Egypt's Blood Money: Sisi’s vision for plasma ‘donation’ has potential risks

In Oct. 2023, President Abdel Fattah El-Sisi unveiled his vision for Egypt’s blood plasma donation project, emphasizing the importance of involving experienced international companies due to previous unsuccessful attempts. “This should be a partnership, and this partnership should bear the name of the global company, which should be with us in all procedures to ensure the full credibility of the name we will operate under,” he said.

The intended partner was the Spanish company Grifols, which soon led to the establishment of Grifols Egypt for Plasma Derivatives/GEPD. During his speech, El-Sisi called upon Egyptian youth to donate plasma twice a week in exchange for a “significant” amount of money, which currently stands at 733 pounds (approximately $15) per donation session.

El-Sisi noted that if his dream of millions of young donors comes true, it would generate “income” at the national level. As of the publication date of this article, ten Grifols-affiliated centers are operating across six Egyptian governorates, with plans for nationwide expansion.

A magical treatment

Plasma is a clear yellow fluid that constitutes about 55% of blood volume and contains vital proteins such as immunoglobulin and clotting factors. Its therapeutic applications first emerged in the late 19th century for treating diphtheria and gained prominence during the 1918 influenza pandemic. During World War II, dried plasma became a cornerstone in field hospitals.

The evolution of plasma donation has been remarkable. Since the 1950s, centrifugation and plasma separation techniques were developed by Dr. Grifols-Lucas and later by his son José Antonio to safely extract plasma and return blood cells back to the donor. These methods allow for the production of plasma-derived treatments like albumin and clotting factors.

Quality standards improved, especially after crises like the HIV/AIDS epidemic in the 1980s, leading to stringent blood testing and safe isolation methods or viral inactivation/removal.

Plasma-derived therapies are used to treat rare and chronic diseases, saving the lives of patients with hemophilia, immunodeficiency, and burn-related complications. Annually, over 16.5 million patients worldwide receive plasma-derived treatments. Europe consumes more than 44% of the plasma collected each year but relies on imports from USA, which supplies around 40% of the continent’s needs.

USA and the global plasma market

The US presents a controversial model; in impoverished areas of states like Ohio, plasma collection centers are prevalent in the most vulnerable neighborhoods. According to a French documentary, these centers operate 12 hours a day, seven days a week, functioning as continuous production lines.

Many donors depend on this process as their primary income source. Some donate twice weekly, despite side effects like fatigue and dizziness, while others sell their donation cards to drug dealers in exchange for money or drugs. This creates a complex cycle of social and health exploitation.

The global plasma market is experiencing steady growth; its value was estimated at around $35 billion in 2024, with expectations to exceed $78 billion by 2032, reflecting an annual growth over 10%, driven by the demand for rare and chronic diseases. North America alone controls about 44% of the global market, despite representing only 5% of the world’s population, indicating a clear concentration of production and compensated donation in that region.

In Arab countries, the situation varies; in Saudi Arabia and the UAE, voluntary plasma donation without financial compensation is encouraged, with regular awareness campaigns highlighting its humanitarian aspect. To date, there are no examples in the Arab world supporting a commercially compensated donation model, making Egypt’s partnership with a profit-driven company a concerning exception.

Sisi’s vision and the price of Egyptian blood

Returning to President Sisi’s vision, the Cabinet issued a law in 2021 permitting financial compensation for plasma donation, allowing up to 104 donations annually—more than double the limit in countries like Austria. Although “compensation” for Egyptian donors increased in April 2024 to 733 pounds (about €13), it remains significantly lower than Austria’s, which reaches €30.

While any monetary payments to plasma donors in Austria or other countries are classified as “compensation” for travel time or temporary productivity loss, Sisi described it in his televised speech as a “source of income”. In a country suffering from extreme poverty and unemployment, this presents a significant cause for concern.

For a company like Grifols, Egypt is a plasma mine where they can harvest more at a much lower cost.

Why Grifols’ presence in Egypt is concerning?

First, Grifols does not adhere to a compensated donation model in its home country. Spanish law actually prohibits financial compensation for plasma donation and sets a much lower annual donation limit compared to Egyptian law. Spain is a member of the European Blood Alliance/EBA, which enforces the principle of voluntary, unpaid donation/VUD.

Secondly, Grifols has faced international controversy, having been criticized in Canada over concerns about exporting donated plasma abroad for profit. Reports indicate that the company profits from these operations by exporting plasma to Europe to produce highly expensive medications without disclosing the source of the biomaterials.

Thirdly, the direct involvement of the Egyptian military in operating the centers raises questions about transparency, accountability, and human rights.

With the worsening plasma shortage in Europe, the establishment of partnerships between European companies and countries lacking transparency and fundamental rights, like Egypt, cannot be overlooked. Human rights reports highlight concerning conditions, necessitating careful scrutiny of such partnerships to prevent exploitation in a country where 30% of the population lives below the poverty line.

Global health circles are always alarmed when pharmaceutical giants rush to conduct their clinical trials in African or South American countries with inadequate regulations. The absence of oversight is the main attraction, but the low operating costs also directly translate into increased profits.

Against this backdrop, the partnership between the Egyptian military and Grifols exhibits a complete lack of transparency, whether regarding the destination and marketing of Egyptian plasma, or its prices. Worse still, the law issued by the Egyptian Cabinet imposes no restrictions on its export or its derivatives. Furthermore, we know nothing about the military’s share in this deal.

Health and social risks of paid donation

The greatest danger in the Egyptian context lies in excessive donation, especially when it becomes a source of livelihood. What is most alarming in Sisi’s speech was his focus on youth, including university students.

Egyptian youth are exposed to a range of health risks including the depletion of immune proteins, leading to weakened immunity, chronic dizziness and fatigue due to loss of fluids and vital substances, encouragement to lie or conceal health conditions to avoid losing compensation; and attracting socially vulnerable groups who may suffer from malnutrition or drug addiction as in USA.

Add to this the risk of compromised standards and a lack of transparency given the military control over the process,.

Recycling health failures

In the 1990s, China experienced a disaster known as the “Plasma Economy” scandal, where poor farmers were incentivized to donate plasma for money without basic health safeguards. Needles were reused, blood was mixed, and red blood cells were reinjected into donors after plasma extraction. This led to a widespread HIV outbreak, with an estimated 40–50% of donors infected in the process, resulting in between 0.5 million to 1.2 million infections in Henan province alone.

Between the 1950s and 1980s, the Egyptian Ministry of Health, in collaboration with the WHO, organized campaigns to treat schistosomiasis/bilharzia using unsterilized injections, leading to the largest hepatitis C epidemic in modern history, caused by medical treatment.

Dr. Mostafa Kamal El-Din Mohamed, of Ain Shams University, clearly revealed this in his paper published in the prestigious journal “The Lancet,” highlighting that schistosomiasis treatment campaigns were a primary cause of the spread of hepatitis C in Egypt.

Painfully, both experiences reveal the same logic: developmental or therapeutic intentions that ignore proper health safety frameworks. In China, the process aimed to provide off-the-books income for farmers and pharmaceutical companies, while in Egypt, the path was official and under WHO recommendations, but the result was the same: a widespread health epidemic affecting millions.

Today, with the paid plasma donation project, there looms the threat of producing a new epidemic, this time in service of a profit-driven pharmaceutical market that disregards donor dignity and safety. Are we repeating the same mistakes?

I urge Egypt’s National Council for Human Rights and the EU Parliament to launch a comprehensive and transparent investigation into this controversial partnership between Grifols and Egyptian authorities. These institutions must intervene to protect the health and rights of Egyptian citizens and ensure that international ethical and legal standards are upheld in plasma donation. Ignoring this issue could lead to greater exploitation and turn the blood of Egyptians into a commodity, traded at the expense of their dignity and safety.