China analyst David Cowhig has provided the following translation of an article from the China Business Herald about Doctor Gao Yaojie and the AIDS epidemic in China. Below is a note from the translator followed by the translation:
Translator’s note:
Dr. Gao Yaojie will receive a Global Leadership Award from Vital Voices on March 14 at the Kennedy Center.
Last night I ran across a March 6, 2007 newspaper article discussing Dr. Gao’s current campaign about exposing and stopping unsafe blood collection and transfusion practices. Dr. Gao is best known for exposing the HIV epidemic in Henan and other provinces and for helping AIDS orphans. Now she is very concerned about many recent cases of people getting HIV from blood transfusions in Henan Province.
She has been collecting cases about these infections and their spread. She has linked 40 cases of HIV/AIDS to one hospital in central Henan and has been collecting information about a cluster of cases at two other Henan hospitals and reports of other cases around the province. Dr. Gao has been describing these cases on her blog, using pseudonyms for the AIDS patients. She finds that listing case after case after case will prove that she is not exaggerating that blood borne spread of HIV/AIDS remains a problem in Henan. It is for this work compiling and publicizing these cases on her blog that resulted in her recent soft arrest/home detention in Zengzhou, Henan.
Dr. Gao believes that there must be many more cases than the ones she has been able to document. Dr. Gao sees the root of the problem to be widespread corruption and unbridled power leading to disregard of laws and regulations that were put in place to protect the blood supply.
The section about cut off the common interests (which I translated as no perverse confluence of interests) of the blood collection stations and blood products companies was a bit difficult. The blood collection stations were before the 2006 reforms a public institution (事业单位), a government run enterprise partially funded by business profits under the public health system. Since they were under the same system as the hospitals, senior management of the health system would have a special incentive to hide problems. Transforming the public institutions into companies is meant to break the subordinate relationship of the blood collection stations to the public health system. Kind of hard to wrap your mind around, since one might think that distancing the public health system from the blood collection stations might make things worse; in the Chinese environment it is an effort to make things better.
In Translation:Gao Yaojie is Not Sensationalizing the Problem
By Yan Lieshan China Business Herald (an 800,000 circulation daily PRC business and financial paper; the author is an editor with the Nanfang group of newspapers.) Full text of the original in Chinese is here.
AIDS is a malignant epidemic disease that seriously threatens the health of the Chinese people. No one can close their eyes to this any longer but there is some disagreement about just what are the most important modes of transmission of the HIV virus. Some experts and officials believe that sexual promiscuity and injection using dirty needles are the most important transmission modes. However, China’s first person for AIDS prevention, Dr. Gao Yaojie, believes that the most important mode for HIV transmission is still blood collection, blood transfusion and medical products made from blood, and so argues that the government needs to focus its attention more on blood collection, transfusion and blood products and not on pushing for virtue and self-control on the part of high risk groups and wide distribution of condoms.
In my view, they are both right, and both are needed just as in different regions there are different people and so different measures need to be taken. As for the view of some officials and experts that Dr. Gao Yaojie’s views are already outmoded, early in 2007 in my article “Dr. Gao Yaojie Sick at Heart”, I wrote that Gao Yaojie, “in her blog on Sina.com wrote something that is confirmed in economic theory and practice. She wrote ‘With China being short of blood, how can illegal blood collection be controlled? A poor person sells 800 cc of blood for 50 RMB, so how can the bloodhead [illegal blood collector and seller] give up the tremendous profits that can be reaped’?”
Recent press reports confirm this fact and again confirm Gao Yaojie’s judgment.
Baiyi of Guangdong Province, which manufactures injectable immunoglobulin was found not to be manufacturing in line with regulations. Clinical practice found that some of the products of that company have caused some patients to become positive for Hepatitis C antibodies as a result. On January 26, 2007 the Xinmin Evening News reported on a journalist’s undercover visit to a Lianshan plasma collection center of the Baiyi of Guangdong. The journalist found that the process for collecting blood gave reason for serious concern.
On January 24, 2007, the journalist went to that blood plasma collection station and found a notice posted on the front door: “This Company announced that plasma collection ends tomorrow, collection times will be announced later.” The notice was dated January 22, 2007. That is, blood plasma collections continued until the day before the Ministry of Health, State Food and Drug Management Commission issued a public notice that there were problems with the immunoglobulin products of the Baiyi Pharmaceutical Co., Ltd., even though this company had previously been listed by the concerned department of Guangdong Province.
It cannot be said that the administrative departments don’t know about this situation or are not doing anything. In April 2006, the Ministry of Public Health drafted the “Program for Reforming the Blood Plasma Collection Stations.” According to this program, the ties between blood plasma collection stations and the county level people’s government health bureaus will be ended, and these public health bureaus will not longer set up blood plasma collection stations. After these blood collection stations are separated from the county level health bureaus, companies will put up the capital to buy them and what was once a public institution (‰∫ã‰∏öÂçï‰ΩçÔºâwill be transformed into a company under a blood products manufacturing company. The company will be fully responsible for managing and operating the blood plasma collection stations. From now on, a blood plasma collection station established by a company that does not make blood products will immediately lose its “blood plasma collection permit”. This action is intended to control the spread of HIV and other blood borne diseases, systematize the oversight and management of blood plasma collection stations, and prevent perverse confluence of interests between the blood plasma collection stations [note: now operating as private enterprises and not part of the public health system] and the biological products companies [note: which are regulated by the public health system] since they belong to separately managed systems.
We need to understand clearly that Chinese reality cannot be changed merely by one or two laws or regulations.
The essence of the problem of illegal blood collection and controlling the supply of blood (and products made from blood), is the existence of a large population of poor, destitute people. Many reports have described in considerable detail the wretched lives of people who need to support themselves by selling blood. Those descriptions will not be repeated here. We have seen many news articles about people who do not have money to pay for schooling, who have no money for medical care and no money to support their families. Even in districts that are not extremely poor, even in the lively districts of prosperous cities, we can every day see impoverished elderly people, women and children who have no place to turn. Although it cannot be said that they face a choice of sell blood or die, the choice to sell blood looms large as their condition steadily deteriorates. Living for the moment is what poor people are forced to do. How can they in those circumstances stop to consider whether they might catch HIV or hepatitis? If those people did not live in such dire straits, if they had some basic guarantee of their livelihood, wouldn’t they, just like those Americans “cravenly fear death” and treasure their own lives? We want to prevent AIDS; a strong foundation in our work is helping those people who are struggling to just barely get by (especially the large numbers of poor peasants). This is of course much harder than giving out large numbers of condoms, but it must be done, and China is capable of doing it.
The second reason why there is still a problem with illegal blood collection and blood transfusions from blood that was not safely collected and processed is that some companies without a conscience operate illegally for the sake of big profits. The article revealed that the hidden risk caused by long term improper management of blood collection did not end when the blood plasma sold the plasma to a company. There are many hidden risks to blood collection – many of the people doing blood collection have not been properly trained; at first they checked the ID card and the household registry of the person selling blood, but later they didn’t do that; “one 500 cc bag of blood plasma means 80 RMB for the blood seller. About 100 people come to sell blood each day Even after allowing for the costs, the company earns astonishingly high profits from this.”
Those criticizing Gao Yaojie said that blood plasma collection in China is already strictly regulated. However, this latest article together with the report on the Guizhou blood plasma collection station in “Nanfeng Chuang” shows that illegal blood collection behavior by legal permitted blood collection stations is a big problem. As for the claim that “the production of blood products goes through three checkpoints so that even if the collected blood has a virus, it will be certain that the virus will be killed,” the Baiyi case proves that this is just a fond hope and government departments need to strengthen their regulatory oversight. This time the people were infected with hepatitis, next time it could be HIV. They spread the same way.
If we do not address these problems properly, we are acting no differently when we failed to ignore the threat of HIV early on in the epidemic. Once we make this kind of mistake, it is very hard to make up for the error. The words of the old lady Gao Yaojie may well be putting some special emphasis on this kind of hazard, but she is certainly not being sensational.
