A Hand Up or Handout?
Zika virus causes grave concern among public health officials where mosquito-borne transmission is possible. Beyond the risk the virus represents to fetal central nervous system (CNS) development, it might wreak havoc on the developing CNS throughout its developmental period-many years.
Congress will (eventually) pass appropriations to help control this virus and its vectors. The Centers for Disease Control sees blood safety as one of five areas of focus, and we could attempt to lay claim to a portion of these funds directly from federal agencies or through state health departments that provide the boots on the ground in this war. New revenue sources are welcomed by cash-strapped blood collectors beset by falling blood use and hypercompetitive pricing, donor losses, costs of new procedures and SOPs, loss of units in inventory as Zika spreads, and the cost of testing. Increased cost for new safety measures ought to be passed to hospitals for reimbursement through the usual chain. However, hospitals seek lower, not higher, prices (despite their higher margins than ours), so an opportunity for direct federal assistance is tempting, particularly if the funds were targeted toward pathogen reduction to protect from the unremitting appearance of new safety threats.
Should our community push for a share of the $1 billion or more likely to be allocated to Zika? Despite inherent attractiveness, there are good reasons to say "no." Health department budgets were decimated during the Great Recession as states slashed "non-essential" services. Funding for mosquito surveillance and control vanished. Control of Zika vectors represents the greatest opportunity to prevent its morbidity (and other such threats that are likely not far behind). We depend on information from these departments to make proactive decisions in mosquito-borne epidemics, and that information is just not there at present. It is arguable that funding us will reduce funding for these more important tasks. Critically, hospitals have been increasingly shielded from the true cost of providing a safe and adequate blood supply for several years, as we have competed with each other on price. The result is a blood system with reduced margins and capability to respond to catastrophic events. "Letting hospitals off the hook" for Zika mitigation demeans the value of the crucial services that we offer, including rapid responses to new threats to the blood supply. The more we protect our customers from the cost of safe blood, the less they will value what we do.
HHS has commissioned RAND to study the sustainability of our blood system's structure and ability to respond to crises. Direct federal payment for blood safety measures is a new (and likely unsustainable) approach to funding our efforts that might confound that analysis. It has always been a community's responsibility to support the transfusion needs of its members, traditionally through a free-enterprise approach with payments rendered for services provided. Does Zika ask us to change this course? And at what ultimate cost?
Jim AuBuchon, MD; ABC Board Member; President & CEO, Bloodworks Northwest; JimA@bloodworksnw.org