The European Union looks like it might take the foolish step of banning financial incentives for a variety of substances of human origin, including blood, blood plasma, sperm, and breast milk. The legislation on the safety and quality of Substances of Human Origin includes an approved amendment that says donors can only be compensated for "quantifiable losses" and that such donations are to be "financially neutral." This legislation is supposed to harmonize the rules across the 27 member countries, promote safety, with the ban on financial incentives intended to avoid commodification and the exploitation of the poor.
What it threatens to do instead is make access to these substances much more difficult—and so threaten the saving and creating of lives. And a further unintended consequence of this is that it will also likely help better line the pockets of American-based sperm banks and plasma collectors.
Take Canada as an illustrative example. In 2004, Canada passed the Assisted Human Reproduction Act. The legislation banned payment for sperm donation and was also billed as a way to promote safety and avoid commodification and exploitation. But the act did none of those things.
Instead, the act resulted in a near-total collapse in the amount of Canadians willing to donate sperm and a massive increase in reliance on American sperm donors, who, of course, are financially incentivized to donate. In 2010, about 80 percent of the sperm used by Canadian women was provided by American men. In 2022, it was reported that 95 percent of sperm donations in Canada were imported.
Something similar happened with blood plasma. Today, more than 80 percent of the plasma therapies Canadian rare disease patients rely on are made from plasma donated by Americans.
Much of this dependence is a result of bans on financial incentives in the largest provinces of Quebec, Ontario, and British Columbia. In 2014, Canada was 60 percent dependent on American plasma when Ontario passed a ban on financial incentives for plasma donation in order to stop a private company from opening three paid plasma collection centers there.
Despite protests from patient organizations, exhortations that literally patient lives were on the line, and the fact that a majority of Canadians don't object to such financial incentives, public sector unions in the province managed to get the bill through. They did the same in Alberta in 2017 and then again in British Columbia in 2018.
While publicly the unions spoke about the need for safety and avoiding commodification and exploitation, they revealed to their membership that these bills will preserve their monopoly on plasma collection jobs and so protect union jobs. But instead of doing any of that, the bans just increased Canada's dependence on American paid plasma from 60 percent to over 80 percent, thereby protecting the profits and increasing the jobs available at American-based plasma collection companies.
To their credit, Alberta repealed the ban in 2020 and in a year or two will collect approximately as much plasma as the rest of Canada combined. Similarly to their credit, Canadian Blood Services has formed a partnership with the Spanish company Grifols, taking advantage of the exemption to the ban on financial incentives by having Grifols open paid plasma centers in Ontario as an "agent" on behalf of Canadian Blood Services. At least when it comes to plasma, Alberta and Canadian Blood Services have seen the folly of bans on financial incentives.
But the E.U. is set to repeat the mistakes Canada appears to have learned from.
Already the E.U. is dependent on plasma collected in the United States for around 40 percent of the needs of its 300,000 rare disease patients. They're not as dependent as Canada because Germany, Austria, Hungary, and the Czech Republic allow a flat-fee donor compensation model and so are able to have surplus collections that contribute 56 percent of the E.U. total. The remaining 23 countries, each of which runs a plasma collection deficit, manage just 44 percent.
So what is likely to happen if the new rules make this flat-fee donor compensation model illegal? Will safety improve and commodification and exploitation be avoided? No, the E.U. will just become even more dependent on the United States.
That's what makes laws like these hypocritical and counterproductive.
If you think safety is an issue when it comes to therapies made from paid plasma then, first, you are being fooled by misinformation and, second, you'll need to answer how switching from domestic paid plasma to American paid plasma makes the therapies any safer.
The United States currently supplies about 70 percent of the plasma used to manufacture therapies for the entire world. Canada would not import these therapies if they thought them less safe than therapies made with unpaid plasma. Neither would France nor Spain nor Italy nor Belgium nor the Netherlands. But they all do.
What about the twin phantoms of commodification and exploitation, apparitions conjured up as sophisticated-sounding objections to the use of market mechanisms like financial incentives? Even if these demons were real, banning domestic incentives but relying on so-incentivized donations from abroad doesn't exorcize them, it just exports them. And it's no moral improvement to "commodify" and "exploit" Americans rather than Canadians or Europeans.
But the financial incentives used don't commodify anyone. There is no evidence that German attitudes about their own bodies changed for the worse when they started to get paid for plasma. There's also no reason to believe that Austrians, unlike the French or English, think of body parts as mere commodities because they pay for plasma. Now that more Canadians will be paid for their plasma, do we really think that Canadian attitudes will be dramatically worse because of this? Surely not. We shouldn't threaten patient access to life-saving medicine for fear of some hypothetical bogeyman.
As for exploitation, the average donor gets around $65 in the U.S. for just over an hour of their time. That money represents about 20 percent to 30 percent of the total revenue per liter of plasma (which now is about $200 to $230). Donor compensation is the largest share of total revenue. That's not exploitative; that's lucrative. It's not taking advantage of anyone; it's a good and fair deal. And even if you think that's unfair, how much more unfair is giving people $0 when everyone else that has anything to do with plasma donation in countries that ban incentives collects a paycheck from those donations?
And what about altruism or community solidarity?
The point of collecting blood plasma and other medically useful substances of human origin isn't to give people an opportunity to be generous or to foster community. It's to meet the demand of a population of sick people who need a product that other people can offer. The people who provide that product should be compensated. Failure to see this is the real bogeyman, and it will haunt the hospitals of Europe if the E.U. follows through on this plan.