governments they shouldn’t be allowing private collection of blood products, yet those requests seem to be falling on deaf ears. This has led groups like the Canadian Health Coalition and BloodWatch to start a campaign to oppose any expansion of for-profit plasma centres. In their press materials, they say our plasma will be sold overseas and once that happens, because of international trade deals, “We will not be able to safeguard and store Canadian plasma for Canadian use even in the event of a blood borne virus which may affect the international plasma supply.”

Adrienne Silnicki reminded me the Canadian Health Coalition’s mandate is to protect and expand public healthcare so they are naturally opposed to these for-profit clinics. The company, however, is blasting ahead. Apparently, they need 10 Canadian clinics to be profitable and are currently proposing a new clinic for Saint John in New Brunswick.

What can the feds do? Well, at the very least, the regulators can, well, regulate. The federal government can revoke the establishment licenses of these clinics and refuse to issue any new ones. But will this happen?

What was so appalling in the Maclean’s article was how “cosy” the relations were between the Canadian Blood Services and Canadian Plasma resources. Adrienne Silnicki called it a “disgusting cosiness,” noting, “We’re obviously very concerned about it.”

CBS immediately sent a letter to Maclean’s slamming the magazine for “fostering panic over unfounded safety concerns.” But why didn’t they slam Health Canada for mismanaging this file? Their response seems to be to just increase the amount of voluntary plasma donations they can get. Seems they have convinced the provincial health ministers to go along with that plan. A health minister meeting in Edmonton in October resulted in a consensus statement stating, “Immediate action is needed to improve and expand domestic plasma collection.” Good luck on that front.

This isn’t good enough for me. If the Canadian Blood Service wants to keep the voluntary blood donation system going, they will have to play hardball with the regulators in Canada and tell them, in no uncertain terms, that the viability of our voluntary blood system is in jeopardy.

Will this happen? Hmm, good question.

We have seen on the pharmaceutical file that Health Canada seems to think its job is to protect companies and not patients, so don’t expect them to crack down anytime soon on the moneylenders. Not unless they get the right pressure. It’s too bad CBS is caught in the middle, trying to be nice. But let’s face it, they’re cowards.

In the meantime, I’ll do without the cookies and the juice while they’ll have to do without my blood. j

Alan Cassels is a pharmaceutical policy researcher in Victoria. www.alancassels.com

Publish in the Common Ground Magazine.