30 June 2020

Pay for plasma? We bloody well should

By

We’re in the midst of a global shortage in blood plasma.

Blood plasma and products derived from it like Immune Globulin have a large and rapidly growing list of medical applications, ranging from hemophilia, sepsis and burn treatments to NHS-led coronavirus treatment trials. But demand for plasma therapies is growing at 6-10% a year and supply has simply not been able to keep up. Thanks to artificially inflated world plasma prices, the situation is particularly dire in low to middle income countries. In 2015, the WHO estimated that over 75% of people in these areas do not have access to appropriate plasma therapies. As demand continues to outpace supply, the situation will only get worse without urgent reform.

The World Health Organization is making the problem worse by discouraging developing countries from compensating plasma donors in cash or in-kind. Its reasons for doing so are flatly contradicted by the available evidence on paid plasma collection. Patients who could benefit from plasma therapies—especially those in low to middle income countries—are dying as a result.

In a new paper for the Adam Smith Institute, Bloody Well Pay Them, Dr Peter Jaworski argues that the UK, Canada, Australia and New Zealand should abandon WHO’s harmful guidelines and instead adopt Voluntary Remunerated Plasma Collections (VRPC). The CANZUK countries have similar blood and plasma collection policies in place, and our trade links will only grow stronger in the coming years. Strategic independence in our shared plasma supply is a real possibility.

The UK’s supply of plasma relies almost exclusively on imports from the USA, which when combined with Germany, Austria, Czechia and Hungary accounts for 89% of global supply. This is not the efficient result of specialisation and comparative advantage: all of these countries permit remuneration of plasma donors, unlike other developed nations. Jaworski’s analysis of international plasma collection rates finds that, unsurprisingly, paying for plasma gets you more of it.

It’s also cheaper to collect, since it takes a substantial marketing budget to recruit and convince people to give up an hour of their time for no compensation. Economist Robert Slonim has pointed out that “the domestic supply of immunoglobulin costs over three times more per unit than what is imported, despite domestic donors not being compensated”.

The UK hasn’t collected domestic plasma for manufacturing plasma therapies since 1999 as a result of an unreasonably cautious approach to combating variant Creutzfeld-Jakob Disease (CJD), which cannot be detected with modern screening tests. Patient groups like PID UK have pointed out that “the UK has now had the same levels of sporadic CJD as the rest of the world for many years, and there is no evidence of onward transmission of CJD in plasma,” but have been ignored.

Other objections to paid plasma collection also fail to pass basic scrutiny. Practical concerns, like the notion that offering compensation will significantly crowd out charitable plasma donations, are not borne out by evidence from Canada and Germany. Concerns about exploitation and safety—though understandable—are not relevant in CANZUK countries which have the capability and track record to enforce appropriate regulatory safeguards.

As for the purported evil of ‘commodifying’ plasma collection, it’s hard to see how our current situation of importing paid plasma is morally distinct from allowing British donors to be compensated. It’s also worth asking how much extra death and suffering we would be willing to tolerate from plasma shortages in exchange for keeping markets out of our lives. The only moral answer is zero. As Jaworski and his co-author Jason Brennan make clear in their book Markets without Limits, the anti-commodification thesis about how markets can corrupt or offend our dignity, is on very shaky ground.

If we don’t pay for plasma, it will cost patients their lives. So we should bloody well pay them.

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Daniel Pryor is Head of Programmes at the Adam Smith Institute.

Columns are the author's own opinion and do not necessarily reflect the views of CapX.