THE STANDING SENATE COMMITTEE ON SOCIAL AFFAIRS, SCIENCE AND TECHNOLOGY
OTTAWA, Wednesday, December 5, 2018
The Standing Senate Committee on Social Affairs, Science and Technology, to which was referred Bill S-252, Voluntary Blood Donations Act (An Act to amend the Blood Regulations), met this day at 4:15 p.m. to give consideration to the bill.
Senator Chantal Petitclerc (Chair) in the chair.
The Chair: Welcome, everyone, to the Standing Senate Committee on Social Affairs, Science and Technology.
I’m Senator Chantal Petitclerc from Quebec. I am very pleased to be chairing this meeting.
Before I give the floor to our witness, I would like my colleagues to please introduce themselves.
Senator Seidman: Judith Seidman, Quebec.
Senator Poirier: Rose-May Poirier from New Brunswick.
Senator Hartling: Nancy Hartling, New Brunswick.
Senator Forest-Niesing: Josée Forest-Niesing from northern Ontario.
Senator Ravalia: Mohamed Ravalia, Newfoundland and Labrador.
Senator Mégie: Marie-François Mégie from Quebec.
Senator Manning: Fabian Manning, Newfoundland and Labrador.
Senator Munson: Jim Munson, Ontario.
Senator Oh: Victor Oh, Ontario.
Senator Wells: David Wells, Newfoundland and Labrador.
Senator Omidvar: Ratna Omidvar, Ontario.
The Chair: Welcome, everyone. Today, we are beginning our study of Bill S-252, Voluntary Blood Donations Act (An Act to amend the Blood Regulations).
I would like to introduce our witness, the Honourable Senator Pamela Wallin, sponsor of the bill.
Senator Wallin, I believe you have some opening remarks for us before we go to questions.
Hon. Pamela Wallin, sponsor of the bill: Thank you, chair and colleagues, for the opportunity to appear before the committee today to discuss Bill S-252, the proposed voluntary blood donations act.
The intent of this bill is clear: to put an end to paying people for their blood, and to put an end to the sale and export of that blood to foreign buyers.
The cash-for-blood system undermines the voluntary nature of giving — an act deeply rooted in Canadian society, an act of generosity by Canadians to save the lives of loved ones and strangers alike.
Having private plasma collection clinics in Canada creates other problems. They set up shop in disadvantaged areas with vulnerable populations. This is an ethical issue, for sure. Because they sell their product — the product they collect for a profit only to foreign buyers — there is no contribution to Canadian needs. Therefore, this bill won’t affect the supply for rare blood needs.
Currently, Canada is dependent on the United States for 80 to 85 per cent of all the plasma being used in our medical system.
Canadian Blood Services, our national not-for-profit blood and plasma collector, is aiming for 50 per cent self-sufficiency. However, they can’t reach that goal if their voluntary base is being poached for profit.
There is more than anecdotal evidence. We have information obtained under freedom of information, as well as, of course, the public record. Canadian Plasma Resources, the only private for-profit plasma collection operator in Canada, now boasts having over 300 visits a week at its Moncton location and aims for 1,000 a week. They claim to have over 3,000 regular donors in Saskatoon. It is not surprising, then, that Canadian Blood Services has recently experienced a drop in its donor base, particularly in young adults. Why? Because for-profit clinics have been targeting their physical and online advertising to 18- to 24-year-olds, including putting up ads in university washrooms, promising cash.
Colleagues, paying for plasma incentivizes the wrong behaviour. This is not building altruistic citizens or a strong donor base. Canadian donors are not meant to be a revenue stream for private companies looking to make a profit, and Canadians have never required a financial reward to find the will to donate.
I’d like to take a moment to remind all of us why we are having this discussion.
It was nearly 30 years ago that tainted blood infected over 30,000 Canadians with HIV or hepatitis C. It is thought another 8,000 may yet die as a result of that contamination.
Canada set up the Krever commission in 1993. The resulting report called for Canada’s blood donor system to remain a protected public resource.
Canadian Blood Services was created as the sole entity for blood collection. For the past 20 years, CBS has been working to rebuild the voluntary system that once flourished under the auspices of the Red Cross. It has proved difficult to rebuild public trust and confidence. CBS does not have the name recognition or, as we say today, “brand awareness,” as the Red Cross once had. It is even harder when the voluntary system is being actively undermined.
But memories are short. In 2013, Health Canada decided to open up access to blood collection by private for-profit companies and began issuing licences to Canadian Plasma Resources, or CPR. No one on earth can figure out why these licences were ever issued. There was one meeting with some stakeholders. There was no public consultation and no demonstrated public need. Before long, Ontario, Alberta and then British Columbia all moved to pass legislation to stop private operators.
Bill S-252 is modelled on that legislation and is inspired in part by the fact that Quebec has — for more than 20 years — banned all private plasma collection.
When I learned that one of the two private plasma collection facilities was operating in my home province of Saskatchewan, I knew I had a responsibility to introduce this legislation.
Media reports to the contrary, legislation to ban paid plasma is supported by over 80 per cent of the stakeholders in Canada’s blood system, including, of course, Canadian Blood Services. The ban is also supported by the International Red Cross, the World Health Organization, the European Blood Alliance, and the International Society of Blood Transfusion, by medical professionals everywhere, and, of course, it crosses all party lines.
Colleagues, I believe ensuring a safe and voluntary blood donation system in Canada is the right thing to do.
The objective of this bill is to rebuild and then retain the true blood donor base in Canada, but it can’t happen if we let for-profit operations entice donors away from the public system with credit cards or cash.
The licensing of paid plasma clinics in Canada contravenes every single fundamental recommendation of the Krever inquiry. We need an immediate moratorium on the granting of any new licences until this issue is fully vetted — a process that we have begun today.
Thank you for your time and, particularly, for this opportunity.
Before we begin questions, I have with me today Kat Lanteigne. We may invite her to join us at the table. She is the executive director and co-founder of BloodWatch. This is a group that has taken up the cause of those infected during the tainted blood crisis. She has been working on this as a volunteer for years. I first met her when, as a reporter, I was covering some of these stories. She knows far more than I do and brings her heart, not just her brain, to the table.
Kat, would you like to come to the table? I will try to answer the questions too.
The Chair: Thank you, Senator Wallin.
We will proceed with questions. I remind you of five minutes for your questions and answers. Hopefully we will get to a second round.
Before we begin with our deputy chair, I want to hear you on why the bill proposes to amend the blood regulations and not the Food and Drugs Act.
Senator Wallin: It is my understanding this is in the regulations. I think that is where it emerged. Let’s put the hammer on the head of the right nail, is my answer to that.
The Chair: Thank you for that answer.
Senator Seidman: Thank you very much, Senator Wallin, for your sincere presentation. It is much appreciated.
I would like to ask you a couple of questions, the first on the issue of supply. It is my understanding — and I believe you made reference to this — that Canadian Blood Services and Héma-Québec made the domestic demand for whole blood and plasma fractionation. However, beginning around 2016, the combined volume of plasma collected by these two organizations accounts for only close to 17 per cent of the plasma required to meet the needs of Canadians. You made reference to that.
Senator Wallin: Yes, it is 80 to 85 per cent.
Senator Seidman: That is the shortfall. We have to go outside the country and the product is bought from the United States. I think it’s fair to say that we have to recognize in the United States they pay for blood donations. In essence, Canadians are still receiving paid-for blood donations through the creation of the plasma that we then import and use; right? The blood we are getting to create the plasma is paid for in the United States.
The demand for immune globulin continues to increase steadily, about 6 to 10 per cent per year. Canada is now the second highest global user per capita of immune globulins.
If you look at Health Canada’s final report that was released in May 2018 — it is the Expert Panel on Immune Globulin Product Supply and Related Impacts in Canada, and I say it’s Health Canada’s own report — they found that no country in the world has been able to meet their need for plasma solely with a voluntary model.
When you look at that set of facts, the question is how will we meet the Canadian demand for plasma without paying for donations?
Senator Wallin: I think there are two parts to that question which I will deal with.
What we want to see is our own behaviour in this country reflect what it once was. We see it in particular cases like the Humboldt Broncos or when there was the tornado through this area, for example. We need to recreate that altruistic sense of we have a responsibility as citizens to participate in creating supply for our own needs.
The flip side is I don’t think anyone is suggesting we go to 100 per cent. There are medical reasons for that. You don’t want to have all your eggs in one basket if something happens. If there is another contaminated blood issue like we witnessed 30 years ago, we don’t want to have our own supply potentially completely undermined. I think Canadian Blood Services would say they are aiming for approximately 50 per cent self-sufficiently.
Yes, we will import other products, and science and technology will eventually create other products that will help us deal with that situation. First and foremost, we need to get back to where we once were.
I mentioned in my remarks that it is very difficult for Canadian Blood Services. They came out of a difficult time where people didn’t want to go and give blood because they were worried about the safety of giving that blood if they were in a Red Cross facility somewhere.
It has taken a long time to create that entity. It doesn’t have the awareness that the Red Cross did to bring people back to the table. The time is about right for all of the downsides of people having short memories and forgetting what happened during that time. We also have a generation coming up that doesn’t remember that; so they’re not afraid. We also have to create the right attitude in their mind. We are already starting to see the confusion.
Senator Seidman: Could I ask you about the safety? I admire what you are doing. Altruism won’t provide us with a blood product that we need in this country. That is my concern.
I understand what you are doing. I would like to ask you about the safety issue.
Health Canada’s final report — again, I refer to it because it was just released — and I tell you the report is exactly on these issues: Protecting Access to Immune Globulins for Canadians, final report May 2018. In that report they say that there have been no confirmed cases of disease transmitted through plasma-derived products in over two decades. The Network of Rare Blood Disorder Organizations says:
Thanks to rigorous donor screening, testing of donations and viral clearance procedures, these products have maintained a perfect safety record with regard to pathogen transmission for the last 25 years
There are issues of supply and safety. Now we go to the issue of safety, and, yes, there was the Krever Inquiry, and, yes, we had a terrible tragedy decades ago in this country, which I, too, sadly recall.
The fact is that science has allowed us not to repeat that tragedy for decades. Why would you assume that there will be such a tragedy? Do you not have faith in the fact that there hasn’t been any for two and a half decades and science allows us —
Senator Wallin: I don’t assume there will be a tragedy. The standards are high on that issue. We learned a lot of lessons. This is not primarily a safety issue as far as I am concerned. It is about rebuilding and helping to get us some way down the road to supplying our own needs.
As I said earlier, we would never go for 100 per cent for all the reasons we know. There will always be some imported product. Do you have anything to say on those issues, Ms. Lanteigne?
Kat Lanteigne, Executive Director, BloodWatch: I was a participant in that expert report throughout the process. One of the things the report didn’t address is the countries that are almost there in self-sufficiency. For example, New Zealand is almost entirely self-sufficient. They only import about 10 per cent of their IG product. Australia is on the way to 70 per cent self-sufficiency. Belgium will be at a self-sufficiency capacity by 2026.
What these countries that have similar blood systems to ours have discovered is when you promote a plasma strategy and ask donors to donate more in those environments, people will donate.
The issue doesn’t fall on the willingness for Canadians to donate. That is not the issue we are dealing with. Canadian Blood Services hadn’t been collecting the plasma for the IG product.
Senator Seidman: I don’t mean to interrupt you. The chair will tell me I have no more time.
You are referring to the report. You are disagreeing with the report because what the report says is:
Across Europe, Australia and North America, the only jurisdictions that have achieved 100% self-sufficiency for plasma collection are those that have permitted paid plasma donors.
I am reading this out of the report. You are disagreeing?
Ms. Lanteigne: I have a lot that I disagree with in the report, but that is not what I am saying. I am saying that in countries where they have made the effort toward becoming self-sufficient, they are achieving success right now. That is what is happening.
Senator Seidman: Without paying?
Ms. Lanteigne: Without paying, through a voluntary system.
Senator Seidman: Thank you.
Senator Ravalia: Welcome to you both. I’m coming to you from the perspective of a recently practising physician. After my discussions with Senator Wallin, I have had extensive discussions with people in the medical profession, including hematologists, infectious diseases specialists, and patients who have received these products and transfusion specialists.
The concern in Newfoundland and Labrador is that we have a significant cohort of patients who have a variety of medical conditions that are heavily dependent on plasma. It is important for the non-medical people in this room to realize there is a huge difference between the way whole blood is collected and the way plasma is collected.
Plasma is collected through a much more complicated process called plasmapheresis. It can take up to two hours. It is a much larger needle and a more arduous process. The process itself has a number of significant checks to ensure that the plasma is washed, there is viral testing and it is up to standard in terms of purity.
The feedback I got from my constituents and medical cohorts is that it is highly unlikely we will ever become self-sufficient in plasma in this country. The incidents of the diseases we are talking about, primary immune deficiency being one, but a whole host of others, including alpha-1 antitrypsin deficiency, which is a lung and liver condition common in Newfoundland and Labrador; the use of these factors for people who have bleeding disorders like hemophilia, which is prevalent in Canada; its requirement in burn units where albumen comes out of the plasma; and the large volumes of plasma required to treat patients.
It takes 1,200 plasma donations to treat one hemophiliac, for example. It takes 130 plasma donations to treat one patient with primary immune deficiency.
In the discussions I have had, a number of suggestions were made by people I have a great deal of respect for who say that we do okay with the whole blood. The blood transfusion service is doing well with that.
Plasma is where the catch is. Most people I interviewed were not against some form of payment. It doesn’t necessarily have to be a cash payment. It could be in the form of a student tax credit for university, a tax break through Revenue Canada or a tax credit for nutrition.
The bottom line is that we, as Canadians, need to continue to replenish this international pool that we are so heavily dependent upon.
As the requirements of plasma increase globally, if we were to start losing some of this supply, people would start dying. This is such a vital substance that many in the pharmaceutical field now are not thinking of it as a blood product but more an agent that is life-saving because it is extracted in a different way than are red blood cells, platelets and the other constituents of blood. Many pharmaceutical companies are now even doing significant studies to see if there are ways of producing some of these plasma proteins, as they are called, in the lab setting, so as to create life-saving measures. With an aging demographic, a larger influx of immigrant populations and vulnerable genetic populations across Canada, we need to be cautious when we make a decision on this. I applaud you, Pamela. My heart, as an altruistic Canadian, says, “What?” The reality and science behind it is something we need to study carefully.
Senator Wallin: I hear exactly what you are saying. The plasma that’s collected privately here by this company is all exported. We are not solving our problem that way.
Senator Ravalia: We’re not, but we are purchasing some of it back.
I would suggest that we need to rethink this kind of blanket, global ban. We need to look at creative ways, even if it involved some payment, to ensure that we contribute to the global pool of plasma.
Ms. Lanteigne: One of the examples is this really is a security of supply issue. Private corporate blood brokers, like Canadian Plasma Resources and their counterparts, don’t actually secure supply for Canadian patients.
I want to share an example of what has just happened in Romania. It’s called the Romanian IG crisis. You brought up good points about the importance of patient access.
The Romanian government went to the pharmaceutical companies that supply the IG products and said, “They are too expensive. We will tax them so that we can reinvest that back into the health care system to help pay for the drugs.” The pharmaceutical companies said, “No, you’re not.” The government said, “Yes, we are.” The companies said, “No, you’re not. If you do that, we will pull these drugs.” They said, “Okay, we won’t do that,” and they pulled them anyway. The Romanian health minister pushed the NATO button. Austria is now supplying Romania with those IG drugs.
One of the worst possible things we could do as a country is allow our donor base and public blood supply to be controlled by a private corporation, which is what the plasma collectors are.
To clarify: Canadian Blood Services does not have a contract with Canadian Plasma Resources. Canadian Plasma Resources has the autonomy and sovereignty as a broker to collect the plasma they are purchasing from donors who are selling to them, and then they can sell it to the highest bidder on the international blood market. The drugs won’t make it back here, the Canadian plasma they are using.
To offer something to the committee — and thank you very much for allowing me to sit with Senator Wallin — there is zero data and zero evidence domestically to suggest that if Canadian Blood Services unveils their plasma collection strategy, that they cannot meet their goals. There is nothing in the Health Canada report to suggest that. There are currently only seven places in this country that collect plasma.
We are trying to make the argument it wasn’t the fault of the donors or Canadians’ unwillingness to donate; it has just been that they haven’t been collecting.
Senator Munson: I want to follow that questioning in a minute, but I’m curious about this: In our country there are four provinces — Quebec, Ontario, Alberta and British Columbia — that prohibit this. Do you have any idea why the others do not? Have you talked to them in your work in preparing this particular bill as to why they won’t and why they feel it is important that we have paid donors?
Senator Wallin: I have had this conversation in Saskatchewan. The initial interest that was tweaked when Canadian Plasma Resources went to talk to the government was that it was a job-creation plan. These clinics would expand and create local jobs. I’m not sure what the number is now, but I think it is eight people who are employed in Saskatchewan.
Again, I don’t think there was much discussion about where these “clinics” would be placed. We see the one in Saskatchewan in the centre of vulnerable populations.
Senator Munson: Do you see a transition period with your bill if this became law? You talked about another time when people seemed to give more, and so on. However, when you listen to the senator a moment ago, there are some reality checks here that deal with the idea of supply. I get frightened when I hear the words, “People could die because they won’t have blood.”
Senator Wallin: As Ms. Lanteigne explained, this private collection, the plasma that is collected, is not part of the Canadian supply. No Canadian in need can access the product that is collected at the for-profit private clinic. It goes to an international marketplace. That is why we have to focus on a blood collection strategy. We need to have CBS, the public collector, be much more engaged and active. We need Canadians — and perhaps in increasing numbers — to become or return to being volunteers and not create a mindset where they should be paid for this.
Senator Munson: In terms of our testimony here, I would assume we will hear from both sides and that we will invite the person who is supplying blood as well?
The Chair: Yes, we will.
Senator Munson: When you use the word “tainted,” I think all of us in the room of a certain age — I, along with you, covered this story. It was a horrendous and awful story to cover. Perhaps Ms. Lanteigne can talk to us about that. When you are talking about it today and you are thinking about these private companies and a person walking in, there is a worry that this blood is somehow not itemized properly and looked at in terms of health standards. Surely these companies must have to follow rigid procedures.
Senator Wallin: Just to be clear, I wasn’t trying to suggest that, because this clinic operates in a disadvantaged area, somehow the blood is compromised. It is the mindset of approaching vulnerable people and people who are in need of money and asking them to engage in that way. It is not a safety issue in the same sense as we had 30 years ago.
Senator Munson: Are you saying people who are giving blood are being seduced? It almost sounds like, “Come on down the street and give blood. We will give you 50 bucks or 100 bucks.” When you talk about the vulnerable, are you talking about people in poverty? We used the word “students” here. What does the scene look like out there?
Ms. Lanteigne: There is a great documentary that I am sure I sent to the chair’s office. I will make sure we send it to you. It’s called Le business du sang. It was released in April by a Swiss journalist. It gives a picture of where these paid plasma clinics are, in particular, in the U.S. They proliferate in towns like Camden, New Jersey; Youngstown, Ohio; and Flint, Michigan. They interview numerous people who are going in to sell their plasma. The people who are selling their plasma in the U.S. are mostly an impoverished demographic.
What happens under that private model, which is of great concern to our organization, is the care of the donor. When you run a blood system, you have to follow the chain entirely.
Caring for your donors and caring for the health of your donors is critical to that chain — also when you are talking about accessing a student demographic. Canadian Blood Services is saying that they are seeing the 17 to 24 demographic fluctuate in Saskatchewan. In Moncton, men have, for many reasons, the strongest blood and the strongest plasma. That is our new generation of donors. We need them in the Canadian system. The patients who Senator Ravalia were speaking about, we represent many of those voices as well through BloodWatch, also need access to those donors.
There are various issues in terms of a moral argument, which is certainly a strong argument to have. We are arguing that Justice Krever, the European Blood Alliance and the WHO, and hematologists, scientists and doctors all around the world, especially over the last six years, have been studying this issue at great length. They have come up with the same conclusion as Justice Krever, which is the safest way to manage a system, to collect, make and distribute drugs for a population, is through a voluntary public system. The other issue that is really important to address is, what is the cost? When you introduce payment into the system, what are you then incurring? What is happening with a company saying, here is $50? Right now, Canadian Plasma Resources is offering $250 in earnings if you can donate 8 times before Christmas to sell your plasma. You’re creating a market. You’re creating a competitive market for human tissue.
That creates market forces and competition around a resource that is meant to be safeguarded as one that is in the public commons. In our view, that is why this law, federally, is so important. To answer your question, we have advocated for this law in every province and our organization was the driving force with our co-advocates to have it passed in those three provinces. We’re supposed to have a nationalized system because we share blood and plasma. What has happened now is we are depleting supply in Saskatchewan and New Brunswick. They are not contributing to the national source.
Senator Munson: Thank you very much.
The Chair: Thank you for your answer. Senator Munson, we will have many more witnesses from all sides in the coming year. This bill will be studied as it should.
Senator Poirier: Thank you, senator, for being here. I have heard concerns, because it has been in New Brunswick for awhile. I’m sure that a lot of the concerns I’m hearing are probably a lot of the same concerns that you have had or have heard that is bringing forth this bill. One of the concerns I have heard in New Brunswick — again, even lately, since you introduced the bill, I have had people from home approach me and talk to me about it — is what is the impact this will have on our voluntary system?
I’m wondering, is it too soon to evaluate if it has an impact? Do we have any statistics to claim this support that it is going to affect the voluntary system? Do you have any of that available or is it too early?
Senator Wallin: Thank you, senator. We have numbers that we can offer, which is if they are taking 300, 500 or 1000 people out of the system, then that is obviously going to have an impact.
I think in one of the documents that we have — Kat is more familiar with this, but this was a document obtained under freedom of information where there was a letter to the Government of Saskatchewan from Canadian Blood Services. They were making the point that they are already seeing, in their voluntary donor base, fluctuations in the donors aged 17 to 24, confusion and misunderstanding amongst donors over the distinction between Canadian Plasma Resources and Canadian Blood Services, and who is what. We were told of stories in New Brunswick where people went into Canadian Blood Services, the public collector, and said, “Can I give again? I was just here last week.” There was no record of them because they had been at CPR because it’s not really distinctive — that identification is not there yet.
It also has an impact, as Canadian Blood Services was explaining, in trying to explain to the Saskatchewan government that it then has additional costs for the public collector to go out and recruit and make sure they have to advertise and say be a good citizen and do this because the targeting is going towards that young generation.
Senator Poirier: Do we know, senator, if the 300 a week that you’re getting, are these 300 people a week that before were giving to the voluntary system and are no longer going there? Or are these 300 people who have started giving blood all of a sudden because they are getting paid for it? Is it affecting the voluntary system? That is what I’m trying to find out.
Senator Wallin: I’m not sure if we know that right off the top. Kat has more facts on this one.
Ms. Lanteigne: The Canadian Blood Services is the organization who can answer that. They are monitoring it as best they can. There is only so much access that they can have. They had about 20 people a week coming in to say, well, I went and I already — so then that’s a lot. It’s hard to monitor on one facility. What their argument has been, and the documentation that we have read and in our conversations with them, was the same behaviour has been mirrored now in New Brunswick. They are losing donors.
There is a book onThe New York Times list right now about the blood and the blood system and the author went to CPR. There is a whole chapter in there about what is happening in Canada. She interviews a lot of donors in the CPR clinic. They used to be donors to Canadian Blood Services. It’s just common — if there is a Canadian Blood Services on one side and you are going to donate but somebody else is offering you $50 and $80 the next time you return, then they are going to turn around and sell that bag for $400 on the international market for a profit, it’s pretty easy, especially if you’re a student.
Senator Poirier: Thank you. I want to jump to something different for a minute. Then, if I have time, I’ll come back.
I understand there are certain provinces which have prohibited blood donor compensation while other provinces have allowed it. New Brunswick is one of them. If Bill S-252 becomes law, how will it affect the provincial law? Does it infringe on provincial jurisdictions?
Senator Wallin: It’s not really a jurisdictional issue, if I understand it. Health Canada grants a licence to this company to set up shop. In Saskatchewan, there is a particular — I think there was some quid pro quo for the —
Ms. Lanteigne: They have to get an additional —
Senator Wallin: Yes, just use the microphone.
Senator Poirier: Doesn’t the province — Health Canada gives the okay that the provinces can do —
Senator Wallin: Do it with a licence, yes.
Senator Poirier: Don’t the provinces have to put in legislation in order for it to happen within the province?
Senator Wallin: They don’t have to. It was the other way around, which is why these other provinces acted. This company was able to set up and was setting up in places like Toronto and everywhere. The government of the day, the provincial government, had to then respond, because the licences come from Ottawa and say, no, you can’t set up shop here. It’s the flip side.
Senator Poirier: Okay. If the bill was in place then the provinces have no say in it. Is that what you’re telling me?
Senator Wallin: The licence wouldn’t be granted because that comes from the federal side.
Senator Poirier: The ones that are there now, would they lose?
Senator Wallin: There would be no new ones. Whether they grandfathered them out or — I don’t know what the approach would be — we would like to see them closed, obviously. Even at this moment, a moratorium on granting — I think there was something like 18 licence requests in the system right now.
Senator Manning: Thank you senator. Canadian Plasma Resources, are there other companies in the country that collect plasma or just this company? How many outlets does this company have? What provinces are they in? How widespread are they?
Ms. Lanteigne: Canadian Plasma Resources has two clinics, one in Moncton and one in Saskatoon. There has been a collector in Winnipeg, which used to be called Cangene. It’s now called Prometic.
They were grandfathered into the Krever Inquiry as a rare circumstance. They collect RH; it’s a very rare blood type. They make a medication that helps prevent women from having stillborns. That was what Justice Krever cited as a rare circumstance.
The difference between that facility, about which we have made the recommendation that they should be grandfathered in, so they can continue their operations, and a company like Canadian Plasma Resources is that CPR is a competitor to CBS in terms of collection, and they are not a rare circumstance. They are large-scale plasma collectors. They really have to proliferate in order to succeed. They need to retain thousands and thousands of donors in order to make their profit margins work to sell their plasma on the blood market.
Senator Manning: If I heard you correctly, we don’t use Canadian Plasma Resources’ plasma here in Canada; it’s all sold outside.
Senator Wallin: Yes.
Senator Manning: Does Canadian Blood Services provide the plasma that we need? Do we have enough plasma in Canada for our patients? Where does it come from?
Senator Wallin: No, we don’t have enough plasma in Canada. One of the things we mentioned earlier was that CBS, Canadian Blood Services — I think you said there were only seven venues to collect that. That needs to be increased. We import most of the product we need that we don’t supply from the U.S.
Ms. Lanteigne: To make the distinction: Canada is self-sufficient in blood and plasma for transfusions, which is vein to vein. Then we provided between 17 and 20 per cent — we were at 30 not too long ago — of plasma-derived medication, which is the plasma drugs that use a very big volume of pooled plasma — a lot of donations — in order to make those medications.
One of the biggest concerns Canadian Blood Services has had and why they also view this as an urgent issue — we’re official stakeholders with Canadian Blood Services — is that the demand of the IG, the plasma drugs, has increased. If there is a disruption in supply in the U.S., if there is a non-envelope virus that breaks out — mad cow that breaks out in the U.S. — we could lose our access to plasma drugs.
Having the patients be that dependent on a foreign source is actually not a good model. Europe has realized that too. European countries have been importing these plasma drugs as well. What’s happening around the world, and which Canadian Blood Services, New Zealand, Australia and the European countries are doing, is they are increasing domestic supply through a voluntary system, so they can secure supply for patients. That’s what happens.
The discussions we had with the provincial governments and the reason they stopped the company coming in — because Health Canada wouldn’t refuse the issuing of the licences, the only way they could do it, because the company discovered this loophole in our blood regulation, was to implement a law to ban them. It was the only way to protect the donor base, provincially.
Senator Manning: If we don’t have enough plasma here — you’re saying we’re supplied by the United States — why are we not buying it off Canadian Plasma Resources?
Ms. Lanteigne: Canadian Blood Services doesn’t purchase raw plasma. They are not allowed to, because they don’t oversee the testing directly, so they don’t pool it with our Canadian plasma. It doesn’t go vein to vein. What they purchase is a finished drug. They are purchasing a medication and a drug that is being sold to them. That source plasma is coming from the U.S., where it’s coming from both paid and voluntary donors.
Senator Manning: Are the Canadian Plasma Resources collected — they sell it outside the country, and it’s not checked by our blood services? Somebody in Canada doesn’t check that?
Senator Wallin: It’s an export.
Ms. Lanteigne: They collect it. They sell it to Biotest AG, which is based in Germany. Biotest AG pools our plasma — now currently putting our plasma — with other donations. We don’t know where those donations come from. Then they try to sell that drug somewhere.
I want to be fundamentally clear: It’s never coming back to a Canadian patient. This company will never help a Canadian patient. Canadian Blood Services will verify that for you.
The Chair: Thank you.
Senator Oh: Thank you, Senator Wallin, for working diligently on this bill. I want to follow up. Now, there are four provinces, approximately about 87 per cent of our population; in other words, most of the people won’t be compensated for a plasma donation.
Do you know any other provinces that are coming on board beside the four that are already there? The last one was British Columbia in May of this year.
Senator Wallin: What we’re hoping will happen through this discussion is that New Brunswick and Saskatchewan might come on board, because they are the places where CPR is already established, has a foothold and is asking for the ability to expand. We’re hoping this discussion will help focus the attention on that.
Senator Oh: I was not clear just now, but will Bill S-252 supersede provincial laws when it becomes law?
Senator Wallin: It’s not a provincial law. The licensing is done by Health Canada. The licences aren’t granted by a province. There is no infringement on a provincial right or jurisdiction, because that is just where they set up shop; that’s where they do business. Unless they are explicitly banned. The provinces have come in — the four that you named — and said, “No way. We’re not going to allow you to do that, even if you were licensed before.” Now the issue is in places like Saskatchewan and New Brunswick, which is that they are licensed. We want Health Canada to stop issuing those licences and stop issuing any new ones.
Then it would also be helpful if the other provinces followed suit — British Columbia, Alberta, Ontario and Quebec — and said this is just not something that should be done in Canada.
Senator Oh: Okay, my next question is that we know paid-for blood is all for export and sold to the highest bidder. Who are the common bidders in the market? Do we know?
Senator Wallin: Kat just talked a little bit about that, but why don’t you recap.
Ms. Lanteigne: It’s primarily the big pharmaceutical giants that make the plasma drug. It would be Grifols, CSL Behring and similar companies that are making the drugs. A company like Canadian Plasma Resources is a middle broker. They are a collector. They make their money selling to Biotest AG in Germany, which is the pharmaceutical company. That’s how they make their money.
They have been licensed as a pharmaceutical company, which we find confusing, but they are just a collector.
Senator Oh: Are we aware of a black market for this?
Senator Wallin: A black market?
Ms. Lanteigne: There used to be a big black market for plasma. We don’t know the underpinnings of that. We have issues even with the legalized market in terms of sourcing practices, because a lot of the time, the target is for paid-for plasma.
Senator Oh: There is a black market?
Ms. Lanteigne: I don’t know about the black market. I’m sorry, are you saying black or blood?
Senator Oh: Black. Trade.
Ms. Lanteigne: Oh right. There used to be, which is one of the reasons we ended up in the tainted blood crisis. It’s a really good question. The tainted blood crisis in our country — the culprit wasn’t HIV or hepatitis C. It wasn’t bad science. It was huge motivations to make profit off of blood and to ignore regulations that were in place.
What is happening today, we have seen footage of trucks moving around Russia and going to small impoverished towns and paying people to sell their blood.
The Russian government is allowing it. We have absolutely no idea where that plasma is going and where it’s being sold.
Senator Wells: Thank you, Pamela and Ms. Lanteigne.
I want to ask a question about the prohibition that you’re proposing. This would prohibit private companies or companies that pay to collect plasma or blood from doing that. Therefore, there would be no more export market from Canada?
Senator Wallin: It would prohibit Health Canada from issuing licences.
Senator Wells: Okay.
Senator Wallin: Is that fair?
Ms. Lanteigne: Yes.
Senator Wells: With the result that there would be —
Senator Wallin: With the result, that’s right.
Senator Wells: Do you think that would encourage a black market?
Senator Wallin: I don’t, because what we’re trying to do is shine a light, and when CBS starts to, in a much more active way, talk about the need to create, I think that discussion will shine a light on that area and, therefore, make it more difficult for that to happen in a country like this.
Senator Wells: Thank you for that. I note in the legislation this gives what I will call a relief valve for Canadian Blood Services to be exempt from the purchase of blood or plasma. They, of course, state on the website that they will not pay donors. What would be the reason for that?
Senator Wallin: A national emergency, a crisis or some determination that the blood in a certain area was problematic and they needed supply instantly and urgently.
Senator Wells: Got it. It goes to an earlier comment you made about trying to get the volunteering spirit back with Canadians or increase it for Canadians. I don’t think we have lost it.
Do you think, if there was a national or local emergency, that Canadians would rally to the cause in any event? It’s kind of what we do anyway.
Senator Wallin: I do. I think it is what we do. I think that’s just a fallback. I think it also affects the need for specialty blood. You know, there is an exemption for what goes on in Manitoba where they collect. You have to have that in case there is something none of us have even imagined.
Senator Wells: Is it your belief that, if financial compensation is prohibited, people who currently provide blood under a compensation regime would simply voluntarily donate?
Senator Wallin: I think that’s part of this discussion. I think when people see it happening in a circumstance — I’m very familiar with what happened in Humboldt, for example — and they see that they can contribute and it makes a difference that they do something, they do. Even if they don’t know where to go, they phone the hospital and say, “What should I do?”
That’s what we are trying to create. If the younger generation is reading the posters over the urinals at the university on Friday offering $50 for the weekend, if we can somehow have the conversation with them about the nature of giving and the rights, roles and responsibilities of being a citizen, I think that’s a good place to start that conversation with them.
I’m having it with my three young nieces and nephews, who are 17, 19 and 22, because their response to this was that if they could get paid, why not? That’s why you want to have that conversation.
Senator Wells: I’m sympathetic to this. I donate blood every 56 days and when a call goes out, people are there and I’m there as well.
I’m having some difficulty with the concept of not permitting others to buy and sell a product for export — that it is an export product and doesn’t end up in Canada and is not for Canadian use. For the most part, that doesn’t have an effect on the level of voluntarily giving blood.
Senator Wallin: That’s what we’re not sure of. Canadian Blood Services is already indicating that it does have an impact. They are seeing that decline in the 17-to-24 or 26-year-olds. They are a very specific target population. They are seeing their numbers drop. Do we have a complete statistical —
Senator Wells: Do we have correlating data?
Senator Wallin: I don’t think that’s there, but I think it is coming. I think they will be able to connect the dots. Do you have more to say?
Senator Mégie: Senator Wallin, thank you for your comments and for the idea of introducing a bill like this. No one can be against motherhood and apple pie. However, I have a small ethical problem when they say that we cannot be against altruistic blood donation. It is a value that should be maintained. However, immunoglobulin needs are increasingly significant, and the demand cannot be met.
While talking to a hematologist colleague, I learned that in Quebec, where the ban is in effect, a clinic is being set up, not to accept paid donations, but to process plasma and manufacture immunoglobulins. When I told her that I was happy with that news, she said that only 10 or 15 per cent of the needs could be met.
Since that clinic will be set up, and assuming that Bill S-252 is passed, is there a plan already for the future? We will mobilize Canadians. Is there a plan to increase the number of donors to increase immunoglobulin production? Assuming it stays in Quebec, we could then transfer it to the provinces that prohibit it. Suppose we create an immunoglobulin manufacturing clinic somewhere, how will we mobilize the people? Do you have a plan? Have you considered this possibility?
Senator Wallin: I think that’s what Kat made reference to about Canadian Blood Services. We as a country have to talk about a blood collection strategy. We need to have this discussion. I think for many years it was just handled over there. You didn’t know about it unless you were in need. I think it is time, given where we’re at, to have that discussion, to be very transparent about what needs to happen and how to go about that, because we’re considerably behind on the plasma collection.
I’ll have Kat jump in on this too.
Ms. Lanteigne: Quebec is always a great example. They have started their Plasmavie program in 2013 through Héma-Québec. It’s very successful in one of their facilities. They already have a 50 per cent return rate for donors, which is very high. It takes about 60 to 75 minutes to donate plasma, and you can donate more often because you get the whole blood back into your system.
Canadian Blood Services has introduced a major pan-Canadian plasma strategy. They will be unrolling that next year. That is critical to secure supply for Canada and Canadian patients. Any measures towards those private paid plasma clinics undermine their success. It’s happening. It’s unfolding.
The supply management is up to Canadian Blood Services and Canadian donors. This is really about protecting the security of supply. The only way we can provide a regulation or law for Health Canada officials not to issue these licences that subvert our system is to create a federal law that essentially takes the profit motive out of the blood supply.
Those two, hand in hand, are the answer to your solution.
The Chair: I know Héma-Québec has a strategy plan. It will be interesting to hear from them.
Senator Omidvar: Thank you, Senator Wallin, for your dedication in bringing this bill to our attention. I am still trying to sort through all of it.
I have a letter in front of me — and I am sure everyone has a copy — from theNetwork of Rare Blood Disorder Organizations. I will read what I think is a provocative statement. It is not that I agree with the statement, but I want to get your response to it. It reads:
Plasma is used by the for-profit pharmaceutical companies to create plasma-derived medicinal products such as immunoglobulins which they in turn sell.
The manufacture and sale of plasma products are almost entirely a private for-profit operation with plasma being the main raw ingredient. One could argue in this scenario that not compensating for plasma is unethical.
Senator Wallin: I don’t know what to say to that. I don’t know how that argument could be made.
Ms. Lanteigne: I want to let you know that our organization was co-founded by tainted blood survivors and a group of lawyers from the Krever inquiry. It is something that is this meme — I think is the word — that comes up for a particular argument.
The reason why Justice Krever recommended the principles that he did was so the source plasma, the control over the Canadian blood supply, the trace-back methods for our donors here, the testing we do here through our blood system in Canada, was nationalized and remained in control of the public common so there was direct oversight.
Fundamental to Justice Krever’s recommendations was that the fractionation of the medications be separate and that Canadian Blood Services, the new blood operator, does not engage in terms of making a profit off Canadian blood; neither does the Canadian government. Health Canada’s role became clear to act as the regulator and Canadian Blood Services was the national blood authority.
Particular to the fractionation side of the industry, Canadian Blood Services was meant to have a choice of fractionators in the biotech world, anywhere in the world. If there was a new fractionator that opened in Norway that made a new drug that was better for a patient, Canadian Blood Services could contract fractionate our plasma there and have a different drug made by that provider.
There are clear roles and a specific chain. There was a model that we were meant to follow.
In the Netherlands, they have success of a different model. They are almost entirely self-sufficient. They do that entire process through a not-for-profit model, including the fractionation facility. There are different models that are a success that don’t use the model that you suggested.
Senator Omidvar: I appreciate your answer.
I agree with all of the senators around the table. I believe in altruism and Canadians stepping up to do their bit to make, in this context, our country healthier and safer. No one can argue with that.
However, I am having a challenge with the following. You are talking about change management and changing the hearts and minds of Canadians so they donate more blood, and in this case more plasma. At the same time, we are looking at a shortage of 85 per cent. I know enough about change management to know it is always an uphill task.
If the law comes into effect, the shortages will grow. Have you thought about a change in strategy?
Senator Wallin: The plasma collected by Canadian Plasma Resources has no impact on Canadian needs or supplies or sources. It’s a product that they take out of Canada and export. It doesn’t stop anywhere, and it doesn’t come back anywhere. It doesn’t lead to higher or more serious shortages. What we need — as Kat and CBS will explain when they come here — is they have a strategy for getting back out there and building a base and collecting more plasma in this country. As they said, there are only seven centres.
This is a big country; there can be more. There is nowhere in that equation where the outcome need be affected by payment. It’s going on now. It has historically been there. I think we had some issues post the tainted blood situation and with Krever where there was identity or, as I said in my comments, brand awareness issues. I think once they get out there talking about this, we will be on the road.
Preventing the issuing of licences to companies who export and serve no Canadian need will not impact our issues here, not even indirectly.
Senator Hartling: Thank you, Senator Wallin and Ms. Kat Lanteigne.
It is kind of synchronistic that I am here because I am not on this committee. However, I live in Moncton. On Saturday, I went for a coffee with my husband at Starbucks and there was the Canadian Plasma Resources sign. I thought, oh, that’s where it is. It’s not apparent that it’s there. They must be finding other ways to advertise.
When it first opened, I had folks from home who were protesting about it, but we haven’t heard a lot lately. I was thinking about where it is. To your point, it is not far from the university. It is out a way and quite far from the Red Cross centre.
Do you know how they advertise in Moncton? Are there other places in New Brunswick waiting for licences? The other part is: What is in it for Health Canada?
Senator Wallin: To stop this?
Senator Hartling: No, to do it.
Senator Wallin: Are you talking about the private collector that you saw or the public collector?
Senator Hartling: No, the private. It is the private collector.
Senator Wallin: You mean why is Health Canada doing this?
Senator Hartling: Yes. There are three things. How is the private clinic advertising in our community because it is not obvious to me? I live there, and it is not a big place. I didn’t know where it was. How are they attracting people?
Second, are there other places in New Brunswick waiting for licences? What is in it for Health Canada to issue licences?
Senator Wallin: That is the $64 million question. We do not know why Health Canada did this, in the wake of everything we know in this country and the reaction of our largest provinces to say this is not something we want to have in our country. We are not sure why.
Senator Hartling: And why Moncton?
Senator Wallin: I think the company has gone into smaller markets, having been shut out of the larger cities. They are going to places where jobs are always an issue and making that particular case.
Ms. Lanteigne: Saint John is their second location.
Senator Hartling: Saint John, New Brunswick?
Ms. Lanteigne: Yes. That is where they are sited.
The ATIPs published in the Maclean’s article, “A bloody mess,” written by Anne Kingston, details the story behind paid plasma. When you review those documents and the exchanges with the Health Canada officials — because it was pre- and then through the fight in Ontario for us to have them shut down — the licences were issued on the specious claim that the proliferation of Canadian Plasma Resources in Canada was going to bring us to self-sufficiency; that, essentially inviting the paid model, as they do in America, was going to create an environment where Canadian Blood Services would then buy from Canadian Plasma Resources. They would have it fractionated, et cetera, and then we wouldn’t be importing so much U.S. plasma product. And it wasn’t true. In the documentation we reviewed from Saskatchewan and in New Brunswick through ATIPs in their engagements with the health ministers in those provinces, that was also the pitch.
What is fascinating and incredible to our organization and the people we represent is that all of this undermines our best practices we have had in place for 20 years. We don’t need another blood-borne virus to be introduced into the blood system to know what not to do in terms of our country and how we collect blood and plasma.
They have a second location there. One of the reasons why we feel this bill is so urgent for senators to consider is that if we can’t stop this company and Health Canada from issuing these licences, we will start to farm plasma from the eastern provinces, where even the weather makes it difficult to get donors out to our clinics. One donor out of the system, if they’re a qualified donor, that’s a blood donor and we are losing blood and plasma from that donor.
Senator Hartling: I am trying to figure out where they are advertising.
Senator Wallin: Facebook.
Ms. Lanteigne: They have a very aggressive Facebook campaign.
Senator Hartling: I just saw. It was an accident. It is not obvious that it is there.
Ms. Lanteigne: They have an aggressive Facebook campaign. They have them above the urinals in universities, which I can assure you is extremely offensive to the tainted blood survivors we represent in this country. After 8,000 people, billions of dollars in compensation, an entirely new blood system nationally and federally and a new blood service, and this is where we have gotten to.
Senator Hartling: Thank you very much. I will be on the lookout for those. I don’t think I will look out for urinals, but I will check it out.
The Chair: We have time for a second round.
Before that, I have one question. We received a lot of letters. I want to get your thoughts on some organizations saying that when you think about it, the fact is even if we get better, it will take years to be self-sufficient. This bill would say we are not paying Canadians for blood, but we are paying other people for blood in the U.S.
Some have said there is a bit of an ethical problem. It is a “we don’t do it here,” or “not in my backyard” kind of philosophy.
What do you think of this idea?
Senator Wallin: I will get Ms. Lanteigne to speak to that as well. We want to keep the option of going to different places in order to purchase product. We are not buying that raw product and not paying people to give us that raw product. What we are buying in the end is medicine that is built from that product. It’s not really a case of “my backyard” and “not in my backyard.”
We also have a need to work toward filling our own demand in this country. There is one way to help. It won’t get us to 100 per cent but it might. We are seeing that happen in smaller countries. We need to begin to do that for all sorts of reasons. We talk about security of supply when it comes to energy, water and food and all the basics you need as a society. This is absolutely one of them.
The Chair: I understand, but even if we are buying the medication and the treatment, someone, somewhere, will be paid to donate this blood.
Senator Wallin: Take this on if you can, Ms. Lanteigne.
Ms. Lanteigne: That’s a really good question. One of the best answers I have heard to that question was when I and others were testifying at Queen’s Park supporting the legislation that was passed. She used to be on our board, Victoria Kinenberg, and she was the mom of two hemophiliacs, one who takes a synthetic product and the other one who is still on the plasma direct product. Synthetic products clearly don’t use the actual plasma.
That question was put to her. She said clearly: “Well, if we had a choice, and if I had a choice for my son, then I would do it differently.”
For the group of people whom we represent, the reason that is so difficult is because it doesn’t fall on the patient. The patient has no choice. The patient needs the medication. They have no control over how that is currently being sourced.
We have criticized Canadian Blood Services heavily for not implementing a plasma strategy in 2009, which they should have. If they had, we would have surpassed 50 per cent self-sufficiency because it is absolutely a fair and correct comment to say that it will take us years to get there. We need to get there. We can do that. We can’t do that if we are at odds; and we can’t do that with this issue constantly swirling around because it confuses donors, and it doesn’t secure our supply for Canadian patients. That is the only way we can answer.
I found that to be profound. There is a helplessness with patients and a fear. We deal with pharmaceutical companies. I make our statements at conferences around the world. The B.C. president of the hemophilia society has adamantly opposed this paid plasma proliferation in Canada. He also shares our view that we would like to do it differently and ensure we secure the supply for Canadian patients. That is what we are trying to do.
The Chair: Thank you. I appreciate that.
Senator Seidman: My heart empathizes with everything you are saying. I understand so well the concept of altruism and getting Canadians behind doing the right thing for other Canadians. I agree with you that when there is a national emergency, a crisis, a tragedy somewhere in this country, Canadians are good at rallying.
However, my concern is about the ongoing needs without the crises and emergencies, just the ever-increasing needs of these products on the part of ordinary Canadians on a daily basis and how we will meet those needs.
It is interesting, among all the letters we received, and we received a lot; I am sure you have as well, Senator Wallin. For example, the Network of Rare Blood Disorder Organizations and the Canadian Immunodeficiencies Patient Organization sent strong letters in disagreement with this legislation. I find that striking because they represent patients who are engaged daily in need of this kind of plasma.
My question is about consultation. What kind of consultation did you do when you were trying to put the bill together? Who did you consult? Were concerns raised during those consultations?
Senator Wallin: In the first place, it wouldn’t be formal consultations; I don’t have those kinds of resources. I reached out to anyone and everyone I could think of. Kat’s organization was very good. We had two separate events here in Ottawa where stakeholders in the health care industry, if I can use that term in the broadest sense, came and participated.
I, too, have received those letters and Ms. Lanteigne will speak to this because she has ongoing discussions with people about this. We tried to explain that this is not something that impacts their supply, their access, their use or their need because we are talking about something that is exported.
Sometimes there is a little confusion around that issue. Then I think there are other issues at play.
Senator Seidman: If you could clarify: you are saying that we will continue to import the plasma that is required —
Senator Wallin: Well, the products.
Senator Seidman: The product that is required.
Senator Wallin: Science is also — we have synthetic product as well.
Senator Seidman: Good. Thank you.
Ms. Lanteigne: Senator Wells, you raised a good question that I thought I answered, but I don’t think I did very well. That is the reason for the exemption for Canadian Blood Services, as I understand it, because it was in each provincial bill as well.
Canadian Blood Services was not doing anything illegal by purchasing those plasma-derived medications. Canadian Blood Services goes into long-term contracts for their tenders for those drugs. It was two-fold. It was so that would not impede any flow for any patients while they were making the transition towards a much higher standard of self-sufficiency. Canadian Blood Services will do a much better job at explaining it.
Essentially, 50 per cent self-sufficiency is sufficient. It means the patients who Senator Ravalia was speaking about would get their drugs, meaning the patients in Canada that have to have plasma-derived products would get them and they would be secured. A lot of the IG products we use today are off label.
There is a recent report I will share that came out of CATH that has spoken to the fact that, for a lot of the IG prescribed in Canada, there are alternative drugs for it but they use it off label. Canadian Blood Services is looking at that to manage how much we use and why we are using so much. They are doing both. They will manage use and collect more to create a balance.
I am hoping that helps answer the question.
Senator Seidman: In the consultations, did you have these concerns expressed when you spoke to these organizations? Did they express their concerns? Obviously, they haven’t been allayed because they have written these letters to us.
Senator Wallin: I received the same letters and we reached out, responded and tried to engage with the answers that we had. That was in the recesses of our mind. Thank you for calling it all up there.
There seems to be a fear and a concern if you are highly dependent. I understand people just wanting every single possible option. I don’t know that we can allay those concerns other than to say, by working on this, we will.
Senator Mégie: Let’s suppose that Bill S-252 is passed. Has a feasibility study been conducted to determine the potential cost of creating a clinic to process immunoglobulin?
Senator Wallin: We haven’t done that analysis, nor would we. That is the job of Canadian Blood Services, or those in the business of creating the product that you need. What I am attempting to do here is say we need to stop the privatization of blood collection for export, because it will be difficult to create a circumstance where we are answering the need if we allow that to carry on simultaneously, undermine the volunteer donor base and the supply issue because it is being exercised. We are trying to create the environment in which both Canadian Blood Services and pharmaceutical companies and other participants in the medical world can function on a level playing field.
Senator Mégie: I know it’s not you or your group. I was thinking of Canadian Blood Services or other organizations could conduct the feasibility study. It hasn’t been done at all?
Senator Wallin: Figured what out exactly?
Senator Mégie: What are the costs of buying from outside versus the costs of manufacturing on site?
Senator Wallin: Ms. Lanteigne, do you have anything? I haven’t read anything on that at all.
Ms. Lanteigne: The Green Cross is what you are referring to, I think. That is a company opening in Quebec that is a fractionator. It is separate from this bill, the fractionation end of the product.
Canadian Blood Services has a fully costed plan for their plasma strategy. The federal government does not fund the blood system in any way whatsoever. The blood system in Canada is funded by the provinces and territories.
Senator Mégie: Okay, thank you.
Senator Omidvar: Thank you again. We are really putting you through the wringer. I appreciate the willingness of you both to answer our questions.
I am still trying to sort this out. One way of looking at this, from my point of view, is that currently the sale of plasma in Canada is a business story. This bill is trying to make it a health story. I understand that Canada is one of the largest users of plasma in the world.
If your bill is passed, the sale of plasma would be prohibited, CBS wouldn’t collect it. Imagine we have all the plasma in the world. We crossed that hill. Hearts and minds have been changed and we are donating as much as we can. Do we have the capacity in Canada to manufacture and produce the fractionated products? No?
Ms. Lanteigne: No.
Senator Omidvar: What would happen there?
Ms. Lanteigne: The fractionated process is a separate process. Currently, Canadian Blood Services contracts for a few different fractionators that make different IG products. That fractionation process is separate from managing the national blood supply and collecting on a voluntary basis. It is a completely different issue.
Senator Omidvar: We need the products. How do we get those?
Ms. Lanteigne: Yes we need the products. You would just contract fractionate more.
Senator Omidvar: In the end, we would get someone else to develop the products and we’d pay a price for them?
Ms. Lanteigne: You contract, yes. What Canadian Blood Services does now, most of the plasma-deprived products come from whole blood donations. They take it, separate it out and use that plasma to manufacture those plasma-deprived products. We only have seven clinics open who can do straight plasma collection. They take our Canadian plasma and they batch fractionate it. They put orders in. They say, we want this drug, we will send you this plasma, we want this drug. It is sent to the biotech facility which is cleaned. It is made and marked for CBS only. It comes back to Canadian Blood Services and they distribute that product to hospitals. With their plan they are strengthening that to do that so we get off of most of the American vein, which is what Senator Petitclerc pointed out.
It just expands that process.
Senator Omidvar: Thank you.
Senator Ravalia: Thank you. You’ve been a very compelling witness. I’m impressed with your knowledge base and compassion.
If I could direct this question to you, Ms. Lanteigne. If we were to look at a made-in-Canada plasma strategy that did involve payment but that did not go to private companies — because I have had a number of patients who are enrolled in studies for new pharmaceutical agents. They get paid. They get a whole lot of bonuses. Sometimes they get the treatment for the rest of their lives for free if it proofs.
I think if we depend on altruism alone, we will always be behind the eight ball to some extent. If we were to create a system where we paid people for plasma, but it was a made-in-Canada solution, independent of these outside private companies, would that sort of notion be appalling to your group?
Ms. Lanteigne: I think there are two parts to our answer. The way this argument has been set — and I’ve been dealing with the pharmaceutical companies and lobbyists who have been pushing this issue forward — is on the premise that the problem has been that Canadians won’t donate the plasma. That’s fundamentally factually incorrect. They were never asked.
I’m in front of thousands of people all across the country on this issue in conference rooms. I get inundated by people who are more angry about not being able to donate than donating. People say: Why can’t gay men donate? Lift the ban. I can’t donate because I went to the U.K. during this time. I had cancer, and they won’t let me.
Canadians really get angry. We believe we should give it a go because currently we have half a million Canadians donating, only 4 per cent of the population, and that keeps us self-sufficient in whole blood and plasma for transfusion. We have this wonderful opportunity. It has been demonstrated in other countries — with, I believe, similar values and systems — that, when they do it, it works.
At the other end of that scale, they discovered in Europe — because there was a mission creep of these paid plasma clinics; they only exist in a couple of countries in Europe — that when payment was introduced, it was very difficult to get people to donate voluntarily, so you change the system.
What is happening right now, Senator Omidvar, is the private-paid plasma industry is trying to change the hearts and minds of Canadians regarding donations: “Hey, we’ll give you money. Really, you don’t need to do that. Your time is precious.” But we actually do it. If we’re given an opportunity to do it more, through Canadian Blood Services, and we protect that value and that system, we have a great opportunity.
If we can’t get there in 10 years, and we need some kind of Canadian-made solution through Canadian Blood Services that is not of cash value, that is not a monetary incentive, that doesn’t turn blood and human tissue into a trade and commercial activity, which much of the world is moving towards ending, including Japan — this is what the WHO doctors and the European blood doctors are all talking about around the world. We need to end the commercialization of this resource that the public commons needs so much, that Canadian Blood Services can work with the health ministers and find a way.
Senator Ravalia: Why do you think this hasn’t happened? An organization like Canadian Blood Services realizes that we have a critical shortage of plasma. They keep collecting whole blood. Why hasn’t there been a proactive campaign to resource plasma? What does your information tell you with respect to that?
Ms. Lanteigne: It was delayed. A few things happened. One was the rapid demand of IG, and then simultaneously the proliferation of paid plasma clinics in the States. It was sort of this perfect storm. It’s a little easier for Héma-Québec because they only deal with Quebec. They have one, and Canadian Blood Services has to deal with all the health ministers. Whenever they table a plan for their next stage, there is a lot of bureaucracy around getting it through.
Senator Ravalia: We should all move to Quebec.
Senator Wallin: This is an important part, and I think Ms. Lanteigne’s phrase is right: Let’s give it a go. We are seeing other countries supply their own needs, getting much closer. We can do it, and this is with not a proactive Canadian Blood Services operation — if they unveil their strategy, if we talk about this, if we engage people again and give them a way to contribute and donate. It’s hard to find where to go. It used to be easier when you saw the Red Cross somewhere. People have to work at it.
Let’s do that. Let’s give this a go. If it doesn’t work 10 or 15 years down the road, there is an alternative.
The Chair: Thank you so much, Ms. Lanteigne and Senator Wallin, for your time and your valuable and in-depth answers. This sets the table, if I may, very well for the study of this bill, which we will continue in the next year.
I want to remind my colleagues that tomorrow we will be continuing with Bill C-243, An Act respecting the development of a national maternity assistance program strategy. We will hear from Canada’s Building Trades Unions, the University of Alberta, and Engineers Canada. We will conduct clause-by-clause review of this bill.
(The committee adjourned.)