The Decibel - The expansion of selling plasma in Canada

Episode Date: September 12, 2022

Plasma is a critical part of some medicines but Canada currently only gets 15 per cent of its supply from Canadians. That means we’re dependent on the paid-plasma international market for 85 per cent of it. So to secure a domestic supply, the Canadian Blood Services has reversed course on its historic position of only administering a voluntary donation system and signed a deal with for-profit Spanish company Grifols, who will collect Canadian plasma by paying people. Report on Business reporter Chris Hannay explains the controversial partnership.

Hi, I'm Manika Raman-Wilms, and you're listening to The Decibel, from The Globe and Mail. In Ontario and BC, you'll soon be able to sell your plasma. Plasma is one of the main components of your blood. It's a straw-colored liquid packed full of proteins, and it's used for certain medications and transfusions. For people who need it, plasma is crucial, which is part of the reason behind a new deal that the Canadian Blood Services has struck with a Spanish for-profit plasma collection company called Griffles. This deal, though, goes against the global norm. The only places that fully allow people to be paid for giving plasma are Germany, Austria, Hungary, Czech Republic, and the U.S. People were generally not in favor of paid plasma collection. And the donors did not want compensation and did not think people

should get compensation for it. Chris Hanne is a reporter with the Globe's Report on Business, and he's been following this story. He'll tell us why some people are concerned about this deal, why others say it's essential, and what it will all mean for people who need plasma. This is The Decibel. Chris, thanks so much for chatting with me. It's great to have you here. Hey, thanks for having me. I think a lot of people have probably given blood before, but I think probably not as many of us have actually given plasma. Can you just like walk me through it? How does that process actually work when someone goes to give plasma?

The process for donating plasma is similar but a little bit different from donating blood. So with plasma, it tends to take a little bit longer. So on average, donors are usually told that it tends to take a little bit longer. So on average, donors are usually told that it's about a 90 minute process. You sit down and they extract your blood like your regular blood donation. And then they have a machine that separates the red and white blood cells and other things from the plasma. And then they inject your blood cells back into you and while keeping the plasma. Another way that blood donation is different from plasma donation is that depending on like health and nutrition, plasma donors can

donate far more often. So in some places, people who donate plasma can donate twice a week for many weeks, which is a much higher frequency than blood donations. Okay. So now I guess the next logical question is how does the collection of plasma work in Canada then? Canadian Blood Services, which operates in every province outside of Quebec, can take plasma donations at some of their centers that also take blood donations. And then they're currently in the process of building centers that are really dedicated for collecting plasma. And then there are a few small private collectors in Canada as well. And they have locations in Alberta, Saskatchewan, and New Brunswick, and paid plasma collection is legal in all of those provinces.

Okay, well, let's talk about prices. How much are donors generally paid to give plasma? It can be, you know, some places in the US, where there is competition between donors, they will, you know, increase the prices to try to get people to go to their location, anywhere up to, I believe, a few hundred dollars a month. In Canada, Canadian Plasma Resources is the largest chain of private plasma collection centers, and they give anywhere between $30 to $65 per donation, depending on how frequently someone donates. And they also, as a key part of the business model, they also pay people for referral bonuses if they get their friends or family to

come donate as well. Really? And what about the toll that takes on somebody's body? That seems like a lot. Yeah, it can be. And that's, there are some health concerns around really frequent and long-term donation, because although your body regenerates plasma a little bit more quickly than it does, you know, your blood cells, it still can be very draining. You're losing a lot of fluids every time you donate, plus they're very protein rich. So for people who are donating twice a week for long-term, they have to be eating a lot of proteins. They have to maintain their very good health. They have to be very well hydrated and that kind of thing, because that's the only way to sort of make up for the constant loss of plasma. And so how much plasma does Canadian Blood Services collect on a voluntary basis?

Yeah, so there's two main things that plasma is used for. So there's direct transfusions, and then there's collecting plasma so that it can be turned into medicine that could be used for people with rare blood disorders and other things. In terms of the transfusions, currently Canadian Blood Services collects all the plasma needs for transfusions. So it's 100% sufficient there. The issue is when it comes to collecting plasma that can then be turned into these other pharmaceutical products. So that number has been declining over time. Currently, Canadian Blood Services collects about 15% of its needs within Canada when it comes to the pharmaceutical products. And the other 85%, it buys from other countries and also buys the plasma products directly from pharmaceutical companies as well.

Interesting. So we're actually really dependent on other countries that allow paid plasma collection at the moment. So this is why we're now talking about expanding paid plasma in Canada today. What has the CBS stance on paid plasma been historically, like in the past? Yeah, so Canadian Blood Services was set up with a mandate to administer a voluntary blood system. Traditionally, Canadian Blood Services has been against paid collection of plasma in Canada. This is not so much a security, a safety issue now because of the screening involved. Where Canadian Blood Services' concern has come from in terms of paid collection of plasma is from it crowding out voluntary donations. So the idea of if you had two donation centers across the street from each other, one which paid

donors and the other one which didn't pay donors, then most people would go to the one where they get money. Yeah. But now, of course, Canadian Blood Services is actually looking at paid plasma here. There's an announcement of a new deal with a Spanish for-profit company called Griffles. And this is early days, Chris, but what do we know so far about this partnership between Canadian Blood Services and Griffles here? So they're supposed to be working essentially arm in arm with Canadian Blood Services to set up locations where they will pay donors for their plasma, and then they will use manufacturing facilities, such as one that they recently purchased in Montreal, to turn that donated plasma into pharmaceutical products that they will then sell to Canadian

Blood Services. And we talked before about 15% of the plasma actually comes from within Canada. What does Canadian Blood Services think this deal will change then in terms of those numbers? Yeah, so Canadian Blood Services has said that the reason for this is sort of renewed urgency around securing a domestic supply of plasma and plasma products. The idea being that the availability of these products in the global market started to go down in 2019, and that became even worse when the pandemic started and when there were supply chain issues. And so it's building new collection centers

that will get it to 25%. But what it really wants to be is like between 50% and 60% plasma and plasma products that are collected and made within Canada, where we don't have to worry about these supply issues. And just to be clear, all the plasma that Griffles collects in Canada, that's supposed to stay in Canada then? Yes, that is what Canadian Blood Services has said is a condition of the deal,

is that everything that Griffles collects within Canada has to stay within Canada. We'll be back in a moment. And I guess we should also touch on like kind of the difference in provinces too as well, because this deal with griffles and the Canadian Blood Services, we're specifically talking about Ontario and BC. Is that right, Chris? Well, Canadian Blood Services says it can apply to any province, but Ontario and BC is sort of seen as like the economic reason why Griffles

would be interested in this deal because paying for plasma donations is currently banned in Ontario and BC. But both those laws have exceptions for Canadian Blood Services. So the language in the law is a little bit more clear in BC and a little bit less clear in Ontario. But essentially what Canadian Blood Services has said and what industry observers were expecting was that Griffles, because it is acting in concert with Canadian Blood Services, will now be able to set up shop in Ontario and BC and get around this ban. And that, you know, when I've talked to people in the industry, that's what they've said is probably the reason why Griffles was interested

in signing this deal in the first place was because they get to very large markets essentially to themselves. They don't have to compete against anybody. That means they can pick whatever price they want to give donors. They don't have any competition. And so they really control the market. So Chris, it has been a few days since this deal was announced. I guess what has been the reaction so far that you've seen?

Yeah, so there are a number of patient groups that work with Canadian Blood Services that represent people with rare blood disorders, who are very in favor of the deal, because they say that pretty much any measures that allow for more supply of plasma in these products is a good thing. It's worth noting that a lot of these patient groups, and they're very open about it, a lot of these patient groups receive some of their funding from pharmaceutical companies, including Griffles, which got the deal, and they're open about this conflict of interest. Other reaction has been less positive, particularly from the Canadian Health Coalition, which is a nonprofit that advocates for public health care. Since I mentioned the patient groups, the Canadian Health

Coalition is also open about receiving a lot of funds from unions that represent workers who work in health care, as well as Bloodwatch, which is also an advocacy group that promotes voluntary donations. And these groups have been less positive about the deal. One of the reasons is really the lack of transparency around the deal. There were not really any public consultations. There were some sort of stakeholder meetings that Canadian Blood Services held earlier this year, but some of the participants in that sort of have felt that the issue of paid plasma wasn't really actually well talked about during those sessions. And there were some public focus groups and surveys that Canadian Blood Services did as well. But given that this is such a major change in direction for the agency, some of the criticism has been about the fact that there were no big committee hearings. There are no big public discussions. Canadian Blood Services

just sort of decided this on its own, which I suppose is its prerogative, and made this deal and just sort of announced it to the public. So you mentioned that some groups like the Canadian Health Coalition have criticized this, the way that CBS made this decision. They'd like to look at alternatives. What would alternative models be though, Chris? Well, one of those alternative models would be build more collection centers, which is one of the options that Canadian Blood Service has looked at. And that's the path that they've taken in Quebec. Quebec has its own agency, HEMA Quebec,

that collects and distributes blood and plasma in that province. And Quebec has a longstanding ban on paid donation of actually any body part, which is given to include both blood and plasma. It's part of Quebec's civil code. They're currently in the midst of a plan to also secure their supply domestically, but they're doing that by just building way more collection centers. They used to be at 15%. They say that with the current collection centers they've built, they're now up 30% of providing their own plasma needs.

They've taken a completely different strategy from Canadian Blood Services and discovered that the more collection centers they build, the more people come out and donate. What about costs? Like the cost of building more centers, is that cheaper than just paying people for plasma? The Quebec agency told me that their collection centers cost between $2 million and $3.5 million each. There's some difference in the economics required with voluntary and paid collection. So with voluntary collection, you have to spend a lot more money with outreach and with your donor community. You know, as we know, we've all seen those at the ads from Canadian Blood Services where they're urging people to donate. There's always a small community of people who are very happy to come back regularly. But for the most part, you have to keep posting your message out there and keep

trying to convince people to come in. With paid collection, the way that that business model really works is that although they have the expense of paying somebody, that person tends to be a repeat donor and they tend to bring in their friends and their family. And so those paid collection sites sort of build up a community of dedicated people who are constantly coming there. And so they don't have to spend as much money on outreach and some of those other costs that Canadian Blood Services does. I'm curious, though, you did say that Canadian Blood Services held some public focus groups or public consultations. What did those groups reveal?

Well, Canadian Blood Services won't give me the results of those public consultations. When they announced the deal with Griffles, they released a report that sort of summarized some of the different options that they were weighing. And in that report, it makes mention of the fact that the public consultations that they held said that people were generally not in favor of paid plasma collection. And that particularly among the donors that they talked to, the donors did not want compensation and did not think people should get compensation for it. That's interesting.

Yes. So I have been asking for the full report and the part that mentions what the public thinks. But so far they say that they don't want to release that. Does the Canadian Blood Services expect to then lose volunteers who might choose to get paid instead? You know, you talk about the idea of if there's two collection centers, one on either side of the street, one pays you to give your plasma, one doesn't.

Won't most people get paid? Yes. So as part of this deal, the Canadian Blood Services has said that part of the agreement gives them veto power over where Griffles sets up shop. So I asked the CEO, like, does this mean that Griffles will give you a list is doing because they want to kind of secure the domestic supply then. Can you, I guess, just before we kind of wrap things up here, Chris, why is it so important to have a domestic supply? It's important because, you know, as we saw in the early days of the pandemic, you know, you don't know what kind of health issues will come up. And, you know, it can be really important to be able to have control over the supply chain. Like if you think back and remember to, you know, the spring of 2020, there's a lot of concern about how to secure masks, how to secure personal protective equipment. That's

kind of the idea here is that Canadian Blood Service just wants to make sure that if there is another big emergency or big health issue or some other big demand in another country that that our supply of plasma products is protected. Chris, thank you so much for taking the time to speak with me today about this. Thanks for having me. That's it for today. I'm Mainika Raman-Wilms. Our producers are Madeline White, Cheryl Sutherland, and Rachel Levy-McLaughlin. David Crosby edits the show. Kasia Mihailovic is our senior producer, and Angela Pichenza is our executive editor. Thanks so much for listening, and I'll talk to you tomorrow.