When the Records Are Gone: What Hepatitis B and C Could Really Do

By The Unheard Voice

Was Britain’s Infected Blood Scandal Really About American Blood?

When Britain’s infected blood scandal is discussed, one explanation appears again and again:

Britain imported contaminated blood from America.

That is part of the story.

But it is not the whole story — and phrasing it that way can actually obscure what happened.

The scandal involved different blood products, different routes of infection and different groups of patients.

For people with haemophilia, one of the most important distinctions is between Factor VIII, used mainly to treat haemophilia A, and Factor IX, used mainly to treat haemophilia B.

Both groups were affected by contaminated clotting-factor concentrates.

But their supply histories were not identical.

It was not simply “American blood”

The first thing to understand is that blood, plasma and manufactured clotting-factor concentrates are not the same thing.

The Infected Blood Inquiry found that the major dependence on overseas commercial supply was particularly associated with Factor VIII concentrate.

During the 1970s, demand for Factor VIII rose rapidly and the NHS could not produce enough domestically.

Commercial concentrates were therefore imported, particularly from the United States.

From 1977 until 1983, more than half of the Factor VIII concentrate supplied in the UK was commercially produced.

That is a hugely important part of the history.

But it should not lead us to write Factor IX recipients out of the scandal.

Factor IX mattered too

Factor IX concentrate was used to treat people with haemophilia B, historically also known as Christmas disease.

Like Factor VIII concentrate, Factor IX was manufactured from pooled human plasma.

The Infected Blood Inquiry’s expert evidence describes the development and industrial manufacture of both Factor VIII and Factor IX concentrates during the period relevant to the scandal.

People receiving Factor IX were therefore also exposed to the dangers associated with plasma-derived clotting-factor treatment.

But there is an important historical distinction.

Britain was generally much more self-sufficient in Factor IX than Factor VIII.

The Inquiry found that Factor IX was mostly domestically produced, whereas Britain’s shortage of domestic Factor VIII led to much greater reliance on imported commercial Factor VIII.

So saying simply that haemophilia patients were infected because Britain “bought American blood” is too crude.

It describes an important part of what happened to many Factor VIII recipients, but it does not accurately describe every infected person’s treatment history.

Why pooled concentrates were dangerous

The fundamental danger was not nationality alone.

It was the way plasma-derived clotting-factor concentrates were manufactured.

Factor concentrates allowed people with haemophilia to treat bleeding much more effectively and, eventually, at home.

They transformed treatment.

But manufacturing concentrate required plasma from large numbers of donors to be pooled together.

That dramatically changed the scale of infectious risk.

If one donor contributing to a pool carried a blood-borne virus, contamination could affect material manufactured from that pool.

The Inquiry records how the pools used for NHS Factor VIII concentrate grew substantially — from around 2,000 donations in 1977 to approximately 10,000 by March 1985.

Commercial concentrates could involve very large donor pools too.

That meant treatment capable of transforming the life of somebody with haemophilia could also expose them to viruses carried within the plasma used to manufacture it.

Why America became such an important part of the story

The American connection matters because Britain imported substantial quantities of commercial Factor VIII manufactured from US plasma.

Unlike Britain’s voluntary blood-donation system, parts of the American plasma industry paid donors.

Commercial plasma collection included populations with increased risks of blood-borne infection.

Evidence examined by the Inquiry included the collection of plasma from prison populations and other paid donors.

When plasma from large numbers of donors was pooled, those risks became magnified.

That is one reason imported commercial Factor VIII became such a powerful symbol of the scandal.

But the words “American blood” can still be misleading.

What arrived in Britain for haemophilia treatment was often not bags of American whole blood being transfused directly into British patients.

It was commercially manufactured plasma-derived concentrate.

That distinction matters.

Factor VIII dominated the imported-product story

The scale of Factor VIII use increased enormously.

The Inquiry records that the main commercial Factor VIII products supplied in Britain included Hemofil, Kryobulin, Profilate, Factorate and Koate.

Some were manufactured in the United States, while others came through international commercial production and distribution arrangements.

By the late 1970s and early 1980s, commercial Factor VIII had become routine at many haemophilia centres.

At some centres, patients received several different commercial products as well as NHS concentrates.

The Inquiry found that it was common for individual patients to receive multiple types of concentrate rather than remaining permanently on one product.

That greatly complicates attempts decades later to reconstruct precisely which product or batch caused a particular infection.

But Factor IX recipients must not disappear from the history

This is where language matters.

Because imported commercial Factor VIII features so prominently in the evidence, discussions of the scandal can easily slip into talking as though haemophilia treatment meant Factor VIII alone.

It did not.

People with haemophilia B required Factor IX.

They too received plasma-derived clotting-factor concentrates.

They too lived with the consequences of blood-borne infection.

And families affected through Factor IX treatment belong within the history of the infected blood scandal.

The distinction is not that Factor VIII mattered while Factor IX did not.

The distinction is that their supply patterns differed.

The Inquiry records that there was generally sufficient domestic Factor IX for most purposes, while the shortage of domestic Factor VIII led Britain to rely heavily on imported commercial Factor VIII.

That is a more accurate account than simply attaching “American” to every clotting-factor infection.

The problem existed within Britain too

Focusing solely on America also risks suggesting that Britain was simply the unfortunate recipient of somebody else’s unsafe product.

The Infected Blood Inquiry’s findings are much broader than that.

The history includes decisions about UK production capacity, procurement, the use of concentrates, responses to emerging evidence about hepatitis and AIDS, communication with patients and the failure to achieve adequate self-sufficiency in Factor VIII.

Warnings about hepatitis associated with large-pool concentrates were known years before the AIDS crisis.

The Inquiry records concerns during the 1970s about hepatitis risks from concentrates and evidence of chronic liver disease among people receiving treatment.

That means the scandal cannot be reduced to one contaminated shipment or one foreign donor population.

It was a systemic failure developing over years.

Treatment brought enormous benefits — and enormous risks

There is another uncomfortable truth.

Factor concentrates were revolutionary.

Before effective clotting-factor replacement, haemophilia could cause repeated painful bleeding, disability and premature death.

Concentrates offered something extraordinary: treatment that was easier to administer, more concentrated and increasingly suitable for use at home.

The Inquiry’s expert evidence describes the dramatic improvement in life expectancy associated with advances in haemophilia treatment.

That helps explain why clinicians and patients embraced concentrates.

But medical benefit did not cancel infectious risk.

The question was how those risks were understood, communicated and acted upon.

Hepatitis came before HIV

It is easy to view the scandal primarily through HIV because its consequences were so devastating.

But viral hepatitis was already demonstrating the dangers of blood products.

Concerns about hepatitis transmission through large-pool Factor VIII concentrates were documented during the 1970s.

By the end of that decade there was evidence of persistent abnormal liver function and chronic liver disease among some people with haemophilia.

Then HIV emerged.

The combination produced one of the worst treatment disasters in the history of the NHS.

So was the scandal about American blood?

Partly.

American commercial plasma and imported Factor VIII are central parts of the history.

They should not be sanitised or minimised.

But describing the entire infected blood scandal simply as Britain importing “bad American blood” is too simplistic.

It risks confusing whole blood with plasma-derived concentrates.

It risks overlooking infections transmitted through other routes.

And it risks marginalising people treated with Factor IX simply because Britain’s Factor IX supply was predominantly domestic.

The deeper story is about how blood and plasma products were collected, pooled, manufactured, purchased and used — and how authorities responded as evidence of risk accumulated.

America is part of that story.

Commercial plasma is part of it.

Factor VIII is a major part of it.

Factor IX is part of it too.

And the British decisions surrounding treatment and blood-product policy cannot be separated from what followed.

Perhaps the better question is not:

“Was Britain’s infected blood scandal caused by American blood?”

It is:

How did a treatment designed to give people with haemophilia longer and better lives become the route through which so many were exposed to devastating infections — and why were the dangers not acted upon sooner?

That is a much bigger story.

And it belongs to everyone affected.

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The Unheard Voice

This article distinguishes Factor VIII from Factor IX because their supply histories were not identical. Factor VIII was used primarily for haemophilia A and Factor IX for haemophilia B. Both plasma-derived concentrates form part of the history of the infected blood scandal, although the UK relied much more heavily on imported commercial Factor VIII while Factor IX was predominantly produced domestically.

— The Unheard Voice