Canada’s blood agency is on the verge of signing an agreement with a Spanish pharmaceutical giant that would transform plasma collection in Canada into a for-profit system, a Breach investigation reveals.
It raises the spectre of the United States, where over 900 private clinics operate in low-income neighbourhoods from Michigan to Mississippi, enticing poor people to sell their plasma so that a handful of multinational companies can manufacture expensive drugs for massive profits.
According to sources familiar with developments at Canadian Blood Services, the agency is set to sign a contract soon with Grifols, the world’s largest plasma producer that made $807 million in profits in 2020.
Plasma contains vital antibodies used to develop treatments for hemophilia, immune disorders and neurological conditions, and it has grown into a $24 billion-a-year global sector.
Most plasma collected for Canada within the country is done by the publicly-funded agency without paying donors, but the deal would dramatically change that—allowing Grifols to set up private clinics to collect plasma, process it, and sell it back to Canadian Blood Services at a profit.
The privatization would fly in the face of the blood agency’s founding principles.
The creation of Canadian Blood Services, entrusted with managing the country’s blood supply and blood products, was based on Royal Commission recommendations that donations remain public and non-paid in the wake of the “tainted blood” scandal of the 1980s.
More than 8,000 Canadians died after they received improperly screened blood from paid donors that was infected with hepatitis C or HIV—prompted in part, the Commission found, by the profit motive.
In July, the Canadian Federation of Nurses Unions and Ontario Nurses Association wrote the Ontario Ministry of Health asking it to push to “freeze any negotiations with the for-profit plasma industry until an open stakeholders meeting can take place to discuss the associated risks to our national blood system.”
The Ontario Public Service Employees Union also wrote the head of Canadian Blood Services, saying the agency “should be focusing on expanding its domestic collection program with more staff and infrastructure, not turning to private, for-profit companies for paid plasma.”
A spokesperson for Canadian Blood Services did not deny the existence of a looming deal, saying the agency is exploring “creative solutions” to meet patients’ needs.
“This includes a potential role for commercial plasma collectors to contribute to national sufficiency and ensure plasma donated in Canada stays in Canada to benefit patients in this country,” they said.
But the deal with Grifols would hand over control over the supply of life-and-death therapies to a private company that “won’t prioritize Canadian patients,” said Kat Lanteigne, executive director of advocacy group Bloodwatch that has tracked the industry for years.
While the Canadian Blood Services has a mandate to make the country self-sufficient in plasma collection, the deal isn’t expected to prevent Grifols from exporting Canadian plasma.
“It is widely known that these companies can redirect their source plasma at any time and break a contract,” said the letter from the nurses’ unions, which was shared to The Breach. “They have an export model which is designed to sell collections to the highest bidder on the international market.”
Once in control of plasma supply chains, pharmaceutical companies have been known to take even more extreme measures.
In Romania, five companies—including one now owned by Grifols—were recently fined after colluding to withhold the supply of plasma from the market in order to pressure the government to retract a tax on their products.
The move toward a for-profit system in Canada would upend the voluntarism that has been at the core of blood and plasma collection for decades.
The European Blood Alliance, comprised of public blood authorities, has warned that “the development of commercial plasma collection centres is eroding the voluntary donor base for blood products and jeopardizing the sustainability of the supply of the full range of blood products.”
In a 2022 investor report, Grifols notes it significantly increased paid donors in Germany by targeting “young people and individuals facing economic difficulties in pandemic times.”
The move would be a historic reversal by Canadian Blood Services.
“Plasma, just like whole blood, is a public resource that must be safeguarded for Canadians,” the agency reiterated as recently as 2017.
Private industry circles
The looming deal is the culmination of a long-term effort by private pharma companies to open up a plasma market within Canada.
Due to its high sensitivity and risks, plasma collection has been tightly limited and done almost entirely by the Canadian Blood Services.
When a company named Canadian Plasma Resources (CPR) first tried to set up a private clinics in Ontario in 2013, public outcry led to police raids and the province passing legislation to ban payment for blood.
But by 2016, Health Canada granted a license to CPR to establish their first clinic in Saskatchewan.
Unlike Ontario, Quebec, and British Columbia, where they are banned, private plasma clinics are legally allowed to operate elsewhere, and currently do in Saskatchewan as well as Alberta, New Brunswick, and Manitoba.
While CPR pays Canadians donors for plasma and sends it to the U.S. for processing, it isn’t able sell the refined product to Canadian Blood Services.
The deal to be struck with Grifols, however, is expected to permit the Spanish pharmaceutical to sell directly to the agency, according to sources.
That will be a major breakthrough for the multinational giant that has acknowledged “consulting” in Canada since 2019.
Grifols acquired a large plant in Montreal in 2020 whose expansion starts this August.
In January it also acquired a small Canadian company that previously sold a specific hard-to-source refined plasma product and was the only one permitted to sell to Canada’s blood agency.
In its investor report this year, Grifols says it is “uniquely positioned for continued growth across full platform of service offerings” in Canada.
The report notes the country is the world’s second largest consumer of intravenous immunoglobulin, a plasma-derived therapy used for infections and immune disorders that can cost up to $8,000 per treatment.
The multinational could now be set to achieve dominance over the market, which would give it enormous leverage in contract negotiations over what price it charges the Canadian blood authority for its plasma products.
“Business principles” collide with the plasma system
Canadian Blood Services and Health Canada, which is responsible for the blood system’s safety and approves blood collection facilities, have long been criticized for being cozy with industry.
An investigation in Macleans in 2017 found that officials closely collaborated with CPR as it tried to make inroads in Canada, doing positive messaging on its behalf and congratulating the company when its private clinic was approved.
“We’re here now primarily because of the rapacious lobbying of the pharma industry, and support for that industry from the leadership at the Canadian Blood Services,” Lanteigne said.
In their statement to The Breach, the blood agency noted that their current direction “follows the report of the Expert Panel on Immune Globulin Product Supply and Related Impacts in Canada, convened by Health Canada, that encouraged governments and Canadian Blood Services to explore creative solutions to meet patients’ needs for immunoglobulins in Canada.”
The expert panel, which took a favourable position toward paid plasma in its report in 2018, concluded that collection should be “based on solid business principles and learnings and/or partnerships with the private sector who have significant expertise.”
It was headed up by a former B.C. deputy minister of Health who oversaw the closing of hospitals and attacks on the Charter-protected labour rights of nurses under the provincial Liberal government.
Another panelist advisor holds stocks in Grifols and previously worked for a plasma division of Bayer pharmaceutical that is now owned by Grifols.
“Dereliction of duty”
According to its mandate, one of the Canadian Blood Services’s goals is to help bring Canada into “self-sufficiency” in blood and plasma collection.
But the agency hasn’t expanded its capacity enough to do so.
It only collects about 15 per cent of domestic demand for plasma antibodies. Through opening new clinics and ramping up existing ones, the agency told The Breach they anticipate hitting 25 per cent of collection sufficiency.
But critics like Lanteigne say the deal with Grifols would undermine that strategy by steering donors to the paid plasma system.
The agency itself concluded exactly that in 2016, acknowledging that voluntary plasma donations had declined in Saskatoon due to Canadian Plasma Resources’s commercial presence.
The shortfall in domestic collection is currently made up by U.S. companies.
U.S. donors supply around 70 per cent of the world’s plasma—a scenario that’s long been criticized for exploiting low-income Americans, since studies have found companies locate collection centres mostly in impoverished neighbourhoods.
Despite a lack of research on the long-term health impacts of frequent donation, most Americans are allowed to donate up to two times a week, receiving $35 to $50 in payment for plasma that will then generate pharmaceutical products worth at least $300.
“Our dependence on the U.S. supply chain wasn’t because Canadians wouldn’t donate,” Lanteigne says. “It was because Canadian Blood Services hadn’t run a collection plasma campaign in order for donors to do so, nor create the capacity for mass plasma collection.”
“This has always been a dereliction of their duty to secure a supply chain,” Lanteigne adds, even though “they have told us that they can collect dollar for dollar against the commercial industry, meaning they can do it just as efficiently.”
Grifols did not return repeated requests from The Breach for comment.
Correction: This article was updated to state that the shortfall in domestic Canadian collection is made up by foreign companies collecting blood in the United States, not by U.S. companies in the United States. It was also updated to state the small Canadian company acquired this year by Grifols had, as of 2017, started to collect all kinds of plasma, not only a hard-to-source refined plasma product.