How AIDS was spread through the blood supply
July 5, 2020 8:32 AM Subscribe
A number of companies were selling HIV-contaminated blood factor for treatment of hemophilia, first from ignorance and then from irresponsibility. I first ran across this about Bayer's complicity, and was pointed at The Origins of AIDS. The first review (by John P. Jones) pointed me at Haemo-Caribbean, a Haitian company which was part of the problem.
Interview with Jacques Pepin, author of The Origins of AIDS.
"I tried not to blame anybody. I just tried to describe what I think most likely happened. When I have been interviewed, journalists focused a lot on the role of medical interventions. They have to find someone who is guilty. It makes for a better story—the good person and the evil person.
I’ve repeatedly said that if I had been a doctor working in Cameroon in the 1920s and 1930s, I certainly would have done the same thing that these doctors did. They did their best with the tools they had at the time and with very little knowledge. So I’m not blaming them at all."
Interview with Jacques Pepin, author of The Origins of AIDS.
"I tried not to blame anybody. I just tried to describe what I think most likely happened. When I have been interviewed, journalists focused a lot on the role of medical interventions. They have to find someone who is guilty. It makes for a better story—the good person and the evil person.
I’ve repeatedly said that if I had been a doctor working in Cameroon in the 1920s and 1930s, I certainly would have done the same thing that these doctors did. They did their best with the tools they had at the time and with very little knowledge. So I’m not blaming them at all."
And never forget how here in Canada, the Red Cross denied it was infecting patients through its blood products due to negligence verging on criminal and a near complete lack of screening until a Royal Commission determined that it had indeed given thousands of people HIV and Hepatitis C. They eventually apologized for it decades later.
As a result, the Red Cross is no longer legally able to collect blood or blood products in the province of Quebec, or indeed anywhere else in Canada, with two new organizations setup to handle those duties.
Text of the report from 1997's Krever Commission, which revealed the extent of the Red Cross' 'gift of death' available here. Summary here.
posted by jordantwodelta at 2:15 PM on July 5, 2020 [6 favorites]
As a result, the Red Cross is no longer legally able to collect blood or blood products in the province of Quebec, or indeed anywhere else in Canada, with two new organizations setup to handle those duties.
Text of the report from 1997's Krever Commission, which revealed the extent of the Red Cross' 'gift of death' available here. Summary here.
posted by jordantwodelta at 2:15 PM on July 5, 2020 [6 favorites]
In Ireland too! The Blood Transfusion Service Board wrought a "bloody disgrace" on a cohort of 60,000 women by giving them a prophylactic dose of anti-D rhesus antibodies [to prevent a condition called haemolytic disease of the newborn HDN or erythroblastosis fetalis if you want to impress people with Latin; which can occur if mum is Rh-ve and baby Rh+ve] which was contaminated with Hep C virus. Not once, in 1977, but again in 1992 through culpable negligence on the blood-donor screening front. In a separate fiasco, the same crew mismanaged to make a whole generation of haemophiliacs HIV+ve. The HepC Tribunal cost the state, and me the tax-payer, ~€1 Billion about half of which went to lawyers because the state fought compensation every step of the way.
But here's a silver lining: the Anti-D women were all about the same, child-bearing, age, from a population with reasonable genetic homogeneity yet they had a variety of responses to tests and in terms of their symptoms and disease progression. Like with SARS-CoV2 you can do tests a) PCR for circulating virus particles b) antibody for are you or have you ever been exposed to the virus?. A small number of women tested PCR-ve and Ab-ve but are known to have received anti-D from an HCV-contaminated batch [the BTSB were better at record keeping than blood cleaning]. They have recently been recruited to see if there is something interestingly peculiar about their innate immune response [the fire-fighting which starts as soon as pathogens are detected and which acts to keep things in check for the 4-5 days it takes for the 'adaptive' immune system to get the anti-bodies up to speed]. The hypothesis is that their innate immune system knocked the virus on the head before the antibodies were required.
That's useful because 180 million people are infected with HCV worldwide and if we knew what aspects of the innate immune system works effectively against the virus then novel therapies are possible.
posted by BobTheScientist at 3:12 PM on July 5, 2020 [6 favorites]
But here's a silver lining: the Anti-D women were all about the same, child-bearing, age, from a population with reasonable genetic homogeneity yet they had a variety of responses to tests and in terms of their symptoms and disease progression. Like with SARS-CoV2 you can do tests a) PCR for circulating virus particles b) antibody for are you or have you ever been exposed to the virus?. A small number of women tested PCR-ve and Ab-ve but are known to have received anti-D from an HCV-contaminated batch [the BTSB were better at record keeping than blood cleaning]. They have recently been recruited to see if there is something interestingly peculiar about their innate immune response [the fire-fighting which starts as soon as pathogens are detected and which acts to keep things in check for the 4-5 days it takes for the 'adaptive' immune system to get the anti-bodies up to speed]. The hypothesis is that their innate immune system knocked the virus on the head before the antibodies were required.
That's useful because 180 million people are infected with HCV worldwide and if we knew what aspects of the innate immune system works effectively against the virus then novel therapies are possible.
posted by BobTheScientist at 3:12 PM on July 5, 2020 [6 favorites]
For a little bit in the 80s, I was a phlebotomist at a plasma donor center. It was weird and scary then, in those types of jobs. AIDS was a death sentence.
I put the executives in the same category as those from Bhopal. Negligent homicide. And both groups got about the same level of justice: none.
posted by j_curiouser at 8:51 PM on July 5, 2020 [4 favorites]
I put the executives in the same category as those from Bhopal. Negligent homicide. And both groups got about the same level of justice: none.
posted by j_curiouser at 8:51 PM on July 5, 2020 [4 favorites]
It's worth remembering that a large cohort of those infected by contaminated blood products were infected before HCV or HIV were in any real way identified or understood. In the case of Haemophilia A patients from, roughly, the mid-70s to the mid-80s, large-pool fractionated Factor VIII was, rightly given the available knowledge, regarded as the single most transformative therapeutic intervention in the entire history of treating the disease. (Heat-treated Factor VIII and, latterly, Recombinant Factor VIII continue to transform the lives of Haemophilia patients in ways their grandparents would have considered miraculous today.) Prior to that development, the future of almost all Haemophilia A patients, particularly those with moderate or severe disease, was incredibly bleak. The overwhelming majority of such patients would have suffered severe disability and very early death. Factor VIII really did change that - even if, entirely inadvertently, novel pathogens led to a sub-set of those patients experiencing entirely different disabilities and early deaths.
Here in Scotland, a concerted, if not wholly successful, attempt to achieve self-sufficiency in blood and blood products reduced reliance upon imported blood and blood products (particularly from the US, where the policy of paid blood donation - a folly beyond belief - inevitably resulted in exceptionally dangerous blood pools and, hence, blood products). Nevertheless, in that roughly decade-long period where HCV and HIV moved cryptically through the population, including the blood donor population, the introduction of either pathogen into the large pools from which Factor VIII was fractionated meant that haemophilia patients, and others, were in retrospect inevitably exposed to the viruses.
The infection of blood and blood products was indeed a tragedy wherever it happened - and in some countries it does indeed appear that both clinicians and those in authority not only made mistakes, both avoidable and unavoidable (and particularly in resistance to emerging knowledge) but also and much less forgivably subsequently refused to own up to those mistakes and make timely amends. Those delaying tactics are utterly reprehensible. That said, at least here in Scotland (and probably elsewhere), in terms of that crucial decade of cryptic transmission, I'm personally of the view - pace Peppin, above, that if I had been a doctor working in blood transfusion/haemophilia care in the late 70s and early 80s, I certainly would have done the same thing that those doctors did. They did their best with the tools they had at the time and with very little knowledge.
Scotland's Penrose Inquiry, including a huge report, here.
posted by deeker at 4:32 AM on July 6, 2020 [3 favorites]
Here in Scotland, a concerted, if not wholly successful, attempt to achieve self-sufficiency in blood and blood products reduced reliance upon imported blood and blood products (particularly from the US, where the policy of paid blood donation - a folly beyond belief - inevitably resulted in exceptionally dangerous blood pools and, hence, blood products). Nevertheless, in that roughly decade-long period where HCV and HIV moved cryptically through the population, including the blood donor population, the introduction of either pathogen into the large pools from which Factor VIII was fractionated meant that haemophilia patients, and others, were in retrospect inevitably exposed to the viruses.
The infection of blood and blood products was indeed a tragedy wherever it happened - and in some countries it does indeed appear that both clinicians and those in authority not only made mistakes, both avoidable and unavoidable (and particularly in resistance to emerging knowledge) but also and much less forgivably subsequently refused to own up to those mistakes and make timely amends. Those delaying tactics are utterly reprehensible. That said, at least here in Scotland (and probably elsewhere), in terms of that crucial decade of cryptic transmission, I'm personally of the view - pace Peppin, above, that if I had been a doctor working in blood transfusion/haemophilia care in the late 70s and early 80s, I certainly would have done the same thing that those doctors did. They did their best with the tools they had at the time and with very little knowledge.
Scotland's Penrose Inquiry, including a huge report, here.
posted by deeker at 4:32 AM on July 6, 2020 [3 favorites]
those in authority...much less forgivably...refused to own up to those mistakes and make timely amends. Those delaying tactics are utterly reprehensible.
That's all I'm referencing. Clinicians did what they had to do.
posted by j_curiouser at 12:24 PM on July 6, 2020
That's all I'm referencing. Clinicians did what they had to do.
posted by j_curiouser at 12:24 PM on July 6, 2020
I'm sorry (and a little confused?) you thought I was replying to your comment, j_curiouser - I wasn't, just adding some information to the discussion...
posted by deeker at 12:35 PM on July 6, 2020
posted by deeker at 12:35 PM on July 6, 2020
« Older The Hurdy-Gurdy Carnival is Present to Conduct You... | The death of the bra: will the lingerie liberation... Newer »
This thread has been archived and is closed to new comments
The blood supply company implicated in that scandal had ties with Japan's infamous Unit 731...
posted by Heywood Mogroot III at 2:02 PM on July 5, 2020