One factor that disqualifies someone from giving blood in France is if they spent over one year in total in the UK between January 1, 1980, and December 31, 1996. This is regardless of nationality and is due to an outbreak of mad cow disease (Creutzfeldt-Jakob Disease, vCJD) in the UK at the time.
The outbreak of the disease, also known as bovine spongiform encephalopathy (BSE), caused the deaths of 177 people – who died after eating infected beef – and also led to the slaughter of millions of cows.
France introduced this blood donation ban in 2000. It is believed that the vCJD infection can remain dormant in a person for several decades.
A spokesperson for the Établissement français du sang (EFS), France’s public administration in charge of blood donations, recently told The Connexion that this rule is “reviewed periodically”, but there are no plans to change it in the short term.
However, several readers have written in to say they feel that the ban is unjust.
To understand France’s decision, we ask Richard Knight, professor of clinical neurology at the University of Edinburgh, and epidemiology lead at the UK’s National CJD Research and Surveillance Unit.
He broke down the complex public health decision that France’s blood authorities have had to take.
Is France’s ban justified?
The first question is, if a person had been in the UK between 1980 and 1996, is there a risk they could have been exposed to BSE through their diet? And the answer is unequivocally yes.
It is well known that a very significant number of cattle - thousands - that were infected with BSE must have entered the food supply chain. There are good reasons for believing that people living in the UK at that time could have been exposed.
The second question is, if they were potentially exposed, would they be infected? And the answer is potentially no.
But if they were infected, would they be carrying infection after all this time and still be healthy? The answer is yes. If they were exposed and they were infected, there is a significant risk they would still be carrying it, despite the fact that a lot of time has gone by.
It is thought, though not absolutely confirmed, that vCJD can remain dormant in a person for several decades.
Finally, if they were carrying the infection, is there a risk they could pass that on through donated blood? The answer is they could.
The real difficulty is if you are trying to determine the magnitude of all these risks, it is extremely complicated because there are so many unknowns.
What you end up with is having to make some sort of informed decision about the likelihood of it all.
Even if you suppose that the likelihood of someone who was in the UK between 1980 and 1996 passing on the infection through blood in France is very low, which is a reasonable point of view, there are other elements to the question.
For example, the political elements.
What do you mean by the political elements?
In the wake of the HIV outbreak and other problems in relation to blood, people were prosecuted in France and it was a very sensitive issue.
[Editor’s note]: In France in the 1980s, around 4,700 people who were treated for haemophilia were given blood contaminated with HIV. Over 300 of them died. France’s former health minister Edmond Herve was charged with manslaughter, and the head of the country’s national blood centre (Centre national de transfusion sanguine), was sentenced to four years in prison.
Therefore, many blood authorities have been taking an ultra precautionary view about blood transmission infection. So even if a risk is quite small, they might decide for political reasons that it would be a good idea.
Was there another political element you wanted to mention?
Yes, there is another policy issue.
If we exclude all the people who live in France who were potentially exposed by living in the UK during the BSE outbreak period, does it mean that France can still maintain a blood supply?
The answer is almost certainly yes. In other words, it doesn’t threaten the amount of blood donated in a way that would harm people.
My guess would be that blood authorities in France have said, ‘well there is a risk, it is difficult to quantify, it’s probably very small but for political reasons we want to avoid the small risk of any further infections being transmitted’.
In all the discussions I have had with blood supply people, I get the feeling there is a bit of a sense of ‘never again’.
That is reasonable, because you want any medical treatment involving blood to be as low a risk as possible.
But on the other hand, no treatment is risk free at all.
I think there is a very high degree of ultra safety in the blood industry in the wake of the HIV / AIDs outbreaks.
It should be noted that France is not the only country to introduce such a ban, with others such as Australia, New Zealand, Switzerland also doing likewise.
France recently ended all final restrictions on men who have sex with men donating blood. What do you make of that?
Another dimension is that when people want to donate blood and they are told they can’t, they feel that this is in some way unfair.
We went through this in the UK in relation to MSM, which means in blood terminology men who have sex with men.
There was huge amount of pressure from gay rights movements in the UK, point out that this was unequable, saying people were being denied their right to contribute to society because of their sexuality.
Indeed, this was revisited and the policies were relaxed. The same has happened in France.
In this case, it wasn’t only the risk of HIV being transmitted that was taken into account, but also the idea of the concept of equality in terms of contribution to society.
It may be that in France, some people feel they are not being allowed to contribute even though they want to. But there was a lot of social pressure from gay rights associations, and there is not the same social pressure from those affected by France’s UK BSE outbreak ban.
To summarise, the question you have to ask is, can we maintain a safe blood supply and do everything we want to do with blood while excluding these people (who carry a very low risk)?
And if you can, then there is not going to be a lot of pressure to include them, unless there is a counter argument, like in the case of MSN where people said that a portion of the population were being treated unfairly.
How many people in the UK have been infected with vCJD?
We don’t know exactly.
On the basis of a 2013 study, it was calculated that somewhere around one in 2,000 people in the UK are infected.
They are all perfectly well, so even if they are infected, we do not know if they are infectious.
Health authorities here decided that we had to make a public health decision regarding blood, so we decided that all of our policies would be based on the estimate that one in 2,000 people who were in the UK in that period were infected, without symptoms.
It is not necessarily a fact that one in 2,000 people are infected. But that is the figure being used to make public health decisions.
Further appendix studies, such as one called the Appendix-3 survey (results published in 2020), cast some doubt on this, suggesting there are fewer people infected than previously thought.
So there is some uncertainty about the actual number of infected people.
On top of this, there have been incredibly few transmissions through blood in the UK, and as far as I know, no transmissions through blood anywhere else.
Indeed, there have been no cases of vCJD in the UK for a number of years.
It is becoming more and more difficult to explain why that is. A simple conclusion to draw would be to say that far fewer than one in 2,000 people are infected.
There is a lot of doubt about the magnitude of the risk.
Cases of vCJD alive in the UK as of March 4, 2022: 0
And what about cases in France?
The problem for France in particular is that they had their own cases of vCJD. If you look at the number of cases in the world, France is number two.
This was probably because of exports from the UK to France. But nonetheless, there would be some intrinsic risk to the population from simply living in France.
So we’re not comparing a zero-risk country to a high-risk country like the UK. We’re comparing a high-risk country (the UK) to a low-but-non-zero risk country.
I think in the end these decisions, about blood donation bans, are pragmatic.
Cases of vCJD alive in rest of world as of March 4, 2022: 0