AFRO-NETS> Bad Blood (3)

[Dieter Neuvians MD <neuvians@harare.iafrica.com>]

Bad Blood (3)
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WHO press release on blood safety

Following the STERN article posted a couple of days ago by Wilbert 
Bannenberg, WHO has issued the following press release:
http://www.who.int/inf-pr-2000/en/state2000-09.html

Statement WHO/9
26 October 2000
WHO RESPONSE TO ARTICLE IN STERN MAGAZINE ON BLOOD SAFETY

The article published today by Stern Magazine under the title "Böses 
Blut" (Bad Blood) raises the issue of illegal plasma re-labelling 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 sup-
plies of blood and blood products in developing countries. The over-
whelming majority of the world's population (80%) live in developing 
countries, yet have access to only 20% of the worlds safe blood sup-
ply. 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 articles 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 Zim-
babwe by describing two prostitutes giving blood. However, according 
to information provided by ZNBTS, the Stern article is incorrect. In 
each of the two cited cases, its safety measures had been duly ap-
plied 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 Zim-
babwe 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 se-
lection process is, thus, a model, which WHO recommends all develop-
ing countries should consider. In addition, all blood donors in Zim-
babwe 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 unfor-
tunate that this article describes the misuse of a blood donor card 
by one prostitute. The blood donor selection process is largely de-
pendent 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 evi-
dence of their danger is jeopardizing human life by reducing the num-
ber of regular blood donors. It would indeed be tragic if Zimbabwe's 
remarkable achievements were to be endangered by an article the in-
tention 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 Transfu-
sion 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 do-
nations 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 pa-
tient. Approximately 80 000 donations of 450 ml 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 prod-
ucts 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 Zim-
babwe, 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 sys-
tem 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, des-
ignated by the Ministry of Health and Child Welfare as the sole or-
ganization in charge of blood transfusion. Therefore its only motiva-
tions are safe blood transfusion and recipient well-being.

In addition, since the beginning of blood transfusion in Zimbabwe, 
the blood transfusion centres have always exclusively recruited vol-
untary, 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 medicine.

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 of-
ficially 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 prod-
ucts.

As for other countries, WHO is working to build an international net-
work for quality management in blood transfusion and will host the 
first meeting of the Global Collaboration for Blood Safety in Novem-
ber. 

For further information, journalists can contact 
Mr Gregory Hartl
WHO Spokesperson, Geneva
Tel:   +41-22-791-4458
mobile +41-79-203-6715
mailto:hartlg@who.int

All WHO press materials and other information can be found on the WHO 
website: 
http://www.who.int

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