The article published today by Stern Magazine under
the title "Böses Blut" (Bad Blood) raises the issue of
illegal plasma relabelling and trafficking, describing unscrupulous
practices including substandard manufacturing of plasma-derived drugs
and their sale for patient use with dramatic consequences. Police
investigations are ongoing.
The World Health Organization (WHO) shares the
concerns which the article highlights, particularly the importance of
ensuring safe supplies of blood and blood products in developing
countries. The overwhelming majority of the world’s population (80%)
live in developing countries, yet have access to only 20% of the world’s
safe blood supply. It is for this reason that WHO has identified blood
safety as one of its seven strategic priorities.
It is therefore unfortunate that the Stern article
contains a number of factual inaccuracies about the Zimbabwe National
Blood Transfusion Service (ZNBTS). Apart from calling into question
the reliability of the article’s reporting in general, these
inaccuracies may jeopardize global efforts to improve access to safe
and adequate supplies of blood and blood products.
The Stern article challenges the selection of blood
donors in Zimbabwe by describing two prostitutes giving blood.
However, according to information provided by ZNBTS, the Stern article
is incorrect. In each of the these two cited cases, its safety
measures had been duly applied and recorded, although confidentiality
of the database prevents disclosure of the details of the handling of
the each case.
The article says that approximately one-quarter of
all adults in Zimbabwe are HIV-positive. However, thanks to systematic
selection of possible blood donors in Zimbabwe, only 0.29% of those
who pass the questionnaire and interview selection process are found
to be HIV-positive. The blood of these donors is then rejected. This
donor selection process is, thus, a model which WHO recommends all
developing countries should consider. In addition, all blood donors in
Zimbabwe benefit from pre- and post-donation counselling.
Allusions to inadequate safety standards in
Zimbabwe represent a grave accusation, contradicted by statistical
data. It is also unfortunate that this article describes the misuse of
a blood donor card by one prostitute. The blood donor selection
process is largely dependent on altruistic motivation as it is based
on the truthfulness in answering a questionnaire. No safety measure in
blood transfusion can yield an absolute zero risk, therefore each and
every safety measure - blood donor selection and donation screening
for viral markers alike - is important for blood safety.
Besides the implied accusations against the ZNBTS,
of further concern is the potential impact of this article on blood
safety in Zimbabwe. Any one who undermines blood transfusion services
without clear evidence of their danger is jeopardizing human life by
reducing the number of regular blood donors. It would indeed be tragic
if Zimbabwe's remarkable achievements were to be endangered by an
article the intention of which, it is assumed, is ultimately to
attempt to promote improved blood safety. Zimbabwe is one of nine
countries in Africa with a legal framework for the transfusion
service, a united national service providing equitable access to blood
products all over the country.
The article says that Dr Jean Emmanuel, presently
in charge of the Department of Blood Safety and Clinical Technology at
WHO, by ‘sheer coincidence’, was the Director of the
Zimbabwe National Blood Transfusion Service (ZNBTS) during the period
in which the story related by Stern took place, namely the early to
mid-1990s. In fact, Dr Emmanuel left ZNBTS in 1989 to join WHO.
Moreover, under his directorship, Zimbabwe was one of the first
countries in the world to test all donations for HIV, even
before France, Japan or the United Kingdom.
Zimbabwe is one of the few African countries that
routinely separates whole blood donations into red cells and plasma.
The advantages of this are that red cells can be stored in an
appropriate preservation medium for a longer period (42 days as
opposed to the ‘35 days’ stated in the article) than whole
blood, and are more beneficial to the patient. Approximately
80 000 donations of 450ml of whole blood are collected each year
in Zimbabwe (and not 80 000 litres, as stated in the article).
Meanwhile, most of the residual plasma from donated units of blood is
not required by patients in Zimbabwe. However, there is a need for
plasma for the manufacture of therapeutic products and for diagnostic
use. Zimbabwe does not have the facilities to manufacture its own
plasma derivatives. Most of its surplus plasma is discarded by
incineration. All remaining plasma, exported from Zimbabwe, has been
clearly documented and approved by national health authorities, with
full transparency. The Zimbabwe National Blood Transfusion Service is
operating under a strict quality control system and all tests, export
documents, etc. can be viewed upon demand.
The Zimbabwe National Blood Transfusion Service is
not a ‘semi-private’ institution but a nongovernmental,
not-for-profit organization, designated by the Ministry of Health and
Child Welfare as the sole organization in charge of blood transfusion.
Therefore its only motivations are safe blood transfusion and
In addition, since the beginning of blood
transfusion in Zimbabwe, the blood transfusion centres have always
exclusively recruited voluntary, non-remunerated donors. This is in
sharp contrast with the majority of developing countries. A wealth of
evidence demonstrates that voluntary non-remunerated blood donation is
a cornerstone of safe blood.
For the reasons mentioned above, the ZNBTS has been
designated as a WHO Collaborating Centre. Indeed, it has recently
hosted the first quality management training course in transfusion
Further, the Stern article faults WHO for not ‘having
ever noticed’ the alleged problem with the Zimbabwe plasma
exports. Apart from what has already been outlined above, if any country
were to have produced and marketed unsafe blood products, it is to
national authorities to officially notify WHO.
In the case of Zimbabwe, as ZNBTS is a WHO
Collaborating Centre, WHO has up-to-date information about the nature
and quality of the blood donation practices current in that country
and can, as stated above, reassure anyone who asks of the quality of
the country’s blood products.
As for other countries, WHO is working to build an
international network for quality management in blood transfusion and
will host the first meeting of the Global Collaboration for Blood
Safety in November.
information, journalists can contact Mr Gregory Hartl, WHO
Spokesperson, Geneva, mobile (+41 79) 203 6715; tel
(+41 22) 791 4458; E-mail: email@example.com
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