Insights: A Cerus Leadership BlogTHE LIFEBLOOD OF PREPAREDNESS
Lindsay Peters, Health Policy Intern, Cerus Corporation
The need for preparedness is here to stay.
Pandemics and epidemics have devastating consequences to human life, healthcare systems, and economies. Even pre-COVID-19, emerging pathogens were recognized as an ever-increasing concern across the globe. From 2011 to 2018, the World Health Organization (WHO) tracked 1483 epidemic events in 172 countries.1 The past thirty years alone have seen three zoonotic coronaviruses that have infected humans.2 Despite the increasing number of disease outbreaks occurring with each passing year, and even with the lessons learned from the COVID-19 pandemic, the global community remains relatively unprepared for when – not if – the next one arrives.
The blood supply is uniquely sensitive to disruption…
The COVID-19 pandemic has revealed several weaknesses regarding preparedness and continuity planning across global healthcare systems. Early on, the pandemic ravaged vital personal protective equipment (PPE) inventories and global supply chains. The pandemic also adversely, albeit more slowly and subtly, impacted one of the most essential, life-saving interventions utilized on a daily basis: the blood supply. With nearly 21 million blood components transfused each year in the U.S. alone, and over 100 million blood donations collected globally every year, blood transfusion remains one of the most common medical procedures in the hospital setting.3 Blood and blood components are used to treat numerous conditions ranging from trauma, cancer, obstetric hemorrhage, hematologic disorders, and surgical bleeding.4,5 Yet, the supply of blood relies exclusively on the community of willing, eligible, and healthy donors.
In the U.S., for example, throughout the COVID-19 pandemic, hospitals have halted and re-started non-emergent procedures in order to prepare for the waves of COVID-19 patients. Consequently, in early 2020, the demand for blood temporarily decreased so that the pandemic’s negative impact on blood availability wasn’t readily apparent. But as hospitals have attempted to reincorporate non-emergent procedures and care for returning patients back into their daily operations, blood centers have been faced with growing demand for blood coupled with the challenges of ramping up supply in the face of a reduced donor pool, increased expenses due to protective measures, reduced staff, and changing requirements for convalescent plasma production.5-7
…and must be included in preparedness planning.
While preparedness planning has recently taken center stage at a high level across the globe due to COVID-19 – from the June 2021 G7 Summit to regionalized initiatives, the need to elevate the security of the blood supply against future pandemic threats has yet to be universally recognized. Markedly, in 2019, U.S. blood industry stakeholders successfully advocated that the blood supply be included in the Pandemic and All-Hazards Preparedness and Advancing Innovation Act (PAHPAIA). Once passed, this legislation called for a report to Congress, which in 2020 recommended measures toward ensuring the adequacy of the blood supply during public health emergencies by instituting a multisectoral taskforce to strengthen blood supply infrastructure.4 Innovation was highlighted throughout the report to Congress as a necessary means to protect the U.S. blood supply against future pandemics.
Innovation is key for blood security.
Despite COVID-19’s negative impact on the blood supply, the potential for a future pathogen to be transfusion-transmitted could be even more damaging. An effective preparedness scenario requires that we leverage all existing – and future – innovative technologies that can protect our blood supply’s availability and safety. Historically, blood safety has relied on reactive approaches to safety such as testing, which requires identification of a pathogen and test development before it can be deployed. This reactive approach does not provide protection in the early days of a pandemic, particularly if and when the infectious agent has a silent, asymptomatic element to it like the SARS-CoV-2 underlying COVID-19.
Pathogen reduction technology (PRT) for platelets, on the other hand, can proactively inactivate a broad spectrum of pathogens; we have witnessed this ability during recent West Nile and Zika virus epidemics. Additionally, through donor deferral replacement, such as with FDA’s guidance for travel-related malaria deferrals, PRT can facilitate an expanded eligible donor pool. The ability to release PRT platelets earlier after collection can also support blood availability, particularly given short shelf life. PRT is just one example of the innovation that can help keep blood on the shelves to sustain essential hospital operations and to protect the health of those in need through ordinary times and during emergencies. With an estimated 1.7 million viruses that have yet to be discovered in mammals and birds, of which 800,000 might be transmissible to humans, we are entering a future with serious pathogenic implications.8
As Morens and Fauci describe, we are living in an era of pandemics.9 With each passing year, the threat lives on, as more emerging pathogens are identified and impact human lives. Innovations that are available today and in the pipeline for tomorrow must be leveraged to help secure the safety and sustainability of our blood supply. Supporting the continuity of hospital care and ensuring all patients have access to life-saving blood transfusions must be made integral to pandemic preparedness across the globe.
- Global Preparedness Monitoring Board. A world at risk: annual report on global preparedness for health emergencies. Geneva: World Health Organization; 2019. License: CC BY-NC-SA 3.0 IGO.
- Perlman S. Another Decade, Another Coronavirus. N Engl J Med. 2020;382:760-762.
- Blood Needs & Blood Supply. (n.d.). Retrieved September 29, 2021, from https://www.redcrossblood.org/donate-blood/how-to-donate/how-blood-donations-help/blood-needs-blood-supply.html.
- Mulcahy AW, Kapinos KA, Briscombe B, Uscher-Pines L, Chaturvedi R., Case SR, Hlavka JP, Miller BM. Toward a Sustainable Blood Supply in the United States: An Analysis of the Current System and Alternatives for the Future. Santa Monica, CA: RAND Corporation, 2016. Retrieved September 29, 2021 from https://www.rand.org/pubs/research_reports/RR1575.html.
- Klein HG, Hrouda JC, Epstein JS. Crisis in the Sustainability of the U.S. Blood System. N Engl J Med. 2018;378:305-6.
- Jones JM, Sapiano MRP, Savinkina AA, Haass KA, Baker ML, Henry RA, Berger JJ, Basavaraju SV. Slowing decline in blood collection and transfusion in the United States – 2017. Transfusion. 2020;60;S1-S9.
- American Red Cross Faces Severe Blood Shortage As Coronavirus Outbreak Threatens Availability of Nation’s Supply. (2020, March 17). Retrieved September 27, 2021, from https://www.redcross.org/about-us/news-and-events/press-release/2020/american-red-cross-faces-severe-blood-shortage-as-coronavirus-outbreak-threatens-availability-of-nations-supply.html.
- Béchard, D. E. (2021, May). Of Viruses And Vectors. Stanford Magazine. Retrieved September 28, 2021, from https://stanfordmag.org/contents/of-viruses-and-vectors.
- Morens DM and Fauci AS. Emerging Pandemic Diseases: How We Got to COVID-19. Cell. 2020; 1077-1092.
About Lindsay Peters
Lindsay Peters is an intern working with the Health Policy team at Cerus Corporation.