Pandemic rages, other issues persist, like blood products and policy
The COVID-19 pandemic has understandably captured the world’s attention. And this situation will not change in 2021.
Yet other health issues remain: the growing impact of many cancers given our aging population, a festering lack of resources (enough talk already) for mental health across the developed and developing worlds, and the overdose crisis which continues to exact a daily toll of lives lost. These are well known health issues among policy makers and, to a degree, members of the public.
But another health issue that has been exacerbated by the global pandemic, and may get worse in 2021, is the state of Canada’s blood products and plasma supply. In fact, this is an issue faced by most OECD countries, but this author will use Canada, which I know best, as the reference point to frame my concern.
To be clear, issues identified herein should in no way be interpreted as an attempt to besmirch Canadian Blood Services (CBS) or Héma-Québec (HQ). Both agencies are effectively run with best practices in supply and formulary management, stakeholder engagement, transparency in communications, financial probity, corporate governance and most importantly, donor and recipient safety.
Just take an hour to read through the latest annual report from CBS; it is informative, comprehensive and documents the successes and challenges in managing our national blood products supply.
In most countries, blood collection, testing, processing, storage, and distribution is governed, and coordinated, at the national level. Despite this level of sophistication, the ongoing challenges of COVID-19 have highlighted some hard truths about the global blood products and blood plasma market.
According to the World Health Organization (WHO), 40% of the world’s blood products are collected from countries that represent a mere 16% of the world’s population. As WHO notes, collection occurs in one of three ways: voluntary unpaid donation, family/replacement donation, or donors are compensated for their donations.
A reliable blood and blood components supply is critical to:
- Meet daily national health needs;
- Support medical research and a growing list of therapies requiring blood plasma refinement, and
- Uphold our commitment to support global health efforts, especially in non-OECD countries.
Canada, with only 4% of Canadians donating blood, is a net importer of a range of blood products paying over $600 million each year to keep our supplies at acceptable levels. Whole blood products are used in surgical procedures, transfusion, and cancer treatment. Meanwhile blood plasma products are used in therapeutic interventions to treat rare diseases, chronic conditions like hemophilia, and other immunodeficiency challenges along with their well-known use in burn units.
For one patient, it can take hundreds of blood donations each year to keep them alive. Therapies derived from blood plasma through a manufacturing process known as fractionation can take up to a year — from initial donation to final product release — to develop before being used in a hospital or other clinical setting. This process is highly regulated, requires specialized equipment, and the consistency and quality of each batch of a final product must be of consistent purity and quality.
Over the past year, we have seen media reports about blood plasma products. More specifically, convalescent plasma, which is a form of antibody treatment that is taken from those who have recovered from COVID-19. In turn, it is given to certain COVID-19 patients to combat the coronavirus in their bloodstream and, hopefully, improve their condition.
Five nations (Austria, the Czech Republic, Germany, Hungary, and the United States) provide the world with 90% of these products.
The United States is the dominant global supplier accounting for over 70% of total supply. And in Canada, we import over 85% of our plasma product needs with more than 80% of this volume coming from our American friends.
While I do not have a position on the contentious and very emotional debate of paying Canadians for their blood donations — think back to the tainted blood scandal of the early 1980s and the consequent Krever Inquiry in 1993 to fathom the deepness of positions held — it is ironic that we are extraordinarily reliant on supply from a country that pays donors for blood and plasma donations.
This brings us back to the intersection of a continuing pandemic and the need to fortify national supply to meet increasing needs. Canadian innovation can be helpful to address this challenge, both public and private.
In the public policy space, revisiting ideas such as tax credits for blood donations should be considered. We provide very favourable tax treatment for political donations and 50% write offs for a portion of business meals: giving the gift of life is, at the very least, on par with such activities. Additionally, Canadas’ clinical trials regime could, stressing could and mindful of the history of blood collection in Canada, be a source of inspiration for ethical approaches to compensation or deferment of expenses for time, travel etc.
On the industry side, if we have a national app for COVID, we should be able to create an app and tracking system that could work with public agencies and private providers alike. Gamification or nudging of donors seems logical as it has worked in other health improvement settings. Better tracking of donor product from source to final recipient and product can be effectively safeguarded. And involving the range of patient groups who rely on blood donation, plasma collection and the resultant therapies should be a no-brainer in eliciting ideas to make Canada more resilient, if not, self-sufficient.
From PPE to ventilators to vaccines and yes, blood and plasma products, the fragility of international supply chains was laid bare to the world in 2020. As the pandemic rages on and policy makers and business leaders both look to regionalize or onshore critical supply chains, a national focus and effort must occur in 2021 to sustain and expand Canada’s blood and plasma product supply.
Private, public and patients’ organizations all have a role to play. It is time for them to collectively engage, drive debate and create solutions. It is my hope that enterprising enterprises and public purpose corporations, with an ethos and culture to drive societal good that is critical for success in this complex and emotional space, will rise to the fore in 2021 with solution platforms that address supply issues, incentivize more donation and collection in an ethical way, and improve the health of Canadians.
This blood products and plasma milieu is a critical component of the broader life sciences ecosystem that is poised for much action in 2021 and the decade that lies ahead.
Walter Robinson has over 25 years of leadership experience in public affairs. He currently works as a consultant in the life sciences sector. He has no paid, or other compensatory affiliations, with any corporate, government or patient interest in the blood products and plasma sector.