The trade in human blood might seem gruesome. In fact, it is essential. Plasma, the main component of blood, is a crucial ingredient for a range of medicines, from haemophilia treatments to rabies vaccines and tetanus jabs. And these days there is not enough of it to go around.

Health services around the world have faced shortages of plasma-derived medicines since at least 2018. The covid-19 pandemic made matters worse. With donors in lockdown, supply was constrained, prompting authorities in France and Italy to instruct doctors how best to ration treatments. Outside America, Australia and Canada, plasma-based medicines are underused. The situation is especially dire in poor countries, which use a fraction of the amount needed to treat even just their sickest patients. The best way to meet demand is for more countries to legalise paying for plasma.

Donation involves extracting blood, separating out the plasma and returning what remains to the donor. In many places, demand is clearly outstripping what unpaid donors provide. Fully 80% of the global supply of plasma comes from just five countries, all of which pay for it: mainly America, but also Austria, the Czech Republic, Germany and Hungary. America earned $37bn from exports of blood products last year, more than from coal or gold. Unless other countries start paying donors, though, the global shortage will persist.

Paying could even be cost-effective. Research done for Canada’s health service suggests that collecting plasma from paid donors costs less than half as much as collecting it from unpaid donors. This is because paid donors donate more, and more often, and also because the sorts of enticements countries come up with in lieu of handing out cash, such as paid days off or tax breaks, are often expensive to provide.

Two worries put countries off allowing paid donation. Neither is well-founded. The first is a concern for safety. In places such as Britain, scandals involving infected blood loom large in the public consciousness. Offering payment, critics say, encourages those who know they are ill to donate anyway, putting recipients at risk. Yet there is little evidence that plasma that is paid for is more likely to transmit disease than plasma from unpaid sources. And even if it was, plasma can be heavily processed to ensure it is safe. Although paid plasma dominates global supply, there has not been a single confirmed case in three decades of a patient getting sick from a medicine made from donated plasma. Even countries that do not allow paid donation are happy to import plasma from those that do.

The second worry is over equality. Critics note that paid donors tend to be those who need the money. Some feel uncomfortable that poorer people are allowed to open their veins. But plasma, which is mainly water, is quickly replaced by the body. Health checks exclude the truly unwell and frequent donation seems safe (although more research could be done in that area). Donors in America are prevented from giving more than twice a week, meaning that payments cannot replace income earned from work. Moreover, paid donation is still voluntary. Those who choose to donate judge that they will be better off for doing so. If it is safe, why not let them?

Blood, threats and fears

Home-grown collection isn’t for everyone. Britain rightly stopped collecting plasma in the 1990s during an outbreak of “mad cow” disease, spread by one of the few pathogens not destroyed by standard sterilisation methods. Poor countries might reasonably worry about their ability to collect plasma from donors safely. Global trade exists precisely to solve such problems. But relying on a handful of countries has its own risks. Disease still has the potential to disrupt a country’s collection, as happened in Britain. And, crucially, supply is failing to keep up with demand. Rich countries with good health systems have no good reason to ban paid plasma donations. Paying up would benefit patients both at home and abroad. ■

From: https://www.economist.com/leaders/2024/08/29/people-should-be-paid-for-blood-plasma