Canada, as a country, is not serious about collecting enough plasma. In fact, with the exception of Germany, Austria, Hungary, the Czech Republic, and the U.S., no country is serious about collecting enough plasma. In each of these countries, commercial plasma collection centres compensate people for giving plasma. In all other countries, they are not so compensated. And every country that does not have commercial paid plasma centres imports therapies from the countries that do.
Plasma is used to make life-saving plasma-derived therapies, including albumin and immunoglobulin, for patients with rare diseases, like immune deficiencies and autoimmune diseases. Outside of the five countries mentioned, the world does not collect enough, and so patients live in fear of shortages.
Back in 2014, New Zealand was the last and only country in the world to manage to collect enough plasma without paying donors. That was seven years ago. New Zealand now imports 12.5% of its immunoglobulin product, made with American plasma.
Global dependence on American plasma has been increasing every year. Today, fully three quarters of the global supply comes out of the veins of American donors.
More than half of Australia’s supply of these therapies is made with American plasma. The United Kingdom is entirely dependent on American plasma ever since they stopped collecting plasma for plasma therapies in 1998, in response to variant Creutzfeld-Jakob disease. Spain is at over 60% dependent.
According to Canadian Blood Services, four out of every five plasma therapies used by Canadian patients is made with American plasma, collected and fractionated by the commercial industry that operates there. That is up from 70% in 2014.
Cookies and milk, biscuits and a cuppa, pins, badges, stickers, t-shirts, expensive advertising campaigns reminding us that it’s “in you to give,” reminders, phone calls, and even a paid day off work, which you can get in Italy, are none of them enough. They each increase donations, but it’s not enough.
The reason why is because the volume of plasma required to meet the needs of patients can only be described as staggering.
Canada needed 1.6 million litres of plasma in 2019 to meet the needs of patients on immunoglobulin. To get a litre of plasma it takes about 1.3 plasmapheresis donations lasting an hour and a half each (or four 45 minute whole blood donations). So we needed Canadians to roll up their sleeves at least 2.08 million times in 2019. We needed Canadians to spend 3.12 million hours at a plasma donation centre.
This didn’t happen.
If we keep doing what we’ve been doing, it will never happen. Not ever.
About four per cent of Canadians donate blood or plasma, and the average Canadian plasma donor donates about 3-5 times per year.
In the United States by comparison, there were more than 50 million plasma donations in 2019, with the average plasma donor giving 17.3 times per year.
Is the difference in plasma collection between our two countries a difference in how much people care? Are Americans more generous than us?
No. We would have similar numbers if Canada had a commercial plasma industry as robust as America’s, with donor’s receiving compensation for giving plasma. (Although it is worth pointing out that Americans, on average and in general, do donate blood, without compensation, at rates a little higher than Canadians).
The urgency of the global situation is under-appreciated. We are currently on the cusp of yet another shortage. Already patient organizations are receiving messages from Canadian Blood Services that the available supply of immunoglobulin is beginning to tighten. Since March of 2020, when the pandemic started, plasma donations in the U.S. have collapsed by at least 20-25%. And since the U.S. supplies nearly every other country with plasma, that means tightening supply for the whole world.
Meanwhile, demand for immunoglobulin continues to rise at rates between 6-10 per cent each year. Projections for well into the future show that this trend is most likely to continue. That means that we needed 6-10% more litres of plasma than 2019 in 2020, and will need 6-10% more than the 2020 numbers for this year.
So let me put this as plainly as possible: We will never, not ever, collect enough plasma for cookies and milk alone. This will never, not ever, happen.
Even if the provinces spend the nearly-billion dollars Canadian Blood Services has asked for to open 40 additional plasma collection centres, we will still not meet the domestic demand. Those 40 plasma centres are expected to collect 600,000 litres of plasma. With 200,000 litres from whole blood donations, we would end up with 800,000 litres, or enough to be 50% self-sufficient in 2019, and less than 50% this year, since we already need more than 1.6 million litres of plasma given the increase in demand.
People who think we can accomplish this without paying donors are living in a fantasy. This hasn’t happened anywhere in the world.
What has this fantasy wrought?
Back in 2012, the two commercial companies that pay for plasma in Canada (Canadian Plasma Resources and Prometic Plasma Resources) had plans to open 19 paid plasma centres across Canada, for a total of 20 (Prometic Plasma Resources runs a paid plasma centre in Winnipeg, which has paid people for plasma since 1984).
Then Ontario banned that business model in 2014 with the passage of a law called The Voluntary Blood Donations Act. At the time, there was a $400 million dollar planned investment on the table for Ontario, which this law erased. Alberta followed suit in 2017, and British Columbia in 2018, passing the very same prohibition. By 2018, the business model that Canadian patients depend upon for the vast majority of their therapies was illegal in our largest provinces.
Hundreds of millions of dollars worth of investment, and hundreds of jobs, all disappeared thanks to prohibition of commercial plasma collections. Those millions of dollars and those jobs instead went into the United States, and Canada became even more dependent on the U.S. for our supply of plasma therapies. Instead of 20 commercial plasma collection centres, Canada saw the opening of just two additional centres, in Saskatoon and Moncton, for a grand total of three commercial plasma collection centres.
When the Ontario government banned paid plasma, there were no plans to open unpaid plasma centres in 2014. No alternative. The ban on paid plasma was effectively a seven year ban on plasma collection altogether. It wasn’t until 2018 that Canadian Blood Services put forward a proposal to open unpaid plasma centres. And only now are we seeing three unpaid plasma centres opening up as proofs-of-concept.
They will collect about 20,000 litres of plasma per year. Maybe 25,000. It will cost at least $412 per litre. Canadian Plasma Resources offered all of their plasma to Canadian Blood Services at $175 per litre back in 2017. Paying people for plasma donations is two to four times cheaper than the cookies-and-milk model Canadian Blood Services will be using. This, according to a Health Canada Expert Panel that looked into the supply of immunoglobulin therapies. Two to four times cheaper.
Those 20 commercial paid plasma centres, by the way, would have been collecting nearly 800,000 litres back in 2019. That would have been enough to meet 50% of our need. But we would have had more than 20 centres. Probably twice that. By now, it is probable that Canada would be 100% self-sufficient. It only took the Czech Republic three years to become self-sufficient in plasma for plasma therapies when commercial plasma collections started in 2008.
Today, we could have had a plasma industry worth a billion dollars to Canada’s economy. Hundreds of jobs. Secure supply of life-saving, essential immunoglobulin for the thousands of patients who need it. Instead, we are spending nearly a billion dollars importing plasma therapies from the U.S., and we have an insecure supply of this essential, life-saving medicine. We will, in a few months, have yet another, avoidable shortage.
But the policy of the governments of Ontario, Quebec, and British Columbia is to prefer to pay Americans for their plasma, rather than permit Canadian companies to pay Canadians for their plasma instead. Rather than be self-sufficient, these provinces appear to prefer to be nearly entirely reliant on the United States.
Alberta repealed the ban on commercial plasma collections this past November. Already, two large plasma centres are being built, one in Calgary and the other in Edmonton, that should open around July of this year. They each have the ability to collect 100,000 litres of plasma per year, and should collect between 60 to 80,000 litres.
Alberta will see more plasma centres. This will help, but it’s not enough.
With half the population of Canada, Ontario needs to lift the ban on the commercial plasma industry, if we are to ever have any hope of being not just self-sufficient, but to finally contribute to the global supply of plasma.
We either repeal The Voluntary Blood Donations Acts in the remaining provinces, or we will rely on American donors forever.