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The trade in human blood may seem gruesome. In fact, it is necessary. Plasma, the main component of blood, is a vital ingredient for a variety of medicines, from haemophilia treatments to rabies vaccines and tetanus jabs. And nowadays that’s not enough to go around.
Health services worldwide have been facing shortages of plasma-derived medicines since at least 2018. The COVID-19 pandemic has made matters worse. With donors in lockdown, supplies were disrupted, leading authorities in France and Italy to instruct doctors on how best to administer the treatment. Outside the US, Australia and Canada, plasma-based medicines are less used. The situation is particularly dire in poor countries, which use a fraction of the amount needed to treat even their sickest patients. The best way to meet demand is for more countries to legalize payment for plasma.
Donation involves drawing blood, separating the plasma, and returning what remains to the donor. In many places, demand is clearly exceeding what unpaid donors can provide. 80% of the entire global supply of plasma comes from just five countries, all of which pay for it: primarily the US, but also Austria, the Czech Republic, Germany and Hungary. The US earned $37 billion last year from exporting blood products, more than coal or gold. However, unless other countries start paying donors, the global shortfall will persist.
Paying can also be cost effective. Research conducted for the Canadian Health Service shows that the cost of collecting plasma from paid donors is less than half that of collecting it from unpaid donors. This is because paid donors donate more and more often, and also because countries offer a variety of inducements in exchange for giving cash, such as paid days off or tax breaks, which are often costly to provide. It happens.
Two concerns prevent countries from allowing paid donations. None are well established. The first concern is safety. In places such as Britain, scandals involving infected blood have loomed large in the public consciousness. Critics say that offering payments encourages people who know they are unwilling to donate anyway, putting recipients at risk. Yet there is little evidence that plasma that is paid for is any more likely to spread disease than plasma obtained from unpaid sources. And even if that were the case, the plasma might have to be processed in large quantities to ensure that it is safe. Although paid plasma dominates the global supply, there has not been a single confirmed case of a patient getting sick from a drug made from donated plasma in three decades. Even countries that do not allow paid donation are happy to import plasma from those who do.
The second concern is about equality. Critics say that paying donors are the ones who need the money. Some people feel uncomfortable with the fact that poor people are allowed to have their veins exposed. But plasma, which is primarily water, is quickly replaced by the body. Health screening does indeed weed out unhealthy people and frequent donations appear to be safe (although more research could be done in that area). Donors in the US are prevented from donating more than twice a week, meaning payments cannot replace income earned from work. Furthermore, paid donations are still voluntary. People who choose to donate decide that doing so would be better for them. If it’s safe, why weren’t they allowed to do it?
blood, threats and fear
Home collecting isn’t for everyone. Britain stopped collecting plasma in the 1990s during an outbreak of “mad cow” disease, spread by one of the few pathogens not destroyed by standard sterilization methods. Poor countries may have concerns about their ability to safely collect plasma from donors. Global trade exists to solve such problems. But relying on a handful of countries has its own risks. The disease still has the potential to disrupt a country’s collection, as it did in Britain. And, crucially, supply is failing to keep up with demand. Rich countries with good health systems have no good reason to ban paid plasma donation. The payment will benefit patients both in the country and abroad.
© 2024, The Economist Newspaper Limited. All rights reserved. From The Economist, published under license. Original content can be found at www.economist.com
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