Pay blood plasma donors for a safe and secure supply
This World Blood Donor Day (14 June, 2020) a new paper — co-published in the United Kingdom by the Adam Smith Institute, the United States by the Niskanen Center, and the Australian Taxpayers Alliance — argues in favour of paying blood plasma donors.
There are significant global shortages of blood plasma used to make plasma therapies. Demand is growing at a rate of 6-10% per year. Three-quarters of people do not have access to the appropriate plasma therapy, largely outside of developed countries.
Shortages are significantly exacerbated by the World Health Organisation’s policy — adopted by the United Kingdom, Australia, New Zealand and some Canadian provinces — to rely exclusively on Voluntary Non-Remunerated Blood Donations (VNRBD).
The United Kingdom currently imports all (100%) of its supply of plasma therapies, Canada four-fifths (84%), Australia half (52%), and New Zealand one-tenth (13%). These countries are too increasingly dependent on imports of plasma therapies from countries that remunerate donors such as the United States and Germany. This inflates the global blood plasma price, making it unaffordable for low to middle income countries.
5% of the world’s population is responsible for more than half of all the plasma collected in the world.
In order to ensure a safe, secure, and sufficient supply of plasma therapies, the United Kingdom, Canada, Australia, and New Zealand should adopt Voluntary Remunerated Plasma Collections (VRPC).
Transfusing the blood plasma of those who have recovered from Covid-19, called convalescent plasma, appears to help against the novel coronavirus.The UK’s National Health Service has already begun trials with recovered Covid-19 patients, including from Health Secretary Matthew Hancock.
However, well meaning bans on paying for blood plasma donations in the 1990s to avoid Creutzfeldt-Jakob disease (CJD) and HIV transmission, has left the UK over-reliant on imports at a time international demand is rising and supply is contracting. A new paper, authored by Georgetown University professor Dr Peter Jaworski, argues this World Blood Donor Day (14th June) that it’s time for donors to be paid for donating blood plasma to ensure a healthy supply.
New uses for plasma therapies, and a reduction in plasma donations during the crisis, will put additional strain on what is already a strained global supply, the report outlines.
In return for a voluntary donation of blood plasma, under a reformed paid system the donor would receive payment — either in the form of cash, or a payment in kind such as time off work, vouchers, or tax credits. By increasing the incentive to donate, donations are expected to substantially increase.
The United States, where donors are paid, is responsible for 70% of the global supply of plasma. Altogether, countries that pay donors (including Germany, Austria, Hungary, and Czechia) account for nearly 90% of the total supply. There is now not a single jurisdiction anywhere in the world that meets its needs exclusively based on non-remunerated plasma collections.
Demand for plasma therapies is growing at around 6-10% per year. Blood plasma is now the USA’s 11th most valuable asset for export, worth US$26 billion and expected to reach US$44.3 billion by 2023.
The report argues that the UK, Canada, New Zealand, and Australia should follow many European countries and the USA in withdrawing prohibitions on voluntary remunerated plasma collections. These developed, English speaking democracies would ensure a domestic security of supply and free themselves from over-reliance on the United States or EU-only schemes.
Stringent viral detection tests required for donations by regulators limit the countries that effective donations can be taken from to reduce risk from blood transmitted diseases such as HIV, HBV, and HCV. Modern procedures including heat treatment, solvent and detergents, and nanofiltration limit this further to developed world countries. However, increasing supply in the UK, New Zealand, Canada and Australia, could have beneficial effects for the developing world too.
Five-percent of the world’s population is responsible for more than half of all the plasma collected in the world. North America and Europe together account for 74% of all immunoglobulin treatments derived from blood plasma used in the world, while Latin America uses just 5%, Middle East and Africa consume just 2%. The UK’s import of plasma therapies means millions of people in the developing world who could be helped by plasma therapies are left to go without.
Due to historic fears over vCJD, the United Kingdom is currently the furthest from the objective of sourcing plasma therapies. All of the country’s plasma therapies are imported, mostly from the United States. “Spontaneous” development of CJD is now, however, comparable in the UK to other developed countries and the over abundance of caution should be removed and paid donations allowed, the think tank argues. This could help meet the near 10% growth per year in demand for plasma therapies.
Peter Jaworski PhD, author of the report:
“Voluntary Remunerated Plasma Collections are the only evidence-based path towards a safe, secure, and sufficient supply of plasma. Relying on non-remunerated donations makes no medical or economic sense. It is at least twice as expensive, and less than half as effective. This is a threat to patients, and a risk to their supply of plasma therapies.”
“The UK, Canada, Australia, and New Zealand are a drain on the global supply of plasma. The only way we can finally begin to contribute to the global supply of plasma is to permit Voluntary Remunerated Plasma Collections at home.”
Nobel Prize winning economist Alvin Roth says of the current over-reliance on the US’ paid donor market:
“I find confusing the position of some countries that compensating domestic plasma donors is immoral, but filling the resulting shortage by purchasing plasma from the U.S. is ok."
John Boyle, President of the Immune Deficiency Foundation (U.S.):
“The global demand for plasma’s life-saving properties continues to grow, so it’s vital that we collectively explore practical ways to increase plasma donations so that supply keeps pace. Because people living with many types of primary immunodeficiencies require lifelong infusions of plasma-derived therapies, our community is especially sensitive to the need for an adequate global plasma supply. We believe that recognizing plasma donors for the heroes that they are and educating the public on the need for more donations is important. We also believe that it’s time the international community looks realistically at the possibility of compensating plasma donors so their most vulnerable community members aren’t forced to go without their medicine because of politics, bias, or misinformation.”
Kate Vander Meer, founder of Plasma for Life (Canada), a patient group:
“At the end of the day, it is patients who bear the biggest risk if there is a safety issue but what is often overlooked is that security of supply is just as essential to patient health. Patients know paid plasma is just as safe. We have been putting it into our bodies for years. It's the negative impacts of shortages, the anxiety over supply, and the guilt of seeing other patients suffering through shortages knowing Canadian patients are a significant drain on the global supply when we should be capable of contributing that weighs heaviest on me.”
Robert Slonim, professor of economics at the University of Sydney, says:
“Professor Jaworski’s brief “Bloody Well Pay Them,” is a must read for all Australian health and blood authorities, and the Australian Red Cross Lifeblood. Jaworski’s sober review of the evidence leaves no room for doubt that Australia’s non-remunerated plasma policy to collect plasma is an unmitigated failure leaving Australia increasingly vulnerable to shortages and health risks that, costing over $1 billion every five years, is unjustifiably and excessively burdensome on Australian citizens. Any fair minded non-dogmatic reader of “Bloody Well Pay Them,” will undoubtedly conclude that Australia should immediately take action towards remunerating plasma donors before the failed non-remunerated policy turns into a national health crisis”
Matthew Lesh, Head of Research at the Adam Smith Institute, says:
“We have a practical need and moral duty to begin remunerating blood plasma donors. Not only would it ensure the safe and secure domestic supplies for life saving treatments, it would also mean contributing to rather than taking away from the global supply.“
Brian Marlow, Executive Director of the Australian Taxpayers Alliance, says:
“Australia’s ongoing policy of non-remuneration for plasma collection is a large part of the reason we have huge shortages and ever increasing public healthcare costs for taxpayers.If adopted, the solutions outlined in this report would help encourage more plasma donations and save the Aussie taxpayer hundreds of millions of dollars over the next few years. I can't think of a better solution.“
Samuel Hammond, Director of poverty and welfare policy at the Niskanen Center, says:
The world's dependency on the United States for blood plasma is unsustainable. It makes health systems in the U.S. and other developed nations more fragile, and reduces access to plasma therapies in many developing nations. The W.H.O.'s opposition to remuneration exacerbates the shortage by standardizing bad policy and perpetuating misinformation about the risks of paid donation. To end the global plasma shortage, our peer countries must end their prohibitions on voluntary, remunerated plasma donation, and shift from a policy of national self-sufficiency to a policy of global contribution.
Notes to editors:
How it works in practice — A unit of raw plasma sells for approximately U.S.$250-300. A unit consists of a litre. The average donation yields roughly 800mL, and is compensated at US$20-50. For a litre of plasma, donors receive between US$30-60. Per litre of plasma, the revenue is split 20-30% for the donor, and 0-5% for the company in the form of profit. Donors receive on average US$20-50, or US$15-35 per hour.
Frequency of donations — the United States permits twice-weekly donations, up to 104 times per year. However, according to data from 2017, the average frequency of donations per 12 months was 21.4, with 14% giving more than 50 times, and 6.7% giving more than 70 times.
For further comments or to arrange an interview, contact Matt Kilcoyne: matt@adamsmith.org | 07904 099599.
The Adam Smith Institute is a free market, neoliberal think tank based in London. It advocates classically liberal public policies to create a richer, freer world.