10.08.2023

Blood on their hands

Ian Spencer examines the infected blood scandal. A tale of political incompetence, corporate greed, imperialism and extreme poverty

Rishi Sunak and the Tories are still refusing to announce a compensation scheme for victims and families affected by the infected blood transfusion scandal. That despite people living blighted lives for decades, thousands killed and an inquiry that has been ongoing since 2017.

Even Sir Brian Langstaff, chair of the inquiry has called for immediate compensation payments. But the government refuses to budge, insisting on waiting for the completion of the inquiry report. Meanwhile, more and more die.

Earlier this year, on April 5, Sir Brian published his second interim report. In it he said:

My conclusion is that wrongs were done at an individual, collective and systemic levels. I will set out the detail of what happened and why in my full report, but my judgement is that not only do the infections themselves and their consequences merit compensation, but so too do the wrongs done by authority, whose response served to compound people’s suffering.¹

His full report is expected in the autumn.

The background is chilling. It is a story of how hazards associated with the international trade in blood products led to companies knowingly using dangerous techniques to provide ‘factor 8’ - essential for the formation of blood clots that should allow haemophiliacs to live a near-normal life. In the UK around 1,250 people with bleeding disorders were infected with human immunodeficiency virus (HIV) and a further 2,400 with hepatitis C virus (HCV). Of these, by 2022, two-thirds of those with HIV had died and around 700 with HCV, which typically kills by causing chronic active hepatitis, leading to cirrhosis.²

It is a story about personal tragedies, deaths and loss, often accompanied by stigma and discrimination. It is also a story of how, even when the damage was done, successive governments, Labour and Conservative, tried to brush the matter under the carpet. Most of all, it is a story of how capitalism in general and imperialism in particular set the scene for the amplification and spread of HCV, hepatitis B (HBV) and HIV.

The inquiry was established in July 2017 by Theresa May as prime minister, following a class action in the courts representing 500 haemophiliacs, most of whom had been infected by HCV and some by HIV. There had been earlier attempts to get to the truth, such as by the privately funded inquiry, under the chairmanship of Sir Peter Archer in 2009, which was established because of government refusal to investigate the matter further. However, it had no statutory powers to subpoena witnesses or documents. What it did discover, though, was the loss of significant numbers of documents relating to the infection of patients with HCV, including the archives of David Owen, from when he was Labour health secretary.

Later, in 2000, it was revealed that the minutes of meetings of the Advisory Committee on the Virological Safety of Blood had also “gone missing”. Owen discovered that NHS self-sufficiency in blood products had not been achieved by 1987, despite the fact that, as early as 1975, the World Health Organisation recognised the dangers of HBV and called for countries to be self-sufficient.³ One of the reasons for the UK failure to become self-sufficient was the underfunding of the then state-owned Bio Products Ltd, which was visited by the Medicine Inspectorate in 1979, where they noted that the buildings were never designed for the scale of production envisaged.

Hepatitis

Generally, HCV is difficult to catch, other than parenterally (that is, by injection or transfusion). Most factor 8 was produced by plasmapheresis, which is when donated blood has the plasma extracted before the packed red cells are re-transfused back to the donor. One of the advantages of this is that plasma can be ‘donated’ much more frequently.

While in the UK the donation of blood is voluntary, elsewhere the selling of blood in general and plasma in particular was carried out often by the poorest in society. In the United States this included intravenous drug users and prisoners. There are examples, such as the Arkansas prison system, profiting by regular blood harvesting.⁴ The poorest in the world, as well as the US, were often ‘donating’ (if it can be called that) several times a month under extreme economic compulsion, and in many developing countries were directly infected, during the process of donating, due to poorly sterilised equipment.⁵

It had long been recognised that there was a ‘serum hepatitis’, as distinct from hepatitis A (HAV), which typically occurs in epidemics, as a result of infected food or water, often in children and rarely with long-term consequences. For example, in 1942, during mass vaccination of US troops, some 50,000 personnel were infected with ‘serum hepatitis’.⁶ In 1963 Baruch Blumberg identified the antigen and by 1971 a test had been developed to screen donations to blood banks.⁷ Worldwide, around 620,000 die each year from HBV and its sequelae - typically cirrhosis and primary liver cancer.⁸ By 1975 HCV was isolated, then identified as ‘non A, non B’ hepatitis.

In 1974, Judith Graham Pool, who had developed cryoprecipitate as a safer treatment for haemophilia, warned of the dangers of the newer form of treatment, using factor concentrates, where large amounts of plasma is pooled to extract factor 8. The WHO had also expressed its concern. It was the development of factor concentrates that led to a huge, worldwide growth in plasma farming in poor countries around the world and large profits for the companies engaged in it.

By May 1983 the risks from HIV, HBV and HBC were well known and concerns were expressed by the head of the UK Centre for Disease Control, Dr NS Galbraith, who recommended the withdrawal of US blood products. By then, France had already halted all US imports. Despite this, Tory health secretary Kenneth Clarke, who this time was obliged to give evidence to the inquiry, said in November 1983, “There is no conclusive evidence that Aids is transmitted by blood products”, and they continued to be used.⁹ Meanwhile, the Cutter Biological Division of the pharmaceutical giant, Bayer, was still not pasteurising plasma donations up until August 1984 and was busily dumping old untreated stock in Asian and Latin American markets in 1985.¹⁰

The inquiry published its first interim report on July 29 2022. Among its recommendations, was that there should be interim compensation payments of £100,000 to those infected and still alive, as well as to the bereaved partners of those who had been killed. However, there was no compensation for the parents of children who were killed and those children who were orphaned by infected blood products. It is expected to be among the recommendations of the enquiry that payments will be extended, but it remains to be seen to what extent culpability will be acknowledged by the government and whether responsible individuals will face justice.

Epidemiology

The dialectical relationship of accident and necessity in history is no better illustrated than in epidemiology. The history of Aids is the history of colonialism, poverty and the subjugation of women. HIV is simian immunodeficiency virus (SIV) from chimpanzees that has crossed over to humans, probably because of the butchering of chimpanzees for meat.

The transition from ape to human is likely to have taken place in the first two decades of the 20th century in Cameroon - a former German colony seized by French and Belgian forces during World War I. HIV2 developed in western Africa and is SIV in sooty mangabeys. However, the crossing of a virus from one species to another is a necessary, but not sufficient, condition to cause a pandemic, which has cost the lives of over 40 million people and has seen a further 39 million living with HIV. In 2022, 630,000 people worldwide died of HIV-related disease.¹¹

There is a direct relationship between the imperialist colonisation of Africa and the spread of HIV, which may have long pre-dated the imperialist epoch, but had only a very limited effect - an epidemiological dead-end, as it were, confined to a village or a small number of people. It was only able to reach first epidemic and then pandemic proportions by the transformation of African society by capitalism, as settled rural communities became urban and rooted in commodity production. Urbanisation was responsible for this, combined with the parenteral (injected) spread of the virus by inadequate colonial medical services disseminating the virus by poorly sterilised needles and syringes - used in well-meaning responses to the treatment of a range of tropical diseases, many of which, such as sleeping sickness, were almost invariably fatal.

Having reached Kinshasa (formally Leopoldville) and neighbouring Brazzaville, HIV was concentrated further by men paying for the use of sex workers, where there were few other opportunities for women to independently earn their living, particularly with the growing poverty in the former Belgian colony in the lead-up to independence.¹² HIV and hepatitis was further spread by poverty and war in Africa and, in the case of South Africa, the denial of its causal role by president Thabo Mbeki. South Africa now has one of the highest rates of HIV prevalence in the world.¹³

When I nursed Aids patients in London in the mid-1980s, the risk factors were cited as the ‘four H’s’: Haemophiliacs, Heroine Users, Homosexuals and Haitians. The last of those seems to be forgotten today, but Haiti saw a huge increase in HIV infection, owing in part to large numbers of Haitians working in Zaire to fill the places formerly occupied by Belgian teachers and administrators who left after the independence of a country where few resources and little effort was put into the education of Africans. At least some of these returned to Haiti with HIV, where another amplification took place.

Haiti, along with many other poor countries in Africa, Asia and beyond, took its place in the worldwide trade in blood products. It is likely that hundreds, if not thousands, of donors taking part in plasmapheresis were infected. Plasmapheresis donors could donate several times a month and were paid as little as $2 a time, making it a lucrative trade for corrupt officials of the Duvalier dictatorship. The donors themselves were often infected by HIV, HCV and HBV. Aids in Haiti was further exacerbated by its well-publicised use for sex tourism, particularly by visitors from the US.

Disease is inseparable from the social conditions that give rise to it. As we have seen with Covid, capitalism is a world system - and so are the diseases which emanate from and are exacerbated by it. The solution is an international, planned society where the interests of people and the natural environment are central. I await the final report of the Infected Blood Inquiry with interest, but I am sceptical that even those responsible for the dissemination of HIV, HCV and HBV by negligence, indifference or corruption will face justice - and more sceptical still that the systemic economic base will be spotlighted, of course.