Some senators are invoking memories of the tainted blood crisis — when more than 30,000 Canadians were infected with HIV and hepatitis C from poorly-screened blood products — to put an end to the re-emergence of for-profit plasma clinics.
Justice Horace Krever led the public inquiry into what was arguably the largest public health disaster in Canadian history. He recommended the establishment of an entirely voluntary blood collection system — to avoid the pitfalls that can come when private companies pay people to donate their blood.
Despite Krever's pleas, at least one outfit — Canadian Plasma Resources (CPR) — has opened two clinics in Canada that offer financial incentives in exchange for plasma donations. The clinics are operating legally and with all the necessary approvals from Health Canada and provincial governments.
Eighteen more such private clinics are awaiting approvals as companies look to cash in on the booming demand for raw plasma, a protein-rich fluid component of blood which is used to make pharmaceutical blood products such as intravenous immunoglobulin, the treatment of choice for patients with antibody deficiencies.
While CPR eventually wants to build its own manufacturing plant in Canada, all the plasma it collects in Canada now is sent abroad.
Independent Saskatchewan Sen. Pamela Wallin is leading the charge against the clinics in the Red Chamber, urging her fellow senators and the government to pass her bill — S-252, the Voluntary Blood Donations Act — and arguing the alternative is the proliferation of clinics like the ones CPR recently opened in Saskatchewan and New Brunswick.
Wallin said too few Canadians remember the tainted blood scandal well enough to fear a repeat.
"When you say Justice Krever, nobody knows what you're talking about. It was too long ago," Wallin said in an interview with CBC News.
While the origins of the scandal were multifaceted and complex, the Krever inquiry of 1993-95 cited a lax screening process for high-risk donors, the failure to use certain tests to screen for hepatitis C and the importation of blood from certain areas in the U.S. as the principal means by which infected blood entered the system. It also flagged paid donations as a safety risk.
An estimated 8,000 Canadians are still living with health complications after receiving transfusions of tainted blood between 1980 and 1990.
Sen. Pamela Wallin: "When you say Justice Krever, nobody knows what you're talking about. It was too long ago." (Adrian Wyld/Canadian Press)
"We need to remind people what happened in the country and why Justice Krever said, 'Please, please, please keep this a public, accountable system, do not go in the other direction.' He was very passionate about that," Wallin said.
Dr. Barzin Bahardoust, president and CEO of Canadian Plasma Resources, defended his company Wednesday against claims that paid plasma collection poses a risk.
"This criticism is definitely not based on facts," Bahardoust said in an interview with CBC News. "This is definitely not a safety risk. We collect plasma for manufacturing. It's not blood or plasma that is used for direct transfusion into patients. This is a distinct procedure."
As for Krever's call to prohibit paid collection, Bahardoust said screening measures have improved dramatically since the tainted blood tragedy and federal regulations have been tightened on how prospective donors are screened.
"Justice Krever looked at this over 25 years ago. The recommendations were made based on events, on what happened in the 70s and 80s. How we are doing things right now (is) very different, including the advancement of how we test the plasma … and the steps we take to inactivate or remove infectious agents, including viruses," he said.
Bahardoust said it's more important that patients get the plasma products they need than to have an "ideological debate" over whether people should be paid for donating blood.
Gift cards for donations
Wallin, a former journalist who covered the public health crisis and the devastating consequences it had for tens of thousands of Canadians, said the federal government needs to remember two of Krever's key recommendations in the face of profit-driven companies: that blood donors should not be paid and that no part of the national blood operator's duties should be contracted out.
"The licensing of paid-plasma clinics in Canada contravenes every single fundamental recommendation of the Krever inquiry," Wallin said. "We need an immediate moratorium on the granting of any new licences until this issue is fully vetted."
CPR is collecting plasma in Wallin's home province and in Moncton, New Brunswick. It offers compensation to donors in the form of prepaid gift cards that can be used anywhere Visa is accepted.
To encourage repeat visits, the clinic boosts the payout to $ 80 for the second donation and $ 50 for every subsequent visit. The company also enrolls frequent donors in a rewards program — called the Super Hero Rewards loyalty program — which entitles them to participate in draws for giveaways and cash prizes.
Health Canada has licensed these sites despite warnings from Canadian Blood Services (CBS), the country's principal blood collection agency, which receives public funds to do its work. CBS has said that for-profit clinics undermine the security of Canada's blood supply.
CPR argues it only seeks healthy donors, who must complete a questionnaire and be screened by on-site medical doctors before donating.
Wallin's bill would explicitly ban any entity from offering a benefit or remuneration to a donor unless the blood collected is of a rare phenotype.
"This situation is actually shocking — that a country on the leading edge of health care delivery allows blood-brokering to continue," Wallin said
"Are we allowing these cash-for-blood operations to set up in areas where they will attract people whose health may already be compromised? Are we exploiting young people at universities who are always short of cash?"
Ontario already has taken action, banning collection sites such as CPR's after the company sought to open three in Ontario — one beside a men's mission in Toronto, another next to methadone clinic in Hamilton. The site CPR selected in Saskatoon is also in a "troubled spot," Wallin said.
"I think it's fair to say they're exploiting people who are in need of money and that should be an ethical question, a moral question for all of us," Wallin said. "We need to get this back on the radar."
Concerns about 'crowding out' blood donations
Wallin, who was appointed by former prime minister Stephen Harper but now sits as a member of the Independent Senators Group (ISG), has support for a federal solution from a key Tory in the upper house: Conservative Manitoba Sen. Don Plett.
Plett, the party's whip in the upper house, said blood donors should be motivated by a wish to save lives, not by the lure of cash compensation. He warned that a proliferation of paid clinics could "crowd out" volunteer operations run by Canadian Blood Services.
In fact, recent data suggest unpaid donations have dropped in Saskatoon since CPR started its operations in February 2016.
Plett argues Canadians would be less inclined to offer voluntary donations if cash-for-plasma clinics are able to offer "such fabulous prizes to their donors," he said.
"With this bill, we have a chance to make a lasting impact on the health system in Canada. We have a chance to prevent our Canadian blood and plasma supplies from being tainted by insincere donors whose donations do not undergo substantive screening processes," he said.
"We have a chance to stop history from repeating itself and create a new, lasting and safe blood collection mechanism within Canada, one that encourages Canadians to help their fellow man in the interest of goodwill and not in that of profit."
Blood samples collected by Canadian Blood Services. (CBC)
Critics of Wallin's bill, and the anti-private plasma donation movement writ large, say this is an example of a 'not in my backyard' attitude, as Canada currently imports more than 70 per cent of its plasma-based medication from the U.S.
CPR says the question is not whether Canada will continue to rely on paid donors from its clinics but rather "whether those paid donors will continue to be exclusively American."
"The insinuation that compensation for donors poses a safety risk … is not only unfounded, it's actually what we're doing right now. The only thing we're trying to do is we want to move part of the production from the U.S. into Canada," Bahardoust said.
But Blood Watch, an advocacy group that lobbies against private interests in the Canadian blood supply, argues that it is also unacceptable to import so much plasma from the U.S.
"Canadian Blood Services (CBS) started to buy a majority of our plasma-based medication from the U.S. because it was cost-effective. This decision has made us over-reliant on foreign plasma product. If there is a disruption in the U.S. supply chain, Canadians would not have access to our own product because we haven't secured a strong plasma donor pool," the group said.
"Private paid plasma in Canada doesn't help change this. It creates competition."
To that end, CBS is aiming for a five-fold increase in plasma collection. It has said it would like to collective in excess of 800,000 litres per year through 30 to 40 collection facilities across Canada.
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