After the storm? UK blood safety and the risk of variant Creutzfeldt-Jakob Disease - Science and Technology Committee Contents

1  Introduction


1. The UK's first voluntary blood service was founded by the British Red Cross in 1921, paving the way for the establishment of a pioneering military service shortly before the outbreak of war in 1939. Over the following years, blood transfusions played an important role in the treatment of servicemen and civilians alike and the benevolent spirit which motivated thousands to donate blood during the war persisted after its conclusion, leading to the creation of the UK Blood Transfusion Service in 1946.[1] Today, approximately 2.2 million whole blood donations are made in the UK each year and are screened, tested, processed and distributed by one of the country's four Blood Services.[2]

2. Despite these altruistic foundations, the story of blood transfusion in the UK is not unblemished. Throughout the 1970s and the first half of the 1980s, many UK haemophiliacs were treated with blood and blood products which carried the hepatitis C virus; some 4,670 became infected as a result. Between 1983 and the early 1990s, contamination of the UK blood supply with HIV led to a further 1,200 infections and it is estimated that these incidents together have led to over 2,000 deaths.[3] Since 1991, all UK blood donations have been tested for both HIV and hepatitis C; however, the 2009 public inquiry investigating these events stated that it was "dismayed" by the time taken for Governmental and scientific agencies to "become fully alive to the dangers" of these emerging infections.[4]

3. Today, we find ourselves facing another potential threat to blood safety. Variant Creutzfeldt-Jakob Disease (vCJD) is a rare neurodegenerative disease thought to be caused by an unusual infectious agent known as a prion. First characterised in 1996, vCJD is considered to be the human form of bovine spongiform encephalopathy (BSE), another infectious prion disease believed to have entered the human food chain in the 19070s or 1980s.[5] Cases of vCJD are extremely rare: official statistics state that 229 people worldwide—177 in the UK, where the BSE crisis primarily took place—have died of the disease since it was first identified nearly 20 years ago.[6] However, in October 2013, a paper published in the British Medical Journal suggested that approximately 1 in 2,000 people in the UK could be unknowingly carrying the prions responsible for the disease, raising the possibility that hundreds of blood donors could potentially be passing the infection on to others through the blood supply.[7] This gave us cause for concern and in November 2013 we held a one-off evidence session examining the ongoing risk posed by vCJD.[8] During this session, we heard evidence from leading experts suggesting that the risk of secondary transmission of vCJD—through both blood and contaminated surgical instruments—remained "significant".[9] We therefore decided to explore these issues further in an inquiry focused on blood safety and the continuing public health risk posed by vCJD.

Our inquiry

4. In December 2013, we issued a call for written evidence addressing the following points:[10]

a)  Are UK policies governing who can donate blood and blood products, tissues and organs sufficiently evidence-based? Is NHS Blood and Transplant overly restrictive about who can donate, or should greater precautions be taken to further reduce risk?

b)  Is the Government and its scientific advisory structure sufficiently responsive to the threat posed by emerging diseases being transmitted through blood and blood products, tissues and organs?

c)  Has the threat of ongoing transmission of vCJD through the blood and blood product supply been adequately mitigated?

d)  What are the strengths and weaknesses of NHS Blood and Transplant's strategy, "Taking Organ Transplantation to 2020"? What further changes could be made to safely increase the supply of blood and blood products, tissues and organs?

e)  What lessons could be learnt from the screening and donation practices of other countries?

We received 55 written submissions and took oral evidence from 27 witnesses, including:

·  Individuals personally affected by the issues under consideration, including patient representatives and the mother of a victim of vCJD;

·  Members of relevant scientific advisory bodies, including UK Blood Services' Joint Professional Advisory Committee, the Advisory Committee on the Safety of Blood, Tissues and Organs and the Advisory Committee on Dangerous Pathogens;

·  Publicly- and privately-funded researchers working in the fields of blood safety and prion disease;

·  Representatives of the National CJD Research and Surveillance Unit;

·  Representatives of NHS Blood and Transplant (NHSBT) and Public Health England; and

·  The Government, represented by Jane Ellison MP, Parliamentary Under-Secretary of State for Public Health, Department of Health (hereafter "the Minister") and Professor Dame Sally Davies, Chief Medical Officer, Department of Health.

We would like to thank those who contributed to this inquiry, with particular thanks to NHS Blood and Transplant for hosting the Committee's visit to its Filton blood processing facility in February 2014.

5. While focusing primarily on issues relating to blood safety, we also took the opportunity during this inquiry to consider the Government's new strategy for organ donation, launched in July 2013.[11] We heard evidence on this topic from the Government and NHSBT and also held one dedicated evidence session during which we heard from representatives of several medical charities.[12] As a result of this work, in July 2014 we wrote to the Minister urging her to maintain close scrutiny over the strategy's implementation in the coming months.[13] This report does not further detail this aspect of our inquiry.

6. In this report, we ask whether the Government and UK Blood Services are doing enough to protect patients from the risk of vCJD and other blood-borne infections. We begin in chapter 2 by considering the types of infectious risks faced by the UK blood supply and the controls currently in place to mitigate these. In response to evidence received on the risk of surgical transmission of CJD, we also extend this analysis beyond blood to consider the risk posed by contaminated surgical instruments. In chapter 3, we move from current risk reduction measures to possible future ones and consider three emerging vCJD risk mitigation technologies. We particularly examine the challenges that researchers have faced in bringing these technologies to market and consider the role of the scientific "gatekeepers" standing between these new technologies and their adoption by the NHS. In chapter 4, we consider the current landscape for national CJD risk management and surveillance and, finally, in chapter 5, we draw some conclusions about the Government's attitude to blood safety and vCJD risk mitigation.

1   NHS Blood and Transplant, History of blood transfusion,, accessed 12 June 2014; The Army Blood Transfusion Service, British Medical Journal, Volume 1, Issue 4297, 15 May 1943, pp.610-11 Back

2   BTO30 para 2 [JPAC] Back

3   Independent Public Inquiry Report on NHS Supplied Contaminated Blood and Blood Products, 'The Archer Inquiry', February 2009, pp.5-6; HIV and Hepatitis C infection from contaminated blood and blood products, Standard Note, SN/SC/5698, House of Commons Library, July 2011 Back

4   Independent Public Inquiry Report on NHS Supplied Contaminated Blood and Blood Products, 'The Archer Inquiry', February 2009, p.104 Back

5   Parliamentary Office of Science and Technology, vCJD in the future, POSTnote number 171, January 2002 Back

6   National CJD Research and Surveillance Unit, Creutzfeldt-Jakob Disease in the UK (by calendar year),, accessed 30 June 2014 Back

7   O. Noel Gill et al, Prevalent abnormal prion protein in human appendixes after bovine spongiform encephalopathy epizootic: large scale survey, British Medical Journal, Volume 349, Issue 7929, 2013. BMJ2013;347:f5675 Back

8   Science and Technology Committee, 'Inquiry: variant Creutzfeldt-Jakob Disease', press release, 27 November 2013 Back

9   Oral evidence taken on 27 November 2013, HC (2013-14) 846, Q4 [Professor John Collinge] Back

10   Science and Technology Committee, MPs launch inquiry on blood, tissue and organ screening following vCJD fears, press release, 3 December 2013 Back

11   NHS Blood and Transplant, Taking organ transplantation to 2020: a UK strategy, July 2013 Back

12   Oral evidence taken on 28 April 2014, HC (2013-14) 990 Back

13   Correspondence from the Chair of the Science and Technology Committee to the Minister for Public Health, 9 July 2014,, accessed 14 July 2014. Back

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Prepared 24 July 2014