How the WHO helped create a global shortage in blood plasma
NRPLUS MEMBER ARTICLE
resident Trump’s decision to withdraw the U.S. from the World Health Organization (WHO) has led many to see the U.N. agency in a harsh new light. As an international public-health organization, the WHO exists precisely for crises such as the coronavirus pandemic and should presumably serve as a trusted, authoritative resource. Yet from the very onset of the pandemic, the WHO has sown confusion — and in some cases, disseminated complete misinformation — about everything from the effectiveness of masks to whether or not the virus is airborne.
Unfortunately, this is par for the course for the WHO. Take its stance on blood donation. Since adopting World Health Assembly Resolution 28.72 back in 1975, the WHO has consistently opposed compensation for blood and blood-plasma donors, pushing member countries to adopt its preferred model of “100 percent voluntary, non-remunerated” donation.
This model is rooted in the belief that paying donors will attract volunteers with risky lifestyles, resulting in less-safe blood and plasma. That may have been true in the 1970s and ’80s, and the safety of blood and plasma used for transfusions remains a complex issue to this day. But advancements in testing and other technologies have made the safety of paying donors a non-issue in the case of plasma used for plasma therapies. Thanks to advanced viral screening, reduction, and inactivation techniques, every national health authority recognizes that plasma therapies derived from paid donations result in medicines that are just as safe and effective as those made from unpaid plasma donations.
Yet the WHO’s stance remains unchanged, and it has contributed to a global supply shortage that forces countries to import their blood plasma from the small number of countries who follow a paid model and thus have a surplus supply. The result has been a growing and unsustainable global reliance on the U.S. for plasma. Over 70 percent of the world’s supply of plasma, which is used to manufacture plasma-derived medicinal therapies such as immunoglobulin, albumin, and clotting factor, comes from the veins of paid American donors. Add in the other countries where donors can be paid — Germany, Austria, Czechia, and Hungary — and what you’re left with is five countries responsible for 90 percent of the global plasma supply.
Global demand for blood plasma is growing at a rate of between 6 and 10 percent around the world each year, while countries are increasing domestic plasma collections at a rate of between 2 and 5 percent a year. In turn, every year the United States is responsible for more and more of the global supply. Sanquin, the national blood operator in the Netherlands, estimates that the United States will account for 90 percent of Europe’s plasma needs as soon as 2025, up from just over 40 percent today.
The novel coronavirus is threatening to make this situation worse. Not only has the pandemic dampened plasma donations in the U.S., but the promise of a plasma therapy — a hyperimmune globulin — for treating SARS-CoV-2 will put additional strain on the world’s already-strained supply. This endangers the availability of plasma for patients in wealthy countries and will continue to make most plasma therapies unaffordable for much of the developing world.
A nationwide study recently found that convalescent plasma therapy, in which hospitalized COVID-19 patients receive transfusions of antibody-rich plasma from recovered patients, reduced mortality by 50 percent. Recovered patients are thus being asked to donate as much plasma as they can, sometimes twice weekly, with each session lasting several hours. This is only possible due to payments that, at the very least, offset the costs of a donor’s time, travel, and foregone wages.
Why does opposition to paying plasma donors exist? The simple answer is that the WHO is wrong about plasma donations for plasma therapies. It has spread misinformation about the risks of paying plasma donors for decades, and has actively pushed for member nations to commit to 100 percent non-remunerated plasma donations on one hand while noting the global supply shortfall on the other. In 2015, the WHO estimated that about 1.4 million people worldwide have a primary immune deficiency (PID), with 75 percent of those lacking access to appropriate plasma therapies. “Without treatment,” the WHO said, “patients with PID have constant life-threatening or life-impairing infections.”
To give patients peace of mind and to make plasma therapies more affordable, countries such as Canada, Australia, the U.K., and New Zealand need to do what the U.S. does. They need to ignore the mistaken and contrary-to-the-evidence recommendations of the WHO, pay their own citizens to donate plasma, and become net contributors to the global supply.
Peter M. Jaworski is an associate teaching professor at Georgetown University’s McDonough School of Business and the author of Bloody Well Pay Them: The Case for Voluntary Remunerated Plasma Collections. Samuel Hammond is the director of poverty and welfare policy at the Niskanen Center.