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Irene Gyba takes blood from donor Pierre Talbot at a clinic on Nov. 29, 2012 in Montreal.Ryan Remiorz/The Canadian Press

The world’s appetite for plasma-derived products has grown voraciously in recent years. During the COVID-19 pandemic, demand for specialized blood products grew sharply again, but donations of the source material dropped.

Canada purchases $850-million worth of plasma-derived products annually, with most of that money being spent on immunoglobulins, which are highly specialized drugs used to treat a range of immune disorders, from leukemia to human immunodeficiency virus (HIV), and even COVID-19.

In a bid to secure supply and stave off shortages, Canadian Blood Services announced last week that it has signed a contract with Grifols SA that will allow the Spanish pharmaceutical multinational to collect and process plasma in Canada. The catch is that, unlike CBS, Grifols will pay plasma donors for the liquid gold that flows through their veins, a move that set off a firestorm in political circles. To understand why, we need a little historical context.

Some 32,000 recipients of blood transfusions and blood products contracted HIV or the hepatitis C virus from donated blood in the 1980s and 1990s, one of the worst public health disasters in Canadian history.

A high-profile public inquiry headed by Mr. Justice Horace Krever meticulously catalogued the systemic malfeasance and calamitous negligence at the heart of the tainted blood tragedy, and made pointed recommendations to ensure this sort of horror would never be repeated.

Aside from paying about $5-billion in compensation to victims, the principal policy response was to create a new agency to collect and distribute blood and its derivatives, called Canadian Blood Services. Quebec created its own parallel agency, Héma-Québec. (The agencies replaced Red Cross Blood Services, which was bankrupted by lawsuits from victims.)

The work of CBS was to be guided by some fundamental tenets, often referred to as the Krever Principles:

CBS should be the single national operator of the system, owned by the provinces, but operate independently; access to blood should be free and universal; Canada should be self-sufficient, so importing products from other countries would be unnecessary; the safety of blood and blood products must be paramount; and blood and blood products should be made from the blood and plasma of unpaid donors, whenever possible.

Flash forward 25 years to today: Does allowing Grifols to pay plasma donors violate the Krever Principles?

Superficially, yes. But, in reality, no. The blood collection and distribution system must have one principle that trumps all others: ensuring patients have the blood and blood products they need.

If we need to pay donors to fulfill that obligation, so be it.

In fact, Judge Krever, in discouraging paid donations, was careful to say “whenever possible.” He even lauded one company (then called Cangene Corp.) that had been paying plasma donors for decades to produce a highly-specialized immunoglobulin to treat pregnant women with a rare condition.

Canada has failed miserably in fulfilling Judge Krever’s admonition that it should be self-sufficient: 85 per cent of plasma-derived products used in this country are made with paid plasma collected by for-profit companies. (Five countries, including the United States and Germany, allow paid plasma collection and they produce 90 per cent of the world’s supply.)

Is buying blood products made with the plasma of paid American donors somehow more principled than paying Canadians for their plasma and manufacturing drugs domestically? Of course not.

Finally, let’s not overlook that provincial governments forced the hand of CBS on this matter. Several provinces – notably Saskatchewan, New Brunswick and Alberta – have already allowed commercial plasma companies that pay donors to set up shop. As a result, there are already more paid-plasma collection facilities than voluntary ones in Canada, and all the paid product is exported.

The provinces, who own CBS, rejected a bold plan to maintain a voluntary-only system by opening 40 plasma collection centres across the country. But they funded just six more centres, to be opened by 2024, in addition to the five that exist now.

What Grifols brings to the table is capital to open plasma collection centres quickly, without government dithering, and the contract provides the added benefit of CBS being able to veto any location where it would compete with a voluntary donation centre.

Grifols also owns a plant in Montreal, where it will manufacture some immunoglobulin products so we can purchase these drugs domestically.

This is exactly what we discussed ad nauseam during COVID-19 – the need to have a domestic supply chain for drugs, from vaccines to blood products, to avoid shortages and build self-sufficiency.

Instead of sabre-rattling about the horrors of paid blood collection, what we should be discussing is the perils of the deadly shortfall of supplies.

We can, and should, have principles, but they also need to be prioritized, and put patients first.

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