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A bloody mess: The story behind paid plasma in Canada

Internal documents show Health Canada working hand-in-glove with a private company to push a donation model the Krever inquiry warned against. Has it failed in its role as regulator?
Canadian Plasma Resources in Saskatoon, SK. (Photograph by Derek Mortensen)
Canadian Plasma Resources in Saskatoon, SK. (Photograph by Derek Mortensen)
Canadian Plasma Resources in Saskatoon, SK. (Photograph by Derek Mortensen)

In February 2016, Canadian Plasma Resources (CPR) opened its first paid plasma collection centre in Saskatoon with a splashy media event attended by then-Saskatchewan health minister Dustin Duncan. That an enterprise paying Canadians for their blood was setting up in Saskatchewan, the cradle of the country’s publicly funded health-care system, was only one jarring detail accompanying CPR’s arrival. For years, safe-blood activists, led by BloodWatch, and medical groups had opposed CPR, concerned about the commercialization of the country’s blood system. The company first made headlines in 2013 when it was poised to open three collection sites in Ontario—one beside a men’s mission in Toronto, another next to methadone clinic in Hamilton. Protest and political debate ensued. In December 2014, Ontario passed legislation banning payment for blood, as Québec had done two decades earlier (Health Canada is responsible for the safety of the blood system and approves blood collection facilities; provinces determine whether people can be paid for blood products).

CPR isn’t the first company in Canada to pay for human plasma; Cangene Corporation, a small outfit in Winnipeg, has for decades paid for plasma that contains a rare antibody (it now also collects regular plasma). But CPR, which reimburses donors for an hour-and-a-half donation via $25 Visa gift certificate (or they can donate that amount to a charity for a tax receipt) was the most ambitious, with plans to expand to other provinces. Donors are encouraged to give often: “Super Hero Rewards” members qualify for monthly draws; “silver” and “gold” donors are eligible for “prizes valued at over $2,000.” The company promotes plasma donation as an altruistic act (“by becoming a plasma donor, you can help Canada satisfy its own needs for plasma therapies”), even though there are no assurances therapies made by the plasma it collects will end up back in the country.

Eight months later, in October 2016, Canadian Blood Services, the non-profit independent organization entrusted with managing the nation’s blood supply and blood products (Héma-Québec does the same in that province) sounded an alarm about CPR. Its Saskatoon operation was impinging on Canada’s plasma self-sufficiency, it announced. The blood authority, which is funded by provinces and territories, called for governments to put a “pause” on for-profit plasma collection, as it came up with its own strategy.

RELATED: What a blood plasma-for-profit clinic means for public health care

The announcement signalled an abrupt, 180-degree turnaround from CBS’s former stance. For years, it appeared on-side with the idea of a blood broker selling a resource harvested in Canada to the highest bidder on the global market. In its communications, the blood authority emphasized the point that paid plasma manufactured into therapies was safe. In fact, a video produced by CBS, funded by tax dollars, ended up on CPR’s website to encourage donation. Nor had CBS appeared concerned that the for-profit company’s “Give plasma, give life” motto might be confused with CBS’s own “It’s in you to give.” Then in December 2016, CBS announced what those who opposed paid plasma had feared: volunteer blood donation in Saskatoon declined due to CPR’s arrival. Yet CBS’s concerns didn’t prevent Health Canada from approving CPR’s Moncton collection site in July 2017, effectively setting it up as a competitor with CBS.

Now documents obtained via access to information—more than 850 pages of communications between Health Canada, CBS and CPR between 2009 and 2016—raise new questions about blood governance in Canada and its ties to industry. They indicate that, since 2009, CPR’s parent has been working in a partnership with then-German-owned Biotest AG, the world’s fifth biggest player in the plasma-proteins therapies market; in 2009, it told Health Canada that it planned to invest $400 million to spearhead a Canadian plasma industry. Health Canada, which describes its relationship with CBS as “arm’s length,” worked closely with the blood authority shaping messaging that paved way for CPR’s arrival. The documents reveal that over years Health Canada worked collaboratively with CPR itself—in one exchange a top Health Canada official asked if CPR planned to announce its Saskatoon facility before or after Health Canada’s inspection, an approval necessary for it to set up business; she later sent “Congratulations!” after the approval was granted.

Emails within Health Canada also indicate the agency wanted to phase out reliance on the five-year 1997 royal commission into the “tainted blood scandal” headed by Justice Horace Krever long upheld as a roadmap for blood governance; it warned against compensation for blood products. In its place: a three-page 2010 document created at a “stakeholder” meeting convened by an industry lobby group. The documents also cast doubt on former health minister Jane Philpott’s statement in a March 2016 interview that she knew nothing of CPR’s business plans. In fact, CPR had provided the ministry with detailed business plans for years; in February 2016, a month before that interview, the minister’s office itself requested information about the number of jobs created by CPR in Saskatoon.

Innocent Gasana processes plasma to prepare it for shipment and testing at Canadian Plasma Resources in Saskatoon, SK. (Photograph by Derek Mortensen)
Innocent Gasana processes plasma to prepare it for shipment and testing at Canadian Plasma Resources in Saskatoon, SK. (Photograph by Derek Mortensen)

Canadian Plasma Resources didn’t exist when Health Canada met with Examon Industries and Consulting Services and Biotest AG on Jan. 25, 2009—a discussion described in Health Canada communications as “relating to corporate interest in the establishment of a human plasma collection business, and subsequent human plasma fractionation facility, in Canada.”

Certainly there’s big money in plasma, the pale yellow protein- and antibody-rich component remaining after white and red blood cells, platelets and other cellular components are removed from blood. It’s used in transfusions, and in plasma-protein therapies processed via fractionation technology—albumin for burns and trauma, factor VIII to help clotting in people with hemophilia and other bleeding disorders, and intravenous immunoglobulin, known as Ig or Ivig. Demand for transfusion plasma is declining due to replacement products and new surgical techniques; demand for raw plasma, on the other hand, to be used in the manufacture of plasma protein therapies is booming— it’s the basis of a multi-billion-dollar business driven by demand for Ig, which can run $7,000 per treatment.

Encouraged by the Health Canada meeting, Exapharma Inc. was incorporated in July 2009 as the parent of Canadian Plasma Resources, which was registered in November 2010 to operate “plasmapheresis centres.” Plasma collection is high-margin business: extraction that nets the donor $25 can yield therapies worth at least $300, hence the proliferation of paid-plasma centres in the U.S., Germany, Hungary and the Czech Republic, the four countries where blood brokers are allowed to operate. Canadian plasma, in particular, has a high value in the world market, Bahardoust told Maclean’s in 2016, due to perceptions of the nation’s health—abetted, ironically, by the country’s publicly-funded health-care system

By 2011, Exapharma was sharing floor plans for its Ontario sites with Health Canada and meeting with officials. CPR applied for a federal license to operate in Ontario in November 2012.

READ: How the new impatient patient is disrupting medicine

Various medical groups, among them Canadian Doctors for Medicare and the Canadian Nurses Association, opposed paid plasma. So did CBS’s own union. Paying blood donors is a charged topic in Canada, home of the “tainted blood” scandal of the early ‘80s. An estimated 8,000 Canadians died—with more than 20,000 afflicted—from improperly screened blood infected with AIDS and Hepatitis C from paid donors in Haiti and American prisons and skid rows.

The Krever inquiry concluded that blood donation should remain voluntary and unpaid “except in rare circumstances.” Blame for the tragedy lay not only with the Canadian Red Cross reacting too slowly to the AIDS crisis, it concluded; the malfeasance was systemic, driven in part by the profit motive. Krever also made clear Health Canada must regulate in the interest of the public—not that of companies engaged in commercial activities.

Krever’s report shaped the current blood system. CBS and Héma-Québec were established  in 1998. In addition to collecting blood from volunteers, both agencies work closely with industry, awarding contracts to manufacturers on behalf of provincial and territorial governments. Again, big money changes hands. In 2016, CBS spent over $623-million of its $1.1-billion budget on plasma-protein drugs, up from $459-million two years earlier.

Internal government documents suggest neither CBS or Health Canada anticipated the intensity of public protest over CPR. They worked closely to “issue manage” the concerns raised: that paid-plasma would weaken the volunteerism on which the blood system depends; that the profit motive could compromise quality standards; that selling plasma could pave way to sale of other blood products such as stem cells; that the poor were being exploited.

CBS’s CEO Graham Sher, a medical doctor, assured the public that paid plasma posed no safety risk due to new safeguards and the “cleansing” that takes place during manufacturing; most plasma-based medications used by Canadians were made from plasma collected from paid U.S. donors, he liked to point out. Sher also waved off concern that paying for plasma would hurt volunteerism, citing data from the U.S. and Winnipeg, where Cangene Corporation operates. Yet other research indicated paid plasma did affect volunteerism: a 2010 report in the Asian Journal of Transfusion Science noted the American Red Cross had to adopt “incentives”—from T-shirts to cash prizes—to spur donations.

As reported by Maclean’s in 2013, CPR representatives met at least twice with Canadian Blood Services between 2009 and 2011, they discussed potential “public-private-sector partnerships,” including CPR testing plasma at CBS labs, using CBS’s storage facility as a backup and referring donors with in-demand blood types to CBS. They also discussed the time frame for CBS’s next tender for plasma-derived products. In 2012, with discussion between Exapharma, CBS and Health Canada ongoing, CBS shuttered its Thunder Bay plasma collection centre, citing a lack of demand in transfusion plasma; some 30 jobs were lost. Meanwhile, the government of Ontario, where CPR was investing millions, had not been apprised of the collection centres opening. Then health minister Deb Matthews told Maclean’s she didn’t hear about the operation until 2013.

CBS and Health Canada coordinated messaging to hammer home the “safety” of plasma-protein products—to make it clear CPR was collecting for manufacturing and that the plasma would never enter the transfusion system.  “I don’t think that message can be given too many times in reference to ‘viral inactivation’,” Catherine Parker, then acting senior executive director of Health Canada’s biologics and genetic therapies directorate (Parker was named general director in June 2015).

Within Health Canada there was dismay that activists, medical groups and the media kept evoking the tainted blood scandal. A letter written by Monika Dutt, chair of Canadian Doctors for Medicare, published in the Hill Times, was circulated internally as “so much misinformation being put forth.” In it, Dutt cited numerous concerns: that although blood screening techniques improved post-Krever, Health Canada “does not know what the next blood-borne pathogen might be and should exercise caution in respect to safety”; that “there is no indication that plasma collected at these facilities will be purchased by Canadian Blood Services, nor has Canadian Blood Services said that there is a supply issue that could be remedied through for-profit, paid-donor plasma clinics.” 

Health Canada found itself under critical fire from CBS for its own “public messaging” focusing on plasma safety. A  July 2013 letter to then-health minister Leona Aglukkaq from Leah Hollins, chair of the CBS board, asked for the minister’s “effort in ensuring this debate stays focused on the policy issue at hand.” Trust between the Canadian public, CBS and the government “is fragile, Hollins told Aglukkaq, “particularly given the history from which we have come.”

The tone of the letter is “completely unacceptable,” Ottawa physician Michele Brill-Edwards, a former Health Canada official who reviewed the ATI documents, tells Maclean’s. Brill-Edwards headed drug approvals at Health Canada between 1987 and 1992; she quit in 1996 after blowing the whistle on the agency’s suppression of prescription drug risks.

“CBS does not instruct the regulator as to how they will frame a safety issue,” Brill-Edwards explains. As she sees it, the letter is a very early signal that CBS is calling the shots and creating a climate of intimidation at Health Canada. “This is like the person charged coming into court telling the judge what to do,” she says. “That’s how backward that letter is.” The instruction to reframe the issue as “a public policy decision” is particularly problematic, she says: “Policies are political options that have nothing to do with safety. Safety has to do with scientific evidence: what we know, what we’re afraid we don’t know.”

CBS spokeswoman Isabelle Robillard says it is “absolutely appropriate” for CBS “to provide advice and expert opinion” on the blood system to the regulator. “In turn,” she added in an email, “it is up to governments to make policy decisions.”

Brill-Edwards, however, says CBS appears to want to ensure that “the half-truth” was the only message. “And the half truth is that payment for plasma is safe until—and this is the other half of the truth—a new infectious agent comes along. At that point, paid plasma is not as safe as voluntary donated plasma,” she says, speaking of raw plasma. The World Health Organization agrees: it has called for all countries to move to unpaid donation systems by 2020, given studies pointing to volunteers having the lowest prevalence of blood-borne infections. CBS’s Robillard insists plasma protein therapies are “exceedingly” safe: “since the introduction of multiple layers of inactivation and purification during the fractionation process, there has not been a single documented case of transmission of HBV, HCV or HIV,” she writes in an email.

The documents also indicate Health Canada wanted to phase out the 1,179-page Krever Commission as a benchmark and replace it with the Dublin Consensus Statement created at a 2010 meeting in Ireland attended by patient groups, health organizations and the Plasma Proteins Therapeutics Association (PPTA), the industry lobbying group. “This is getting very frustrating and one of the messages we are trying to relay is that blind adherence to the Krever recommendations is no longer warranted and we need to look at more recent relevant recommendations such as the Dublin Consensus,” Parker wrote in a May 31 email.

Kat Lanteigne, co-founder of BloodWatch, dismisses the Dublin Consensus as “a three-page Big Pharma-backed position paper that has no Canadian data attached to it.” She adds: “It is incredible Health Canada officials would use this to determine public health policy.” A push to adopt the Dublin Consensus also confounds Brill-Edwards: “The Dublin Consensus has no standing whatsoever in terms of rigorous evaluation of evidence,” she says. “Krever, on the other hand, was a publicly paid and authorized legal mind that studied reams of evidence. So why would a regulator go with the Dublin report as their reference? The answer is that no appropriate, well-informed regulator would do so.”

Health Canada maintains the Krever commission findings do not reflect current technology: “The manufacturing process for plasma products has significantly advanced since the Krever inquiry,” spokesperson Gary Houb tells Maclean’s in an email. Both Health Canada and CBS went to great lengths to reiterate the message that plasma products made from paid and unpaid donors are equally safe: “There is no evidence that pathogens are more likely to be present in plasma protein products from paid donors versus unpaid donors,” writes Robillard, the CBS spokeswoman.

Slowly the Dublin Consensus Statement has entered public discussion of blood safety. During a November 2016 Senate debate over paid plasma, Philpott, a medical doctor, cited it as evidence that “the blood supply in this country is safe and that plasma protein products used in this country are safe.” Sher defended the Dublin consensus  in a January 2017 interview with Maclean’s, calling it “a patient and stakeholder form, not an industry form.” ATI documents showed that Sher referenced the Krever Inquiry to give credence to his point at an April 2014 “stakeholder” roundtable meeting about paid plasma in Toronto. He told the gathering that CBS’s “long-term strategy toward sustainable plasma sufficiency” began in 2003″ and then cited Krever: “Self sufficiency of the blood supply is a desirable goal…the principle of self-sufficiency does not mean that plasma must be fractionated by a domestic fractionation facility.” Philpott also credited the lessons of Krever when it was useful, noting in the Senate debate that Canada has “one of the safest blood supply systems in the world, in large part because there were serious errors made in the past and we had to correct our ways.”

Documents reveal that exchanges between CPR and Health Canada during 2013 and 2014 focused on the protocols required for approval of CPR’s Ontario facilities, the company’s business plans, Ontario’s proposed legislation to ban paid plasma donation, and a July 2014 raid of CPR’s properties by Ontario Ministry of Health inspectors. CPR’s point man was Jim Pimblett, a government lobbyist who was a spokesman for Paul Martin and then executive assistant to Liberal leader Michael Ignatieff. In March 2014, Pimblett sent a “Heads up” email to Health Canada’s Parker about Ontario proposing legislation to ban paid plasma. Parker thanked him and promised “will keep you posted.” Pimblett kept the regulator apprised of positive media coverage; in March 2014, he noted online comments on a Toronto Star story are “in favour of CPR” and that a Globe and Mail reporter “seems to be sympathetic as well.” Parker promises to “check those out.”

Pimblett’s activity at Health Canada was not a matter of public record until March 2016, when he registered as a federal lobbyist a month after the Saskatoon facility was approved. Before that, he lobbied only at the provincial level, Pimblett told Maclean’s via email. His communication with public officials at Health Canada on behalf of CPR wasn’t lobbying, he says: “I was invited to participate in conference calls with Health Canada officials who were processing CPR’s license application. They wanted information with respect to my conversations with various provincial governments on the issue of compensating donors.” There was no need to lobby the feds, Pimblett adds: “They were supporters of the compensated plasma donor model.”

That support was indicated in a Februrary 2014 email from Parker to Bahardoust in which the regulator shared information about “an informal roundtable consultation” between the health minister and a few “key patient groups” to solicit their views on payment for plasma; it “went very well and there was strong support…,” Parker wrote. On Feb. 3, after approval was granted, Parker sent “Congratulations!” to Bahardoust, again asking about the company’s plan to announce. Bahardoust told her Saskatchewan Health Minister Dustin Duncan would be at the opening ceremony and told the regulator company would first inform PPTA, CBS, and select patient groups. 

Shelley Barker checks on Miranda Sadar who is giving plasma on December 22nd, 2016 at Canadian Plasma Resources in Saskatoon, SK. (Photograph by Derek Mortensen)
Shelley Barker checks on Miranda Sadar who is giving plasma on December 22nd, 2016 at Canadian Plasma Resources in Saskatoon, SK.
(Photograph by Derek Mortensen)

Such friendly exchanges between regulator and regulated company are  “inappropriate,” Brill-Edwards says: “We expect a judge or regulator to have no skin in the game, to be objective, to not care on a personal level about who wins and who loses. ” Health Canada has a responsibility to keep an objective distance from companies they regulate, she says, because “they are the safety police in the system and you can’t have friendly relationships that compromise objectivity when making decisions that are solely in the public interest.” A Health Canada spokesman told Maclean’s that “it is normal for Health Canada and a given company to have back and forth communications during the regulatory review process. It is also normal for Health Canada to relay patient or stakeholder feedback to companies.”

In November 2015, months before Health Canada’s inspection of CPR’s Saskatoon collection centre, Bahardoust sent Parker a “confidential” letter outlining CPR’s business plans; it noted the $400-million investment, and referenced its original plan to build 10 centres and a fractionation plant with Biotest AD (the company was bought by a Chinese interests in April 2017 for U.S. $1.4 billion).  Canada is described as the “world’s 4th largest market for IV products.”

Barhardoust also kept Health Canada appraised of Pimblett’s meetings with other provincial health ministers, often accompanied by Biotest executives, “to ensure that a domestic plasma protein industry can take root in as many places as possible.” The company had “comfort letters” from British Columbia, Saskatchewan, New Brunswick and Manitoba and expected one from Nova Scotia; CPR had yet to reach out to Newfoundland, P.E.I. and Alberta. (Provincial opposition has quashed some of the company’s ambitions: Alberta banned selling plasma for profit in 2017; B.C.’s new Health Minister Adrian Dix, named in July 2017, opposes paid plasma.)

Bahardoust wrote he was“very excited” about the upcoming inspection of the Saskatoon centre in an email to Health Canada in December 2015. In response, the government asked about how he planned to announce approval—before or after inspection—so they could be “prepared for any media interest.” Bahardoust said “after”; he kept the regulator appraised about media coverage, including an interview request from the local CBC Saskatoon morning show.

Parker also asked how many jobs CPR would create in Saskatoon. Up to 40, Bardhardout told her, noting the company had purchased a lot for a fractionation plant in the West, with plans to set up “at least 10 CPR centres in western provinces and possibly Atlantic provinces.” He referred to “Phase II” after 2021 with a fractionation plant built in two stages as “a $300 million investment providing 500 jobs for ‘skilled individuals’.”  (In 2014, Green Cross Biotherapeutics, a Canadian subsidiary of South Korea’s Green Cross Corporation, announced construction of Canada’s first IVIG and albumin manufacturing plant in Montreal; it broke ground in 2015.)

Brill-Edwards expresses amazement at Health Canada’s focus on media coverage and business details. “Excuse me? You are the health regulator; you are the referee. You are supposed to make decision on evidence: did the puck go in the net or not. It has nothing to do with attendance at the stadium.” The former regulator expresses concern: “As I read  through the documents, my overall impression is that that ethic of regulation—the understanding of the need for objectivity—has been lost in the current system,” she says. “It tells us that the regulator was more concerned that the messaging about the decision didn’t cause political problems than they were with the decision itself.”

On Jan. 15, 2016, three days before Health Canada inspection of the Saskatoon plant, CBS sent out a “Confidential briefing note to provincial and territorial blood liaison committee” to inform them “it is anticipated that Health Canada will issue an establishment license to CPR approximately one week after inspection is completed.” It laid out “talking points”—that paid plasma is “not a safety issue, a moral and ethical decision for policy makers, requiring consultation with Canadians.” CBS also reiterated concern that a prohibition on paid plasma “would deny Canadian access to plasma drugs.” Yet nowhere in any of the negotiations was there a guarantee, or legal requirement, that plasma collect by CPR from Canadians be manufactured into products that would benefit Canadians.

Miranda Sadar gives plasma on December 22nd, 2016 at Canadian Plasma Resources in Saskatoon, SK. Miranda is a vet at the University of Saskatchewan specializing in zoo exotic and wildlife animals. She gives plasma regularly. (Photograph by Derek Mortensen)
Miranda Sadar gives plasma on December 22nd, 2016 at Canadian Plasma Resources in Saskatoon, SK. Miranda is a vet at the University of Saskatchewan specializing in zoo exotic and wildlife animals. She gives plasma regularly. (Photograph by Derek Mortensen)

CBS assisted Health Canada on communications surrounding handling media coverage of CPR’s opening. An email sent by a government relations person to Parker instructed: “key messages remain the same as they were in 2013 or so…” In February 2016,Parker asked Barhardoust about potential jobs creation in Saskatoon “and any other relevant factors for investment,” explaining “I need this for a question from the minister’s office.” Barhardoust replied with details about finalizing a supply agreement with Biotest to import finished product back to Canada. Its goal was to have a Biotest IVIG product registered in Canada by the fourth quarter of 2017 and additional products registered by 2020. Health ministers should have nothing to do with industry or their lobbyists, says Brill-Edwards: “It is not an industrial or economic issue.”

A month later, in a March 7, 2016 radio interview, then Health Minister Philpott said “I have no idea what the plans of the company are.” (Maclean’s emails and phone calls to the minister requesting response were referred to Health Canada; the department didn’t address them and referred them to the minister.)

Eight months after CPR’s facility was approved in Saskatoon, CBS went public about the risks private enterprise posed to Canada’s plasma self-sufficiency. At its annual general meeting in October 2016, Sher announced that the voluntary blood donation system was not meeting the nation’s need for plasma required for Ig medication. He asked governments for “a pause of support for commercial activity” in plasma until CBS could unveil a strategy to increase voluntary plasma collection. Two months later, Sher blamed CPR’s Saskatoon plasma collection for a decline in volunteer whole blood donations in the city (Bahardoust denied this).

In January 2017, CBS announced a seven-year, $855-million strategy to increase Canada’s plasma self-sufficiency from 17 percent to 50 percent; it would require as many as 40 new plasma collection sites collecting more than 600,000 litres of plasma per year by 2024 and “upwards of 144,000 new plasma donors” annually.

Six months later, in July 2017, Health Canada approved the Moncton CPR plasma collection centre. The “pause” request was directed at the provinces, not the feds, Health Canada told Maclean’s, noting that it can deny a license only for reasons of health and safety. Lanteigne counters that the security of the blood supply is a health and safety issue. “Health Canada and the Minister have the right to deny a private blood broker a license based on the memorandum of understanding and Krever,” she says.

CPR plans to build approximately 10 plasma collection centres to supply the fractionation plant they want to build in Canada, Pimblett tells Maclean’s. The next two centres won’t begin construction until 2019 and will most likely be in Saskatchewan and New Brunswick. CPR, in partnership with Biotest AG, is also exploring potential opportunities with Green Cross.

The concerns now being raised by CBS echo those voiced for years by safe-blood activists: “Plasma, just like whole blood, is a public resource that must be safeguarded for Canadians,” the blood authority announced. It also cited data from Hungary and the U.S. that show expansion of for-profit, remunerated plasma collection “has substantially affected the public blood operator’s ability to collect blood in that country (up to a 20 percent decline in blood donations).”

In emails with Maclean’s, CBS states that data indicating for-profit blood brokers affect voluntary blood donation was not available in 2013 when they “first started considering the impacts of the remunerated plasma system in Canada.” Yet CBS knew of CPR’s plans in 2009 and research dating before 2013 indicated the risks to voluntary donation. CBS says “available evidence—mainly from the U.S.—showed that remunerated and non-remunerated systems could conceivably coexist.”

CBS now says it has no plan to buy plasma from other providers, such as Canadian Plasma Resources (the ATI documents indicate buying from CPR had, in fact, been discussed). CBS points out that it’s a precarious prospect: a third-party provider can sell anywhere when a contract ends. The publicly funded CBS says it has no plans to pay donors, other than the traditional cookies and juice. (Again messaging has been blurred: at the 2016 CBS annual meeting, Sher said that the plasma strategy would start with non-paid, per Krever, but they would have to consider payment if that didn’t work.)

BloodWatch’s Lanteigne finds it “incredible” that, since 2013, CBS “did not voice the appropriate position consistently to Health Canada or provincial health ministers.” Both CBS and Health Canada officials would have understood that a company like Canadian Plasma Resources would not increase plasma product for Canadians, nor would it help us become less-reliant on foreign sourced plasma, she says: “It is tantamount to selling the sovereignty of our donors and a major portion of our blood supply to a foreign multinational corporation.”

BloodWatch wants the CBS board and Parliament to review how CPR got a foothold in Canada: “We have yet to receive clear and definitive answers as to why CBS supported CPR and their private venture, considering their private operation was a direct threat to the security of our public blood supply,” she says. “It is antithetical that CBS—born out of our country’s greatest health-care disaster in order to run and maintain a voluntary blood system in Canada—did not take action to warn against blood brokers in 2013.” BloodWatch is calling for CPR’s licenses to be revoked in light of Canadian Blood Services’ announcement.

In its communications with Maclean’s, CBS refers to the “emergence of a new dynamic in Canada—commercial, for profit plasma collection—is an example of a highly complex issue affecting the blood system in Canada, one which the national blood authority and governments continue to discuss.” Yet had CBS and Health Canada not paved way, these “highly complex issues” would not exist. CBS also insists “the Krever inquiry and resulting recommendations will always be paramount and foundational to the blood system in Canada.” That doesn’t explain why CBS, for a time, rejected the commission’s paramount principle: that blood products not be sold “except in rare circumstances.” It is now one question among many that both CBS and Health Canada need to answer.

This story has been updated to include additional response from Canadian Blood Services

Clarification: Friday, Nov. 24 

An earlier version of this story said that Leah Hollins, chair of the board of Canadian Blood Services, did not respond to a request for direct comment. That statement has been removed because Maclean’s has been unable to confirm that our request for response reached Hollins. The article will be updated in the event that Hollins provides comment.