A private member’s bill was tabled in the Alberta legislature during its spring sitting that would repeal the 2017 Voluntary Blood Donations Act. This act, like similar legislation in Ontario and British Columbia, was established to ensure that blood and blood plasma donated in Alberta supports a safe and sustainable blood supply, and to ensure that for-profit companies cannot commercialize the blood of Albertans. As the legislature wrapped up for the summer, the bill passed second reading.
The arguments supporting repeal have been largely based on the idea that Canada needs more plasma because the country is reliant on American sources. It is important to note, however, that there are two different uses of plasma in the Canadian context, and that concerns differ for fresh plasma (for transfusion) and for plasma protein products (treatments made out of plasma proteins). The suggestion is that allowing for-profit collection centres that pay for plasma will incentivize people to donate more, which would improve Canadian self-sufficiency and address a gap between supply and demand in plasma protein products. This is the wrong approach on both accounts.
Regarding fresh plasma, even if people start going to new for-profit clinics in great numbers, the plasma collected will not be used in Canada. Canadian Blood Services — which manages the Canadian blood supply outside of Quebec — has stated clearly that it does not acquire fresh plasma from collection centres where the donors are paid. Canada is self-sufficient in fresh plasma for transfusion because Canadian Blood Services collects enough through its regular voluntary blood collections.
The company operating pay-for-plasma centres in Moncton and Saskatoon has offered to sell the fresh plasma it collects to Canadian Blood Services at a discounted rate (effectively selling Canadians back the plasma they were paid to provide). However, despite early reports to the contrary, Canadian Blood Services has stated that it remains committed to the non-commercialization of the blood supply and will not be buying plasma from these newly established collection centres. What this means is that the fresh plasma extracted in any new for-profit centres in Alberta will be sold abroad and will not, in any way, contribute to the Canadian supply.
Regarding plasma protein products, advocates of selling plasma often point out that Canada currently only collects a small part, roughly 13 percent, of what is required to support Canadian demand. To fill the gap, Canadian Blood Services currently acquires plasma protein products made from paid American donors. However, Canadian Blood Services has a plan under way to reduce this reliance and to increase the voluntary provision of plasma. Still, as Canada is among the leading users of plasma protein products in the world, there is reason to question this growing demand rather than simply ask why donations have not increased to meet it.
There are two main reasons for this rapid growth. The first is that the most commonly used plasma protein product, known as IVIG (intravenous immunoglobulin), is often prescribed off-label. There are six medical conditions for which IVIG is officially approved, but IVIG is often prescribed for many more, at times because IVIG is seen as a last resort when other treatments are not working. A recent review by the Canadian Agency for Drugs and Technologies in Health on the off-label use of IVIG reveals limited evidence supporting the use of IVIG for many conditions for which it is often prescribed.
Second, IVIG is often prescribed even when other alternatives are available. Canadian physicians may prescribe IVIG — provided at no cost in hospital — rather than other medications that patients can take at home, but for which patients must pay. In the absence of a pharmacare program that could provide a lower-cost alternative, prescribing higher-cost IVIG administered in hospital allows patients who do not have drug coverage to receive the (funded) treatment they need.
The right way to cope with a need for more plasma protein products is not to focus only on increasing supply, but also to control demand. Addressing why Canadians use IVIG at the rates they do will be a far more efficient approach to improving self-sufficiency in these products than payment for plasma that is destined for the international market.
The Alberta private member’s bill is a distraction that will allow for private interests to profit while doing nothing to address very real concerns about self-sufficiency and the growing demand for plasma protein products. Just as the pay-for-plasma clinics established in Saskatchewan and New Brunswick have not done anything to address these issues, neither will one (or more) established in Alberta. The solutions lie in continuing to support a voluntary blood and plasma donation system while addressing the uptake of IVIG.
It is telling that those arguing in favour of pay-for-plasma in Alberta largely fall into two categories: politicians and their supporters who want the free market to rule, no matter the human costs; and the companies that stand to profit from increasing the production of plasma-based therapies. It was lobbyists from an industry group, the Plasma Protein Therapeutics Association, who brought forward the new bill in Alberta, trying to move quickly under a government that has proven time and again that it will plunder every public resource it can.
Albertans deserve public policy that legitimately takes up concerns about self-sufficiency and the growing demand for IVIG, rather than trying to bleed Albertans dry.
Disclosure: Alana Cattapan received research funding from Canadian Blood Services as part of the 2018-19 James Kreppner Award program. Canadian Blood Services was not involved in the preparation of this article.