In late March, a 19-year-old young man in Xinzhou, Shanxi Province, died suddenly after donating plasma, and his family filed a complaint against the plasma station, bringing the blood product industry to the forefront of public opinion and bringing the plasma donor into the public's field of vision.
Plasma is the core and scarce raw material of the blood products industry, and in the mainland, the raw plasma used to produce blood products must be collected through apheresis stations established by law. At the same time, the supply of blood products produced from human plasma has been relatively tight in China, and during the period of high incidence of public health incidents, some types of blood products have even become "life-saving drugs" at a price of one day.
Is there any risk of donating plasma? If so, where is the risk?
Who is donating plasma?
"There are a lot of people who go to the pulp station, and many young people also go. On the morning of April 18, on the way to an apheresis station, the taxi driver told Silver Persimmon Finance.
The pulp station is located in the southeast of Anhui Province, where the county-level city borders Jiangsu and Zhejiang provinces. It was a working day, and at nine o'clock in the morning, the flow of people in the pulp station was still small, and the hall of the pulp station was very empty, with sporadic people entering from the entrance of the registration area.
However, in the health check-up area, there are already people waiting outside many rooms. According to the regulations, each time a plasma donor donates, he must go through the procedures for donating plasma with his valid ID card and "Plasma Donation Certificate", and can donate plasma only after passing the physical examination and blood test. The blood test items of the fixed donors can be collected first and then tested (the donors who have participated in the donation of pulp for 2 or more times in a row within half a year are generally referred to as regular donors).
According to the situation observed by Silver Persimmon Finance at the pulp station, the majority of pulp donors are middle-aged people, followed by young people.
"I'm used to it. A male pulp donor in his 40s said, "The impact of donating pulp on the body is similar to donating blood, which is to help the blood circulate." When asked by Silver Persimmon Finance whether the pulp donor could receive subsidies such as lost time pay, the other party said "I don't know".
During conversations, "it's the same as donating blood" became a frequent description.
When asked why he had come to donate pulp, a young man in his twenties said that he had been "introduced by a friend" and that "my friend had been here several times." For more specific reasons, no clear answer was given.
In a break room, a middle-aged woman told Silver Persimmon Finance: "(Offering pulp) is not harmful to the body, maybe it is good." Since there is no harm to the body, we should do good. ”
She was accompanied by a relatively young woman who, according to her village's village committee, had publicized the donation and described it as "state-supported". Both of them are participating in the pulp donation for the first time. At that time, they were waiting in the lounge, ready to listen to the staff's lecture on the relevant pulp donation knowledge.
In the interview, Silver Persimmon Finance also met a middle-aged man who has been donating pulp continuously from 2018 to the present. He said that the reason why he insisted on participating in the pulp donation activity was mainly out of personal health considerations. In addition, he mentioned that the free medical check-up and vaccination services provided by the donor center may be an additional attraction for him.
In the course of the dialogue, most of the respondents did not actively mention the pulp donation subsidy. There was an exception, a female interviewee in her mid-30s, accompanied by an 8-year-old boy, waiting in the rest area to offer pulp. Initially, when asked why she was involved in the donation, she simply replied that she was "introduced by a friend". And when asked further about the more specific motivation, she bluntly said: "Exchange money." ”
In the exchange with Silver Persimmon Finance, the female pulp donor revealed that this is the third time she has come to donate pulp, and "her body doesn't feel anything". She recalled that she received a subsidy of 270 yuan for the first donation of pulp and 370 yuan for the second time. She also mentioned that when she first came to donate pulp, there was a long queue.
According to her, according to the regulations, you can donate pulp up to twice a month, and she has added the WeChat of the nurse of the apheresis station, and the nurse will remind her regularly, "If you come to donate pulp on the day or the next day when the nurse reminds you, the subsidy amount may be the highest, and it will be reduced in two days."
The motivations for donating plasma are more diverse than might think, but the importance of subsidies is undeniable. According to the information provided by a staff member of a Henan apheresis plasma station contacted by Silver Persimmon Finance, the pulp station where he is located is launching an activity, and for those who donate pulp for the first time or have not donated pulp for more than half a year, make an appointment in advance, and the subsidy for a single pulp donation can reach up to 450 yuan.
It is worth noting that, unlike the blood station, which is a "non-profit-making public welfare organization", the plasma station is an enterprise unit that is self-financed for its own profits and losses, and the main body of the blood station is the health administrative department of the State Council or the provincial people's government, and the main body of the blood station is the blood product production enterprise.
A listed company that produces blood products has mentioned that the cost of raw plasma is an important factor affecting the cost of blood products, and the cost of plasma is gradually rising with the continuous improvement of the nutrition fee of plasma donors.
"Attracting new customers" and "pushing the ground" of pulp station
In this single pulp mining station in Anhui, Silver Persimmon Finance also saw the staff of the pulp station chatting with the old pulp donors about "bringing the old with the new".
A staff member said to the old pulpter: "We mainly want you to help us find new people, and the introduction fee is 100 yuan, you know?"
In the process of communication, in order to allow the old pulp donors to better introduce plasma and plasma donation knowledge to the newcomers, the staff will carry out the popularization of relevant knowledge, among which "what does plasma do" is the focus of science popularization.
In the introduction of the staff, plasma is mainly used to make medicines and vaccines, and is the country's war preparation material, which can save lives and help the wounded; in terms of benefits to the body, plasma donation can clean up blood vessel oil and reduce blood viscosity. Silver Persimmon Finance noticed that after spending a few minutes listening to the staff's explanation, the old pulp donor could receive a new portable water cup for free. The staff will complete a form while communicating, record the situation and communication of the veteran donors who participated in the communication, and ask them to add the official WeChat of the plasma station.
The staff of the pulp station told Silver Persimmon Finance that this was a communication meeting specially organized by the unit, in order to let the people who had donated pulp learn the knowledge of pulp donation again. "Now that we are in short supply, let those who have donated help us talk to those who have not. If you don't call someone to come and get the cup, they probably won't want to sit here and listen to you. ”
In daily work, the company will also send a special publicity team to go deep into the streets and alleys to popularize plasma knowledge to the public, "similar to pushing, because many people may want to donate, but they don't know what plasma is used for and what social significance it has."
From the above-mentioned talks between the donors and the staff of the pulp station, some aspects of the current situation of plasma donation in China can be outlined. For example, in terms of publicity strategies, open the official public accounts of apheresis plasma stations in various places, and words such as "free physical health check-up", "lost work allowance", "love for love" and "good for health" frequently appear. In the publicity of many public accounts, it is emphasized that donating plasma is not the same as "selling blood", and there is an essential difference between the two.
Plasma and blood are two different concepts. According to the China Post Securities Research Report, human blood is composed of plasma, red blood cells, white blood cells and platelets, of which plasma accounts for about 55% of the blood volume. About 90% of human plasma is water and about 7% is protein. Of the proteins, about 60% are albumin, about 15% are immunoglobulins, about 4% are coagulation factors, and about 21% are other protein components.
The so-called plasma donation is to collect human blood, collect plasma through a separator, and transfuse red blood cells. Blood products are a variety of products prepared by separating different proteins in the blood, which are used for patients with different diseases. There are three main categories of blood products: human albumin, human immunoglobulins (intravenous C) and coagulation factors.
According to the Technical Operating Procedures for Apheresis Plasma Stations (2022 Edition) issued by the General Office of the National Health Commission, in most cases, plasma donation is safe, but some people may occasionally experience discomfort such as dizziness, cold sweat, bruising at the puncture site, hematoma, pain, etc., and in rare cases, more serious plasma donation reactions, such as syncope.
Demand is rising, but it is not easy to "increase production".
In fact, publicity is one of the main focuses of the pulp station's work. An A-share listed company bluntly said that there are two ways to alleviate the tension of raw plasma, one is to increase the new pulp station, and the other is to increase the publicity and launch of pulp donors to tap the potential of a single station.
However, as a scarce resource, human plasma is restricted and regulated by national policies and regulations, and it is not easy to add a new plasma station. According to the research report, in the mainland, the collection and supply of raw plasma must be carried out by apheresis plasma stations approved and established in accordance with the law. The state stipulates that apheresis stations can only be set up in counties and county-level cities, and only one apheresis station can be set up in a slurry collection area, and they must not be set up in the same administrative area as whole blood blood stations.
During the "13th Five-Year Plan" period, the state's approval of pulp stations was tightened for a time, and it was relaxed during the "14th Five-Year Plan" period, but it is still under strict supervision. According to the research report, from 2021 to the end of March 2023, a total of 69 new pulp stations (excluding 7 sub-stations and upgrades) have been approved across the country, and the total number of pulp stations has reached 385. Among them, 19 apheresis stations are planned to be set up in Yunnan during the "14th Five-Year Plan" period, and 7 new plasma stations are planned to be added in Henan during the "14th Five-Year Plan" period. During the "12th Five-Year Plan" and "13th Five-Year Plan" periods, the number of new pulp stations in the mainland was only 57 and 54 respectively.
At the same time, the brokerage research report shows that most of the pulp stations in overseas developed countries are located in large cities, while most of the domestic plasma stations are built in the central and western regions. In these areas, due to the large number of migrant laborers, the pulp supply population has further decreased.
The shortage of plasma sources is reflected on the industrial side, which is a continuation of the tight balance between supply and demand in the domestic blood product industry.
Guosheng Securities analysts pointed out that from the demand side, the per capita consumption of blood products in mainland China has more room for improvement, and considering the gradual expansion of the coverage of the medical insurance catalog, the increase in clinical indications of blood products, and the in-depth education of patients, it is expected that the terminal demand will grow steadily.
Analysts from Capital Securities also mentioned in the research report that in the new crown epidemic, blood products such as Jing C have played a great role in the treatment and rehabilitation of patients, improving the awareness of doctors and patients about their clinical value, and it is expected that the growth center of demand will increase.
In the context of the tight supply and demand of blood products and the difficulty of approving plasma stations, the growth of the amount of pulp collected by existing plasma stations is particularly important, and the publicity activities for the public play a key role in this.
In the case of the Xinzhou incident in Shanxi Province, the family members of the deceased young man pointed the finger at the apheresis plasma station involved, believing that the plasma station had "induced" the person concerned to donate plasma by means of money temptation and pulling people's heads, which led to the tragedy.
The parent company of the apheresis station in question responded that the Xinzhou plasma station operated legally in accordance with the requirements of laws and regulations, and strictly followed the relevant regulations to ensure that the interval between the two plasma donations was not less than 14 days;
So far, the results of the official investigation into the apheresis station involved have not been released, and the cause of the tragedy is unknown.
Shareholders and recruiters of pulp stations
From the mouths of several industry insiders, Silver Persimmon Finance also learned that individual pulp stations may have irregular operations, which has affected the safety of plasma donation to a certain extent.
A person in charge of a blood product company told Silver Persimmon Finance that there is a difference between whether the pulp station is wholly owned by a blood product company, and if it is not wholly owned, some shareholders will also participate in management and dividends, which may be risky.
A person familiar with the matter revealed more information to Silver Persimmon Finance. According to the person, some shareholders are more familiar with the local area and may organize a group of recruiters in the area where the pulp station is located to guide people to the pulp station to donate pulp. With their participation, part of the subsidy that the pulp station was supposed to give to the pulp donors will be transferred to the recruiters and the shareholders behind it.
As for the difference between this model and the "new pull" mentioned above, the insider said that there are relatively few ordinary "new pullers", and professional recruiters may take people to the pulp station in whole vehicles, and there may also be cross-regional people, which is illegal. The person familiar with the matter pointed out that in order to "comply", these cross-district pulp donors are generally registered under the names of local people who donate pulp less frequently, and some people who are not physically qualified may get away with it. In addition, recruiters may also have a monopoly attribute in the local area, that is, in a specific area, they can only rely on the leadership of this person's organization to donate pulp.
"In the plasma station that is not fully controlled, those shareholders may be deputy stationmasters, but their power is far greater than that of the stationmasters, because they are iron-clad camps, and the stationmasters come and go. Therefore, there are several employees who should listen to them, and sometimes the stationmaster is in vain, and the rules and regulations cannot be implemented. The person further explained.
Coincidentally, in the Xinzhou incident in Shanxi Province, the apheresis station involved was 80% owned by the listed company, and the other 20% was held by natural persons.
Through the introduction of relevant people, we have a glimpse of some of the current problems in the industry. On the other hand, in order to ensure the healthy development and virtuous cycle of the industry, companies and regulators are also making more efforts. The National Health Commission has replied to the "Proposal on Vigorously Developing the Blood Products Industry", saying that it will improve the service level and publicity and recruitment capabilities of plasma donors, protect the legitimate rights and interests of plasma donors such as health, steadily expand the team of plasma donors, improve the participation of plasma donors, and increase the supply of raw plasma.