montreal

Rock: applying lessons of infected blood scandal following publication of inquiry report. Credit: AP/TOM HANSON

A controversial four-year inquiry into the infection of thousands of Canadians with HIV and hepatitis C through blood products has called for a new national blood agency, run by an independent authority with a mandate to make safety a high priority.

One of the government's first responses has been to set up a Blood Safety Council, headed by a haematologist, to include scientists and representatives of consumer groups. Its tasks will include monitoring the implementation of the 50 recommendations of the commission that carried out the inquiry, headed by Mr Justice Horace Krever.

Among these recommendations is that the chief medical officer of the new blood agency, to be known as Canadian Blood Services, should report directly to its board. Medical scientists had previously complained that their input into decision-making was subordinate to that of administrators (see Nature 384, 602; 1996).

Provincial and federal governments had already begun to set up the new agency, which is expected to be in place by next September. Allan Rock, the federal health minister, said last week that Krever's more detailed recommendations would be taken into account in its design.

In making this move, the government appears to be back-tracking on earlier efforts to undermine the inquiry's conclusions. It had previously tried through court action to prevent Krever from blaming blood products for the infection of thousands of Canadians with HIV and hepatitis C (see Nature 379, 479; 1996).

The Canadian Blood Committee, one of the bodies charged with overseeing the blood supply, denied Krever access to potentially incriminating documents by destroying them in 1989. The government then set up its own task force to reform the blood system before Krever's report was presented.

Krever won an appeal to the Supreme Court that freed him to blame individuals but warned him to use language that would avoid litigation. Individuals are named in the report, with descriptions of actions Krever calls wrong or harmful. The Royal Canadian Mounted Police has announced a review to see if criminal charges are warranted.

Krever's report shows that the widely reported estimates of transfusion-related cases of AIDS (1,200) and hepatitis C (12,000) were far too low. It says that 85 per cent of hepatitis-C infections due to transfusions between 1986 and 1990 and 133 AIDS cases could have been avoided had available tests been used.

Krever suggests that the new service should continue to include provincial and territorial ministers, but not federal government, as its function as the safety regulator places it in a conflict of interest. The Red Cross will no longer be involved.

The separatist government of Quebec will not be a part of the new service, but instead will set up its own. But, according to Rock, Quebec's service will still be regulated for safety by the federal government.

Krever recommended that blood and blood products be paid for directly by hospitals, taking decision-making about needs away from politicians. He called for plans for a C$300 million (US$210 million) blood fractionation plant in Nova Scotia to be scrapped, but recommended that an amount equal to 10 per cent of the annual operating budget be allocated to research and development. The blood service should have its own research facilities, but should also collaborate with other organizations.

Krever also proposed a no-fault insurance system to compensate victims of contaminated blood. Since the 1980s 1,100 individuals infected with HIV in this way have received on average C$30,000 a year, but those infected with hepatitis C have received nothing.

Following Krever's report, the government and the Red Cross have apologized to the victims of the blood tragedy. But the head of the Canadian Haemophilia Society, Durhane Wong-Rieger, expressed disappointment: “While the report is quite strong overall, we are disappointed that the level of responsibility and blame stops at the lower levels,” she said.