This post was updated on Nov. 24, 2017
Canadian Blood Services responds to Maclean’s
Having spent the last two decades rebuilding Canada’s blood system and regaining the trust of Canadians in this critical part of the health fabric of the country, Canadian Blood Services feels compelled to respond to Anne Kingston’s article. While the article delves into many aspects of the complex world of plasma collections, it also contains the assertion that our organization has attempted to intimidate the regulator. This is untrue, not supported by the record, and fails to recognize the necessity of ongoing dialogue between blood system operator and regulator on matters of crucial interest to Canadians.
Canadian Blood Services was founded in 1998 to manage the national supply of blood, blood products and stem cells, and related services for all the provinces and territories (excluding Quebec), based on recommendations from the Krever Report on the tainted blood scandal. We put patients first, and are dedicated to improving patient outcomes through the manufacturing and delivery of safe, relevant, quality products and services to Canadians. I am writing today to clarify the role and perspective of Canadian Blood Services in the public debate on the emergence of commercial, for-profit plasma collection companies in Canada.
Canadian Blood Services has always monitored and managed plasma in Canada, which includes both safety and the security of supply. In 2004, we consulted with experts, governments, patient groups and other key stakeholders and determined that we would meet 100 per cent of patient need for intravenous immune globulins (Ig), the plasma protein products or plasma-derived drug in highest demand by patients, by collecting 40 per cent of the raw plasma needed to make plasma protein products, with the remaining 60 per cent of Ig demand met through finished drugs purchased from the international pharmaceutical industry (largely from the U.S.). In the years that followed, we determined Canada could safely lower the sufficiency target. However, recent increases in demand, coupled with the newly emerging threats to the global supply of plasma, have resulted in the need to bring the country’s sufficiency to a recommended 50 per cent. This approach balances the risk of a supply interruption with affordability of products, and provides some geographic redundancy. While it is true that the safety of plasma protein products was a concern in the 1980s and before, this has not been an area of concern since the modernization of fractionation and purification processes.
Over the years, the security of supply issue has been erroneously confused with the safety of plasma protein products made from raw plasma from paid donors. Canadian Blood Services has clearly stated that plasma protein products derived from remunerated plasma donors do not present a safety issue. There is no evidence that the level of safety of plasma protein products made from paid donors versus unpaid donors, differs. In addition to screening donors and thoroughly testing plasma, there are multiple steps built into the fractionation process known as inactivation steps and purification steps; the plasma products are rendered free of pathogens. Ultimately, plasma protein products are exceedingly safe, a fact that patient organizations themselves believe and support. This is the evidence-based position we have consistently shared with our funders and regulator. Indicating otherwise is misleading and misguided, especially given the thousands of patients in Canada who rely on life-saving and life-sustaining plasma-derived drugs. Not only is fostering panic over unfounded safety concerns potentially devastating to patients, it also introduces unnecessary confusion into the debate. That said, and consistent with the principles to which Canadian Blood Services has consistently held itself, we do not intend to pay plasma donors in our system.
Long-term security of the plasma supply for Ig can only be achieved through increased plasma collection by the publicly funded and publicly accountable not-for-profit blood system we operate on behalf of Canadians. Commercial plasma collectors are not bound to keep the products they collect from Canadians for use by Canadians; they can sell their products on the open market to the highest international bidder. For-profit companies also have no responsibility to consider the impact of paid plasma donations on the unpaid blood donor base. There is evidence internationally, not just in Canada, that when the for-profit, paid plasma systems expand rapidly, it can reduce the ability of the not-for-profit blood industry to meet its blood collection targets. In Hungary, for example, the expansion of for-profit, remunerated plasma collection entities has substantially affected the public blood operator’s ability to collect blood in that country (up to a 20 percent decline in blood donations). Even in more established markets, such as the United States, concerns are being raised that the significant expansion of for-profit paid plasma collection sites is impacting the non-remunerated blood operators’ ability to maintain market penetration. While Canadian Blood Services can likely manage the local challenges brought about by the presence of one or two for-profit clinics, it is the emergence of additional for-profit plasma collection sites, particularly larger-scale operations, that is of concern.
As the stewards of Canada’s blood system, we work with all levels of governments, patient organizations, suppliers, global experts, our counterparts in other countries and all other stakeholders within our evidence-based and risk-based decision-making framework in a transparent manner. As we manage the plasma protein product formulary for Canada, we meet with all potential players in the system. Canadian Plasma Resources did approach Canadian Blood Services. We have aimed to understand their business plan and have determined that their interests do not align with ours or with achieving domestic security of supply.
Canadian Blood Services shared an ambitious plan with governments almost one year ago, outlining how we will ensure a safe and secure supply of plasma needed to manufacture plasma protein products for Canadian patients by owning the infrastructure – starting with the collection of raw plasma and ending with securing access to plasma protein products for Canadian patients. The plan provides a roadmap for significantly increasing the amount of plasma we collect from Canadian donors, as per our voluntary, non-remunerated (unpaid), publicly funded collections model. At the conference of provincial and territorial health ministers in Edmonton in October 2017, “there was consensus that immediate action is needed to improve and expand domestic plasma collection,” as noted in a news release issued by ministers. We look forward to the report from Health Canada’s Expert Panel on Immune Globulin Product Supply and Related Impacts in Canada, and to governments’ response to our plan. Canadians rely on our system to supply them with the blood and blood products that they need, and we must work together in their best interest.
Dr. Graham Sher
Chief Executive Officer, Canadian Blood Services
Farewell Mr. Feschuk
It was with great disappointment that I read in your latest issue that Scott Feschuk had written his final column. No reason was given. We can only surmise:
- His pay was cut by 75 per cent since he only needed to write one-quarter of the columns since you went digital.
- Trump is not providing enough gaffes to fill a column (not likely).
- He is trying to find out how many subscriptions will be cancelled by his leaving.
- He is tired of single-handedly providing humour in a world of chaos (see b).
- He is concerned he cannot be taken seriously when he must follow The Quiz.
- He is tired—sleep-deprived by working non-stop producing great work.
He will be greatly missed. Maclean’s and Canada need him.
F. MacTaggart, Mississauga, Ont.
The opioid crisis
When Insite first opened its doors in September 2003, it received pushback from everyone from the RCMP to the Bush administration (“2,816 dead Canadians and counting,” National, November 2017). As the years have gone by and legal battles have been fought and won, the numbers do not lie, and certainly Insite now has overwhelming support. As the opioid crisis and the resulting fentanyl crisis escalate, places like Insite have recorded no deaths from overdose. But how do we halt this crisis we have created? B.C.’s Minister of Mental Health and Addictions Judy Darcy has suggested the Trudeau administration decriminalize illicit drugs. Trudeau has responded that his administration is battling the fentanyl crisis through other means, such as border control and increasing naloxone access, but that clearly is not enough. Dan Werb, director of the Toronto-based International Centre for Science in Drug Policy, is also calling Trudeau out for being “short-sighted.” I don’t believe that Canada is ready for the decriminalization of illicit drugs and probably won’t be for a couple of years as the provinces scramble to enforce regulations on weed. So what do we do about all this? Currently, a number of community pharmacies in B.C. are carrying naloxone kits and providing training. Go out and get educated—education also goes a long way to destigmatizing the subject matter.
Jane Kim, Victoria
I am deeply concerned and appalled by the disjointed and muddled nature in which the inquiry into missing and murdered Indigenous women is being conducted (“Lost and broken,” National, October 2017). Doomed from the start, and seemingly more about political optics and posturing, this article gives us a rare look into something that has been carried out mostly behind closed doors. While the legalities of what entails in an official inquiry need to be followed, and despite all the challenges, commissioners, government and all those involved are beholden to seeing this through. If there was ever a time to move forward unanimously, that time is now.
Jessica Jones, Red Deer, Alta.
This article, which documents the apparent movement of the National Inquiry into Missing and Murdered Indigenous Women and Girls toward the dismal destiny of so many previous national inquiries, has reignited simmering flames of frustration and anger in me. Time after time we read reports of how these inquiries either strangle on process difficulties, disintegrate in discouragement or disagreement, face conflict with establishment will or have their work discouragingly neglected. Why? I feel the title of the article too ﬁttingly describes how our political and bureaucratic structures fail not only these inquiries but Canadian society and each of us as citizens. Who are the individuals or what are the inadequate processes responsible? With so much that is positive and abundant about Canada in a world faced with so many disturbing challenges, why do we tolerate these critical issues in our country being managed with such disregard and incompetency?
Greg Elliott, Guelph, Ont.
The Legion’s larder
I was feeling a little melancholy when my Thanksgiving dinner plans fell through, and then I picked up my October issue of Maclean’s and read about the revitalized Kensington Legion No. 264 here in Calgary (“Fine dining at the Legion,” National Notes, October, 2017). Suddenly and fortuitously I had a Plan B. My young daughter and I not only had a delicious meal; we were honoured to admire the Canadian war memorials and armed services crests that decorate the new building. What a special way to give thanks!
Connie Lyndon, Calgary
The science minister on the government progress
Science touches nearly every aspect of our lives; it is research that leads to new cancer therapies, breakthroughs in artificial intelligence, even the screen you’re reading this article on at this very moment. It all starts with science.
For our government, it started with an appreciation for the role that science and evidence-based decision making play in building a better society. This core value stands in stark contrast to the Conservatives. Where we seek evidence, they rely on ideology. Where we encourage scientists to speak freely, they muzzled scientists. Where we invest in the full spectrum of research, they tied funding for science to commercial outcomes.
Canadians can be confident our government is making every effort to right the previous government’s wrongs and bring science back to the federal table. The evidence lies in our two federal budgets which saw billions of dollars invested in science and innovation programs.
In fact, Budget 2016 included an increase in annual funding for the three federal granting councils. Contrary to a claim made in Maclean’s (“Science in Canada needs funding, not photo ops,” Macleans.ca, Nov. 5) this investment was the largest in over a decade and is part of the more than $3 billion already disbursed each year through the granting councils to support all sciences.
Our government’s investments complement the actions I am taking to strengthen science in Canada. One of my first steps to achieve this goal was to commission the Fundamental Science Review. I am now implementing many of the review panel’s recommendations to improve the research experience in Canada.
For example, I recently launched the new Canada Research Coordinating Committee (CRCC) and capped renewals of Tier One Canada Research Chairs, a program that has seen more men than women appointed into these roles. The latter move is one of several I have taken to bring greater equity and diversity in academia. I firmly believe we must welcome all minds if we are to realize our greatest potential in research.
Frankly, the moment to seize that potential is at our fingertips. In my recent travels abroad, my G7 counterparts remarked on how Canada is a “beacon” in a world where support for science, facts and evidence is fading in some quarters.
We are open, socially progressive and ambitious country that is putting a spotlight on science. What is revealed in that bright light is a future full of discovery, opportunity and immense possibility for all people.
Kirsty Duncan, Canada’s Minister of Science
Government’s debt to society
There are two factors that play into personal debt on a far greater level than the costs of home ownership or household lines of credit (“How Canadian homes became debt traps,” macleans.ca, Nov. 13, 2017). One is an almost complete lack of education starting at the earliest levels as to how to manage debt and the costs associated with maintaining a debt load. This lack of education is a reflection of the “cheap and easy” credit model that is relatively new in both Canada and the United States. The second is the accessibility of high-interest credit cards and abundance of credit limits well beyond what most can reasonably expect to pay back. Instead of focusing an article on people who are extending lines of credit to, in most cases, pay off those punitive credit cards and bad decisions made by a lack of knowledge or self-control, you instead chose to look at the lowest rate loans as the villain.
The article, while hinting at the true issues, wound up pointing the finger at the wrong target: If you educate more and limit the actual available credit limits these credit cards provide, then the home equity line of credit issue largely resolves itself. The government would be doing its citizenry a huge favour by focusing its eyes on the banks and credit card companies and actually addressing the debt issues at the root. Constantly trying to shift blame away from the banks and the billion-dollar profits generated by these interest rates is protectionism at its worst.
Pete Taylor, Kelowna, B.C.