Topic B: WHO | Blood System Strengthening in Developing Countries
“Ensuring the safety and availability of blood and blood products
is an essential public health responsibility.”
— The World Health Organization
Introduction
Around 112.5 million units of blood are collected every year; however, often, patients who require a blood transfusion are often unable to receive safe blood in a timely manner. In many traumasOften time in traumas, patients bleed out before they obtaindie from exsanguination, bleeding out, without access to safe blood. These blood shortagsehe need for blood areis most prevalent in low-income countries, where median blood donation rate is 4.6 donations per 1000 people per year. The consequences manifest in their effects onDeveloping countries face blood shortages, affecting children with severe anaemia due to malaria or malnutrition. and women who face complications with pregnancy or childbirth. In addition, 99% of the 500,000 women who die eachevery year during pregnancy and childbirth are in developing countries with, and the most common cause of maternal death beingis haemorrhage, which requires blood transfusion in an area that does not have access to an adequate blood supply. In response, bBlood systems have been developedput in place in order to ensure an adequate supply of safe blood and blood products and their safe and rational use through national blood policies. A national blood policy is a formal statement of intent addressing organizational, financial, technical, and legal aspects required to establish and develop a national blood system. Aspects of a national blood policy include national transfusion services (which focus on blood donor recruitment), zonal blood service centers (which focus on the processing of blood), state and local government areas blood service centers (which focus on the appropriate use of blood), armed forces blood service (which focus on personnel and human resource development), and private and other non-governmental health establishments (which focus on technology and research, funding, quality assurance, records and data systems, equipment and consumables, and legislation).
Blood systems are strengthened by the haemovigilance system, which is a series of surveillance procedures that track the blood cold chain by monitoring, reporting, investigation, and analysis of the donation, processing, and transfusion and working to improve these aspects. The blood cold chain is the system of storing and transporting blood and blood products, ensuring blood is transported within the correct temperature range and conditions, from the point of collection from the donor to the point of transfusion to the patient. Haemovigilance has been shown to improve donor and patient safety. Units of blood may be divided into red cell concentrates, fresh frozen plasma, cryoprecipitate, and platelet concentrates in order to maximize the number of patients one unit of blood can benefit. 91% of blood collected in this manner in developed nations is compartmentalized in this way and has proven to be effective in ensuring the most people will benefit from smaller amounts of blood; however, only 31% of blood collected in developing nations, the areas that need more blood the most, is separated in this manner.
Background
Access to blood is less beneficial if that blood is not safe. If a blood donor is infected with a disease, this disease will spread to the patient receiving blood. Some of the most common of these diseases are Human Immunodeficiency Virus (HIV), hepatitis B, hepatitis C, syphilis, malaria, cytomegalovirus, parvovirus B-19 or other bloodborne pathogens and bacteria. These diseases are referred to as transfusion-transmittion infections (TTIs). Blood given to patients needs to be free of infections and disease. According to the World Health Organization, all donated blood needs to be tested for HIV, hepatitis B, hepatitis C, and syphilis before the blood is transfused to the patient.
Before blood is delivered to a patient, it should be tested to ensure it is safe. Nucleic Acid Amplification Testing (NAT) is a method of testing blood for Hepatitis C, HIV, and West Nile Virus in blood. According to the World Health Organization, donated blood should always be screened before it is transferred to the patient. Around 33 countries have implemented NAT for HIV and around 27 countries have implemented testing for Hepatitis B. Some nations have made this testing mandatory; however, most nations still do not have access to the proper resources to be able to implement this testing at all.
The most effective way to prevent the spread of TTIs is by increasing the number of voluntary, non-remunerated blood donations from low-risk populations. The goal of the World Health Organization is to achieve 100% voluntary blood donations; however, this goal has not yet been met in many developing nations. There are four main classifications of blood donors: voluntary non-remunerated donors (unpaid), family donors (direct), commercial donors (paid), and autologous donors (who give blood for their own use). Voluntary non-remunerated donations and autologous donations are among the safest forms of blood donation, as they minimize the risk of TTIs. In developing nations who experience frequent blood shortages, however, commercial donations are the most common form of blood donation, as donors give blood strictly for money. In a twelve year period in Nigeria, voluntary blood donation frequency dropped from 31% to 5%, while commercial blood donations increased from 20% to 63%. 92.9% of people questioned about their knowledge, attitudes, beliefs and motivations about blood donations in Lagos, Nigeria claimed to donate blood because of the benefits they receive from the hospital in return. Nations with 100% voluntary blood donation have shown to have the lowest rates of TTIs. While rates of voluntary donations decrease, the risk of transfusion-transmitted infections increases.
Blood is time sensitive. Once blood has been donated, it is only viable for 35 to 42 days. Within hours of leaving the body, nitric oxide levels in blood begin to drop. When 42 days have passed, the levels of the gas are virtually nonexistent. Nitric oxide is essential to help the body produce cells communicate with each other throughout the body. According to Dr. Jonathan Stamler, a professor of medicine at Duke University Medical Center, "The reality is that we are giving blood that cannot deliver oxygen properly. Many patients who are getting blood are being put at increased risk." The longer blood is stored, the less beneficial it is for the patients.
Current Situation
The World Health Organization had aimed to implement sustainable blood transfusion in Sub-Saharan Africa by 2012; however, this goal not been achieved. More than 60% of all people living with HIV live in Sub-Saharan Africa. Unsafe blood transfusions are one of the main contributors to the spread of HIV in this region; the risk of HIV infection through unsafe blood and blood products is around 95-100%, which is alarmingly high. Many of these nations have established National Blood Safety Programs and National Blood Policies; however, they have not had the resources to provide adequate blood and blood products to patients who need it. Hospitals do not have the safe, affordable, and readily available blood units they need, and it has cost the lives of many patients.
Blood donation rates in Africa are about 5 per 1000 people, which is exceptionally low. Data collected by the World Health Organization shows that 35 countries in Sub-Saharan Africa collect less than half of the blood needed to treat all patients and provide adequate blood transfusions. Only 2.8 million units of blood were collected per 720 million people. The national blood transfusion service (NBTS) reports that Nigeria alone uses nearly 1.5 million units of blood every year to treat patients. With a population of more than 150 people, the amount of blood per person in the nation is equal to less than one pint every year; this illustrates the poor blood supply chain in Nigeria and other developing nations in similar situations.
The 2015 Meeting on Developing Plans to Strengthen the Blood Systems in Ebola-Affected Countries addresses the effect the Ebola outbreak has had on weakening blood systems. National blood services were affected by the outbreak in 2014-2015 and were unable to respond effectively to the outbreak and need for treatment. The lack in resources has made it clear that developing nations need stronger blood systems and resources to supply basic commodities when outbreaks occur. About 1.2 million units of blood were collected from donors who were considered to be at high risk for transmitting HIV, hepatitis B, or hepatitis C in 2004. Data from 30 countries in the African region from the same year show that 9.8% of units of blood, around 183,000 units, were found to be infected with TTIs and were subsequently discarded.
Committee Directive and Jurisdiction
Representing the World Health Organization, delegates should work to improve access to safe blood in developing countries where blood shortages occur frequently. The committee will need to address the aspects of national blood policy that are essential for adequate blood supply and what of these aspects can be effective on an international scale. Delegates should consider the three main components of safe national blood policy set by the World Health Organization: voluntary unpaid blood donation, universal testing of donated blood, and reducing unnecessary transfusions. There has been little to no international intervention in regards to reinforcing blood systems, so delegates are tasked with finding ways to increase the availability of safe blood and resources to test blood to ensure it is safe to deliver to patients. Additionally, the committee should consider methods by which voluntary non-remunerated blood donations can be increased and how the increase of the voluntary blood donations can affect blood systems and the spread of TTIs.
The World Health Organization concerns itself with international health efforts; therefore, debate should revolve around the health issues surrounding blood transfusion. Throughout debate, delegates should remain focused on improving blood systems, rather than any other practices or issues that may contribute to the spread of diseases that can also be transmitted through blood transfusion. Some people in developing countries have claimed to avoid blood donation for religious reasons; however, any discussion of this should be avoided in debate for this committee. Debate should remain within the jurisdiction of the World Health Organization by strictly discussing medical technologies and issues.
Questions to Consider
Does your country have a National Blood Policy? If so, what aspects of it have been effective? Which have not?
How high are the rates of blood donation in your country?
Does your country have access to resources to tests blood for infection?
What are the rates of infection in your country?
Have measures been made to decrease these rates?
What are the rates of voluntary blood donation in your country?
Suggested Sources
WHO | National Blood Policy
http://www.who.int/bloodsafety/transfusion_services/nat_blood_pol/en/
NCBI | Nucleic Acid Testing-Benefits and Constraints
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3943139/
WHO | 10 Facts on Blood Transfusion
http://www.who.int/features/factfiles/blood_transfusion/en/
WHO | Making Safe Blood Available in Africa
http://www.who.int/bloodsafety/makingsafebloodavailableinafricastatement.pdf
WHO | Universal Access to Safe Blood Transfusion
http://www.who.int/bloodsafety/publications/UniversalAccesstoSafeBT.pdf