Securing our domestic blood plasma supply
As countries race to find effective treatments and methods of preventing COVID- 19, some hope has come along in the form of blood plasma transfusions from people who have recovered from the coronavirus, to people who are critically ill. The hope is that the antibodies in the plasma of recovered patients will fight off infection in those who are sick. This has been successfully done as far back as the 1918 Spanish flu pandemic, and as recently as the MERS and SARS outbreaks. The antibodies contained in that plasma can also be concentrated to form a plasma- based therapy against this coronavirus. While this should give us hope, it is also likely to increase demand on the already-strained global plasma supply, which is almost entirely dependent on paid American plasma donors.
In order to ensure that enough people are willing to give plasma to meet the ever- expanding need, we must urgently adopt a payfor- plasma model here at home. That means repealing the short- sighted Voluntary Blood Donations Act in Ontario, Alberta and British Columbia, and urging Canadian Blood Services to change its policies and offer compensation for plasma donations.
Blood plasma is the straw- coloured part of our blood. It contains antibodies, also called immune globulins, which help the body fight infections, along with albumin and clotting factors. We make life-saving and life-improving plasma-based therapies from these components that are used by people the world over to treat a number of autoimmune and immunodeficiency disorders.
Prior to this pandemic, demand for these therapies was growing at 8.7 per cent per year. To meet our needs, we have relied almost entirely on the pay- for- plasma model: approximately 86 per cent of the immunoglobulin we use is made from plasma taken from paid donors, the vast majority of whom live in the United States. Instead of paying Canadians for plasma, we choose to pay Americans instead.
There’s no evidence that anything other than paying for plasma will work. According to an expert panel formed by Health Canada in 2018, paid donors in countries that permit payment are responsible for providing 89 per cent of the plasma used to make therapies, with the United States alone providing 70 per cent of the global supply. The panel also revealed that no country in the world that forbids paid donations collects enough plasma to meet its needs — not one!
Meanwhile, according to the most recent public opinion poll, 63 per cent of Canadians consider paying for plasma donations to be “morally appropriate.”
Those results are consistent with two earlier polls, which found that a significant majority of Canadians support the pay- for- plasma model. But despite public opinion, some provincial governments chose to prohibit the only model that works through the Voluntary Blood Donations Act. Ontario passed the act in 2014, followed by Alberta in 2017 and British Columbia in 2018. Each of these provinces is now more reliant on paid plasma from abroad than before these counterproductive laws were passed.
Had these acts not been passed, we would be in a much better position today. Canadian Plasma Resources had plans to open 10 plasma collection centres across Canada back in 2012, starting with three in Ontario. While its plans for Ontario, Alberta and British Columbia were thwarted, it did manage to open two small collection centres in Saskatoon and Moncton. Yet Prometic Plasma Resources, which operates a collection centre in Winnipeg, has chosen to open plasma collection centres in American cities like Buffalo, N.Y., rather than deal with the political controversy in Canada.
In arguing for the prohibition, opponents of pay- forplasma suggested that it was unsafe. This is nothing but unscientific fearmongering. The pay-for-plasma model results in therapies that are, as Health Canada and Canadian Blood Services have repeatedly said, just as safe as the unpaid model. The only difference is that the paid model actually works.
Opponents say that the plasma collected from companies like Canadian Plasma Resources is exported abroad, rather than kept in Canada. But what would happen if the United States found those same arguments persuasive? Tens of thousands of patients around the world would suffer immense harm. Instead of adopting a selfish, Canada-first attitude, we should be collecting enough plasma to meet not just our own needs, but to finally contribute to the global supply, as well.
The COVID-19 pandemic has only served to highlight the importance of plasma therapies. We need regular and frequent donors of plasma for plasma protein therapies and we will continue to rely on plasma from paid donors. The only question is whether we finally decide to pay Canadian donors and contribute to the global supply, or continue paying Americans for their plasma and keep our fingers crossed that the United States won’t adopt an America-first attitude toward plasma.
Kate Vander Meer is a multifocal motor neuropathy patient who was affected by the 2019 immunoglobulin shortage. Peter Martin Jaworski is an ethics professor at Georgetown University’s Mcdonough School of Business. They are co- founders of Plasma for Life, a plasma patient advocacy group.