The New Straits Times, May 28, 2000
By Prof Dzulkifli Abdul Razak
IN the recent past, much has been written about the transfusion of HIV-tainted blood here. The numbers involved are regarded as "small" but, nevertheless, serious enough to warrant the Cabinet to extend an apology.
Reportedly, there is now an atmosphere of distrust and anxiety about the whole situation. The underlying issue here is safety, which is dependent on a number of factors. Once compromised, the risks to blood safety can be pervasive.
Aptly enough, World Health Day 2000 focuses on the theme "Blood Saves Lives", with the slogan "Safe blood starts with me". Unfortunately, this has not received good publicity, giving the impression that blood safety is not a major issue in this country.
However, given the latest tragic developments, it is worthwhile exploring further the above-mentioned theme and slogan. It could provide an opportunity for all of us to understand the intracacies involved in dealing with the situation.
According to the World Health Organisation, 17 per cent of the population in developed countries benefits from approximately 60 per cent of the 75 million units of blood donated each year globally.
The remaining 83 per cent, living in developing countries, have access to only 40 per cent of the global blood supply.
The World Health Day 2000 is intended to serve as a launch-pad for a long-term advocacy programme for which activities will be undertaken and resources provided in addressing this disparity without sacrificing the aspects of safety.
In fact, it serves as an important reminder on two vital blood safety issues.
It cannot be overemphasised that "availability of blood and blood products is the first safety issue".
People are dying because of lack of blood. For example, each year approximately 150,000 pregnancy-related deaths could be avoided if appropriate transfusion therapy could be carried out.
Like access to medicines, access to an adequate supply of blood and blood products is also a major concern.
Secondly, though 83 per cent of the world's population, living in developing countries, has access to only 40 per cent of the blood supply, the blood collected in about two-thirds of cases are from paid or replacement donors.
It is not from voluntary, non-remunerated, low-risk blood donors. And in more than 43 per cent of cases, it is not tested for transfusion-transmissible infection.
Hence, the second major safety issue is "avoiding the transmission of infection by blood and blood products".
Up to five per cent of HIV infections worldwide are said to be transmitted through the transfusion of contaminated blood and blood products.
In Malaysia, in the last 15 years, 47 cases have been documented to be infected with HIV through blood transfusion, mostly in the days when the system for testing transfusion-transmissible infection was still new (NST, May 23).
In short, as millions of lives could be saved through the transfusion of blood and blood products, it further reinforces the importance of exercising utmost care to guarantee not only the availability of the blood supply but also its safety.
This is indeed one of the key messages of recent World Health Day, namely, safe blood could result in a positive health impact.
But before such a positive impact can be fully realised, there is a need for more safe blood donations and donated blood must be appropriately assured to safeguard patient safety, and at the same time demonstrate a respect for the donor.
The other key message is: "Blood safety is blood and blood products availability as well as transfusion safety."
Since blood safety also includes injection safety, the use of sterilised or single-use syringes and needles can avoid the risk of transmission of blood-borne pathogens, not limited to HIV alone. There must be safety standards in the handling of blood and blood products.
Thirdly, while effective and appropriate measures are needed to prevent the transmission of blood-borne diseases, people everywhere should also play their role in safeguarding their health and, in particular, their blood. For instance, they must avoid transmission of blood or sexually transmitted viruses.
As all of us are potential blood donors and even recipients, it is important for us to be aware that blood could be a vehicle to transmit a number of pathogens and viruses.
In all these messages, the slogan "Safe blood starts with me" is a very appropriate reminder regardless whether they are donors, handlers, administrators or policy-makers for as long as they are involved in blood donation and transfusion activities.
The adoption of this slogan and the overall theme "Blood Saves Life" will go along to realise at least four outcomes as envisaged by WHO:
- Firstly, an increased awareness among the public of the need for blood and therefore an increase in regular blood donations;
- Secondly, to create an increased awareness that blood donation should be a safe process, and that the donation process is handled in confidence and professionally;
- Thirdly, health professionals and the public should be more informed and able to make rational decisions on the need for blood transfusion; and
- Lastly, the government authorities and stakeholders should be more informed of the need for an enabling environment for blood services for the delivery of safe and adequate blood supplies.
For WHO itself, the theme and slogan will enable it to put into practice its new commitment by developing partnerships with organisations related directly to blood safety such as the International Society for Blood Transfusion, the World Federation of Haemophilia, and the International Federation of Thalassaemia.
Another important partner is the International Federation of Red Cross and Red Crescent Societies.
Similarly, societies and organisations at the national level too are encouraged to participate as a primary partner in ensuring that the issue of blood safety is given due attention.
They are particularly suited to educating the public, especially potential blood donors, as to their social responsibility _ not to risk and aggravate the health status of the recipient _ by adopting healthy lifestyles.
In short, blood safety is everyone's concern. To raise awareness of blood safety issues on a long-term basis nationwide as well as at the global level is an important strategy.
In order to ensure the provision of adequate and safe blood it is equally important to fully commit to and support national blood programmes with strict adherence to standard of procedure in conducting blood donations, and the handling of donated blood.
There is a need to implement national blood legislation or a legal framework for such national blood programmes and standards to be operationalised.
However, all these will be an exercise in futility if there are no blood donors or if they remain undoubtful over the entire donation process.
It is therefore most vital to promote and retain donations from voluntary (altruistic), non-remunerated blood donors from low-risk populations. And this can only be done if their confidence in the system is fully restored.
Otherwise the state of distrust and anxiety will continue and may even balloon to further jeopardise the health status in the population.
Insisting on a statutory declaration, as implied in recent discussions, is counterproductive as most potential donors would rather not risk any legal entanglement even though they are certain that they blood is safe.
On the contrary, should there be a need to make the statutory declaration, it should be by the authorities and parties involved in handling the blood.
Moreover, as mentioned by the acting Minister of Health, "the Malaysian health system after all was on par with, if not better, than international standards" and "if the medical staff abide by the standard operating procedures, such incidents would not happen" (NST, May 18).
Source: http://www-nt.who.int/world-health-day/en/ts/index.cfm
