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“It will have blood, they say; blood will have blood.” So says Macbeth in the eponymous play by Shakespeare. In the case of blood being dispensed to seriously ill patients in the United Kingdom and elsewhere over the last few decades, it may also have bacteria, viruses and a variety of unpleasant contaminants that may kill you, or at least make you very ill indeed, probably terminally so. Until very recently, however, doctors, medical staff and especially politicians would have denied that very vigorously, as if their lives depended upon it. As it turned out, it was their careers and reputations that depended upon it while the lives were those of their constituents. Now – and certainly not before time – a series of detailed reports resulting from thorough research has revealed that the UK and other countries have been obtaining blood and blood products from overseas, including the United States, where blood is not donated freely but is paid for, which means that those giving blood have a financial incentive to do so. As a result, much of the blood comes from drug addicts, prison inmates and sex workers, whose blood may not be quite as pure as one might hope.

Let’s take a look at the commonest ailment that can be passed on in blood. Haemophilia is a genetic haematological disease transmitted along with the X-chromosome, which is why it seldom afflicts women, although a woman can pass on the disease to children, especially sons. As a result, the woman is often “carrier” of the disease and rarely becomes ill. Sufferers can benefit from taking frozen cryoprecipitate, a treatment developed in 1955 by the French doctor, Dr. Émile Remigy from Nancy. It is normally injected and must be kept in cold conditions.

Blood circulating in your body is composed of about 55 percent plasma, 40 percent red blood cells, 4per cent platelets and one per cent white blood cells, of which neutrophils are the most common. Now we know it can also contain dangerous contaminants that endanger lives. We tend to take the stuff for granted, by and large. Spilling blood has been something world leaders have done a great deal down the ages and seemingly have thought nothing of it.

Blood transfusions really began in earnest in the 19^th century, with Doctor James Blundell performing the first recorded human blood transfusion in 1818, although there had been a successful blood transfusion in 1667, performed by French doctor Jean-Baptiste Denis. The idea didn’t catch on and was opposed by his fellow-doctors, especially after one of his patients died, although it was later revealed that the man had been poisoned by his wife. Nevertheless, blood transfusion as a concept was fairly well established by 1897. The publication of Dracula by Bram Stoker in 1897 may have put some people off the idea, but not for very long. There are religions that ban the practice of blood transfusions, such as the Jehovah’s Witnesses, who believe no person should sustain his (or her) life with another creature’s blood, whether by injection or orally, (a practice that only applies to Count Dracula and his pals), because, they believe Jehovah will turn his back on anyone who receives blood. Fortunately, the ruling only applies to Jehovah’s Witnesses and is nothing to do with health issues.

In the UK, Prime Minister Rishi Sunak has told the House of Commons that he has issued “a whole-hearted and unequivocal” apology to victims of what was the biggest disaster in terms of medical treatment in the entire history of the UK’s National Health Service. He admitted that the affair brought shame upon the United Kingdom and on quite a few individuals who should have known – and done – better. He told Parliament that it was “a day of shame” for the British state. “Layer and layer upon hurt endured across decades, this is an apology from the State to every single person impacted by the scandal,” he said. And a scandal is what it undoubtedly was, the scale of which has become increasingly clear and utterly shocking. How many people died because of it? Well, it’s hard to tell, but we’re talking of thousands. And it was all avoidable. The inquiry into it has gone on for years, having been started by former Prime Minister Theresa May back in 2017. Evidence has been heard from almost 400 people, while an inquiry has also received more than 5,000 witness statements and read more than 100,000 documents.

The final report, unsurprisingly, runs to 2,527 pages and the government has promised financial compensation to everyone who suffered, although the companies that provided the infected products have not paid a penny towards that and appear unlikely to. In France, the scandal caused national outrage and a crisis of confidence in the entire French health system.

| GALLIC BLOOD

Looking at what happened in the UK is a dispiriting experience, with unchecked blood products coming from overseas, including from the United States, where until 1984 a proportion of the blood was provided by prisoners in exchange for money. The American blood was cheaper, however and warning signs were ignored as “inconvenient”. That’s how young teenagers found themselves infected with Aids and other sexually transmitted diseases, despite never having experienced sexual intercourse. Additionally, some patients were used as human guinea pigs without any possible advantage and without their knowledge or permission. Risks were not assessed. That’s how in the UK almost 400 children ended up with HIV, with all the pain and terror that implies. Every child infected with HIV also got hepatitis C, with the report concluding that it was impossible to summarise the pain and suffering that resulted from the curiosity of some doctors using children as guinea pigs and the simple carelessness of a great many others. Furthermore, there was clearly a cover-up, with a great number of documents disappearing, apparently destroyed, to make any deeper future research impossible. Nobody seems to know who was responsible for all that secrecy. Some senior UK politicians had even claimed – erroneously, of course – that no conclusive evidence existed that Aids could be spread by infected blood. Everyone knew it could, so that was clearly and simply a lie.

Britain was far from being alone in this, as I’ve mentioned. Now we know that much the same thing was happening in France, with blood contaminated with HIV and hepatitis C being used by the French National Blood Transfusion Centre and spreading diseases very widely, especially to haemophiliacs. In France, traceability was recognised as vital which led to the creation of the French Blood Agency in 1993, ten years after the French scientists, Professor Luc Montagnier and fellow professors had identified the virus responsible for AIDS. They notified the Prime Minister. In 1984, Agence France-Presse (AFP) reported a study by the New England Journal of Medicine revealing that blood transfusions were linked to around 1% of AIDS cases. An offer to heat treat blood products was declined. Other opportunities were also missed and in 1991, the medical journalist Anne-Marie Casteret published an article in the periodical, L’Événement du jeudi, claiming that the Centre National de Transfusion Sanguine (CNTS) had knowingly distributed blood products contaminated with HIV to haemophiliacs. Afterwards, neither scientists nor politicians were trusted. Important officials, doctors and even government ministers were implicated, and the prime minister of the time, Laurent Fabius, the former Social Affairs minister Georgina Dufoix and former Health Minister Edmond Hervé were all charged with manslaughter, although only Hervé was convicted but not sentenced because he had been obliged to wait for too long. A doctor, Michel Garretta, Director of the National Blood Centre (CNTS: Centre National de Transfusion Sanguine), was given a four year prison sentence, however.

Much the same thing had happened in Canada in the 1980s. In that case, thousands of Canadians were exposed to HIV and hepatitis C, through the use of contaminated blood products. According to a Royal Commission of Inquiry into the problem in Canada, it was the use of contaminated blood products, sourced from high-risk populations that had led to the introduction of the various diseases through blood transfusions. The Commission concluded that it had been “the largest single (preventable) public health disaster in the history of Canada”. Like France, Britain seems to have turned a blind eye to the entire incident, choosing instead to repeat it, albeit not purposely, but certainly carelessly. It was not the intention, of course, to spread the diseases, but just a little care would have prevented it from happening. This was a case of gross negligence on the part of doctors, health officials and politicians. Interestingly, the Canadian government offered victims 120,000 Canadian dollars (€94,402) in so-called “humanitarian assistance”, but only in return for a guarantee that they would not sue. The Commission of Inquiry into the Canadian scandal, referred to as the Krever Commission after Justice Horace Krever, looked into how and why the Canadian Red Cross and various provincial and federal governments allowed the tainted blood to enter the country’s healthcare system, infecting more than 30,000 Canadians with hepatitis C between 1980 and 1990 and infecting some 2,000 Canadians with HIV between 1980 and 1985. Of those who received the contaminated blood, around 8,000 have already died or are expected to die. Some of the dangerous blood products were also exported to Japan, Germany and the UK, and it seems that too many were not tested, wherever they went. In the case of Japan, 2,576 victims have had to be compensated for hepatitis C infections.

Australia had to pay out A$7-million (€4.3-million) to settle 400 cases there, while Italy’s health ministry has allocated €735-million to compensate victims. In Japan, legal action against the Japanese government and the manufacturers of the tainted blood began in 1989. Three former Green Cross executives received prison sentences of up to two years. And so it goes on.

Private enterprise also played a part in the scandal, perhaps unsurprisingly. Since the 1940s, blood supplies in Canada had been in the hands of the Canadian Red Cross Society, an independent charitable body, but blood that was past its use-by date was sent to Connaught Laboratories, a non-profit concern run by the University of Toronto, for safety checks. By the 1980s, Connaught had been sold into the private sector, although it was the Canadian Red Cross that continued to set safety standards. In 1984, some of the large blood banks in the United States started to use a new test to screen for hepatitis B, which is an indicator for HIV. The Canadian Red Cross didn’t follow suit and failed to check for HIV until 1985, but by then another virus, hepatitis C, was getting into the system. It was only in November 1985 that the Canadian Red Cross Society began testing all donated blood for the presence of an antibody linked to HIV. Less than a month after the release of the Krever report, the Royal Canadian Mounted Police (RCMP) laid 32 charges against two senior bureaucrats at Health Canada, as well as against the head of the Red Cross’s blood programme and against a vice-president of the New Jersey-based company Armour Pharmaceutical, which manufactures the Factor VIII concentrate for haemophiliacs. The company itself and the Canadian Red Cross Society were also charged. Justice at last? Seemingly not. In 2005, the Red Cross pleaded guilty to violating the Food and Drug Regulation Act for distributing a contaminated drug and were fined the maximum sum the Act allowed, Canadian $5,000 (€3,371.51) and all criminal charges were dropped. Those who suffered personally or who had lost loved ones may feel that the accused got off quite lightly.

This story of stupidity, idleness, self-interest and lying goes back a long, long way. Governments down the years have issued assurances based on guesswork or simply an unwillingness to investigate or accept responsibility. That seems to been very much the case in France and the UK. Former British Prime Minister Margaret Thatcher insisted that people who had been infected with HIV from tainted blood products had been given “the best treatment possible”, although she must have known that wasn’t true. It was, of course, a very gross untruth. Nobody wanted to accept responsibility for anything, especially since it was so much easier (and potentially cheaper) to turn a blind eye to it all and hope it would go away. Even before she said it, her Health Minister at the time, Ken Clarke, had said that there was no conclusive proof that AIDS could be transmitted through blood or blood products.

He did not know this, of course – it was untrue anyway – but it didn’t stop him from trying to avoid responsibility, even at that early stage. Inquiry leader Sir Brian Langstaff pointed out that it had been known since the 1940s that blood could transmit hepatitis, but patients were not warned of the risks, although the World Health Organisation raised the issues with some concern in the 1950s, as well as highlighting ways to minimise them. I’m fairly convinced that most schoolchildren could have seen that Ken Clarke’s assurances were nonsense in any case and were simply “politics” with no connection to truth at any point. It seems that for too many politicians the most important thing to do when faced with an avoidable crisis is to escape the blame, rather than to attempt to put things right.

| WHO’S TO BLAME?

Indeed, that seems to be pretty much the same approach as in Britain’s Infected Blood Inquiry. In its final report, it admitted that the infected blood scandal in Britain was not an accident but the fault of doctors, scientists, and a succession of governments. It led to 3,000 deaths and thousands more people contracting hepatitis or HIV. “People put their faith in doctors and in governments to keep them safe and their trust was betrayed”, says the report. It continues in terms that politicians will not have liked. “The NHS and successive governments compounded the agony by refusing to accept that wrong had been done. More than that, the government repeatedly maintained that people received the best possible treatment and that testing of blood donations began as soon as the technology was available. And both claims were untrue.” Indeed, looking at the various ethical failures, the writer of the report, Sir Brian Langstaff pointed to several factors, including “the intentional destruction of some documents” and the decision of the government to use phrases such as “no conclusive proof” (of a link between blood products and HIV) to give ‘false comfort’ and misrepresent the known risks.

Of course, there was plenty of proof. All in all, it must be one of the most damning reports about a government’s action (or inaction) any western nation has ever experienced. It is, quite literally, shocking, revealing a total lack of responsibility for people’s lives and health by all leading politicians and medical practitioners.

The report speaks of a “defensive culture” within government and the civil service, as those most closely involved sought ways to escape blame for their acts (or lack of them). Sir Brian’s report calls for serious lessons to be learned, including changes to the way in which medical staff (including doctors) are trained. The report also states that: “Individuals in leadership positions should be required by terms of appointment and secondary legislation to record, consider and respond to any concern about the healthcare being provided, or the way it is being provided, where there reasonably appears to be a risk that a patient might suffer harm, or has done so. Any person in authority to whom such a report is made should be personally accountable for a failure to consider it adequately.” Sir Brian clearly wants to ensure that trying to duck the blame for failures will no longer be acceptable. It’s an extremely detailed report that is also very damning of common practices.

The government has reacted quite quickly, with Prime Minister Rishi Sunak calling it “a day of shame for the British state”. He is not wrong there. He offered an apology, although it cannot bring back the great many who have died because of the scandal. The scale of the whole affair is clear from the Prime Ministers’ promise to pay compensation to the many victims promptly, with officials from the Treasury talking of sums in excess of £10-billion (€11.73-billion). The size of the final pay-out should become clearer at the time of the Treasury’s next Autumn Statement. Nothing is likely to be finalised before Britain’s upcoming General Election in July, although the report writer, Sir Brian Langstaff, has urged speed in dealing with the issue. The UK government had previously accepted the moral case for generous compensation to be paid as quickly as possible.

It has since become clear that the infected blood and blood products used in various treatments had not all necessarily been required for clinical reasons, leaving a great many questions to be answered, such as why did the UK continue to import such products as the very risky Factor VIII concentrates from the United States after the dangers had been realised? Some of the various ingredients continued to be used for transfusions, even when safer alternatives were known about and available. Some of the concentrates being imported carried the HIV virus, but the authorities decided not to switch to safer alternatives, even deciding in 1983 not to halt imports, despite knowing the likely consequences. The report has no powers to recommend prosecutions, but in France the former health minister Edmond Hervé was convicted for his rôle in a similar scandal there, although he was not punished for it. The judge ruled that the length of the scandal meant he had not benefited from the “presumption of innocence”. The director of France’s national blood centre, Michel Garretta, received a 4-year jail term for the part he played in the issue, however.

| LEARNING LESSONS? WHAT LESSONS?

According to Britain’s Haemophilia Society, during the 1970s and 1980s, some 6,000 people received treatment for bleeding disorders that involved the use of contaminated blood products. In quite a few cases, sufferers had accidentally infected a partner with such things as HIV and hepatitis viruses because they were unaware that they carried them. During those two decades, some 6,000 people suffered from haemophilia or other bleeding diseases and more than 3,000 people died, including 380 children. According to the Haemophilia Society, fewer than 250 sufferers remain alive. Sir Brian Langstaff, Chair of the inquiry, has concluded that many of the HIV and hepatitis C infections inflicted on the community could and should have been prevented and he blamed a cover up which had been “subtle…pervasive and…chilling,” as he put it, explaining that: “To save face and to save expense, there has been a hiding of much of the truth.” That is now over – probably – but knowing the truth won’t bring back the hundreds whose lives were lost or severely blighted. The prison system in the United States is known to have made huge profits from selling its infected blood products to foreign health authorities that they should have checked for safety but failed to do so. There is so much blame here attached to so many people that it would have to be spread around with a large shovel.

At the same time, a lot of individuals look likely to come in for severe criticism. Take, for example, Dr. Peter Jones of the Newcastle Haemophilia Centre at Newcastle’s Royal Victoria Infirmary. He had consistently played down the risks of haemophilia treatment spreading AIDS. He was wrong, and even gets a mention in the final report for “not taking the risk of AIDS as seriously as he should have done.” The report comes too late to make a difference; Dr. Jones retired in 2000, but he’s not alone in shouldering some of the blame. Leading haematologist Professor Arthur Bloom has also come in for heavy criticism for the way he “disastrously” influenced the thinking of the UK Department for Health and Social Security (DHSS), failing to pass on warnings and advising the continued import of commercial factor concentrates. Some of the worst mistakes of the scandal were made at Lord Mayor Treloar College, in Alton, Hampshire, during the 1970s and 1980s, where a number of male pupils were given on-site treatment for haemophilia, but unintentionally using plasma blood products that were infected with hepatitis C and HIV. More than half the students who received the treatment are now dead. The report doesn’t blame the school’s administrators, but it does place quite a lot of blame on the NHS clinicians who administered the treatment on-site and seem to have regarded the students as “objects of research”.

nd so, this scandal grinds to a somewhat belated halt, just like the one in France. Politicians are supposed to protect us all from harm, not exploit us for money, but by no means all of them seem to have realised that. Similarly, doctors, surgeons and specialists have been trained to help us to overcome the many and various germs, bacteria and viruses that beset us on our ways through life, but it seems that they, too, can be deflected off course by the lure of cash and well-stuffed bank accounts, given half a chance. At the end of the day, it’s not politicians who rule us, it seems, but their individual greed and self-interest. It’s a disappointing lesson we have learned in both France and the UK: trust nobody, whether from the world of politics or the medical profession. This scandal has – sadly – shown where their true interests lie. Money, as has been shown to be the case so many times in the past and on so many occasions, rules. I received this email from one campaigner who has learned the cost of inaction: “My name is Sam Rushby. I lost my Mother, Father and four-month old baby sister to HIV as a result of the infected blood scandal. By the time I was three years old, my entire family had died. I lost them because my father received HIV-infected blood products, unwittingly infecting my mother, who gave birth to her HIV-positive daughter. Evidence seen by the Infected Blood Inquiry has proven that the Government, pharmaceutical companies and the medical profession knew that these blood products were infected. No one, including my family, was warned.” They were just three of the thousands of people impacted by this scandal. Sam Rushby, like a great many other victims, deserves rather more than financial compensation and an apology, although he certainly deserves that, too. But he also deserves a guaranteed assurance that this kind of shocking misbehaviour by the people in charge, both in the medical profession and in government, will never be repeated, while those responsible on this occasion must be properly, fairly punished.