US supplies most of the world’s plasma. No country depends on it more than China

As she watched the pale yellow liquid drip into her mother’s vein, Ge Lan felt the weight of every drop.

Her mother, recovering from stomach cancer surgery, relied on daily infusions of human albumin to restore her blood protein levels. At about $46 for a 10-gram bottle, the imported blood product was the costliest medicine in her mother’s treatment.

“I just hope (she) gets better soon,” the 44-year-old told CNN. “I’m worried about the money too, but I have no choice.”

Over two months, her mother used 72 bottles, costing the equivalent of seven months’ income for Ge, a local store worker in Henan, central China. Without help from her sister, she said she simply couldn’t have afforded the treatment – and without it, her mother’s condition could worsen.

China is the world’s biggest consumer of human albumin, the most abundant protein in plasma, which is widely used in care for critical trauma such as burns, and restoring blood protein levels from chronic conditions, like liver diseases.

But it’s long suffered a domestic shortfall largely due to strict rules on plasma collection – a legacy of an HIV infection scandal in the 1990s – and it remains heavily reliant on plasma from its biggest geopolitical rival, the United States, for much of its human albumin supply.

The US supplies about 70% of global plasma and is one of the few countries that pays donors. Every year, millions of Americans offer up their arms to cover everyday costs – people like 25-year-old Sky Tucker.

“While I do know it could save a life, most of the time, I’m just worried about if I’m gonna get my next meal or if I can feed my cats,” said the community college student who sold plasma twice a week for seven years to help make ends meet.

More than 60% of China’s albumin market is supplied by foreign manufacturers and all of it is made from plasma collected in the US, according to a 2024 study co-authored by researchers from China’s national and Zhejiang drug inspection authorities.

That reliance carries growing risks for Chinese patients.

Researchers told CNN that China’s domestic plasma shortfall could leave patients vulnerable to drug shortages and price spikes if US-dominated supply flows are disrupted by geopolitical tensions or global health emergencies, like the Covid-19 pandemic.

Beijing appears increasingly aware of that vulnerability.

“That’s why they wanted to enhance the capacity of collecting the plasma in the Chinese market,” said Xi Chen, associate professor of Public Health at Yale University.

After opening dozens of new licensed plasma collection centers in 2023, the country cleared its first rice-based albumin for market last July, as part of a broader push to reduce reliance on American plasma.

Despite the efforts, China still faces an annual shortfall of around 6,000 tons of plasma, according to a CNN calculation based on industry data and estimation of domestic demand cited by Chinese state media.

Totally weaning itself off American plasma is deeply complicated for a country still haunted by a 1990s “plasma economy” scandal, where unsafe blood and plasma collection infected tens of thousands of rural residents in central China with HIV.

In the 1990s, local authorities in the impoverished Henan province pinned its economic ambitions on the plasma trade, rallying hundreds of thousands of cash-strapped farmers to sell their plasma, according to archived Chinese state media reports.

“Stretch your arm, show your veins; one stretch, one fist — 50 yuan earned,” went the slogan spread widely through villages in central China, according to a 2004 report by The Beijing News, a state-run newspaper. Back then, 50 yuan was roughly equivalent to a month’s income for many rural residents.

The frenzy followed Beijing’s decision in the mid-1980s to ban imports of almost all blood products – except human albumin – amid growing fears over the global HIV/AIDS crisis. China sought to build its own plasma-based industry – but the boom ended in catastrophe.

China Photos/Getty Images

The plasma collection spree, found to be rife with unsafe and unsanitary practices such as reused needles, ended up fueling one of China’s worst HIV outbreaks. Henan reported its first HIV case in 1995, prompting local authorities to shut down blood banks across the province.

Nine years later, Henan officials admitted 25,000 former plasma sellers in the province had contracted HIV, according to a 2004 official provincial census reported by Chinese state broadcaster CCTV. Independent investigators, including the late doctor and whistleblower Gao Yaojie, argued the actual number could be much higher.

The devastating outbreak reshaped China’s blood products industry, prompting sweeping regulations throughout the entire chain from plasma collection to clinical use. It also left a lasting legacy of public distrust.

Due to the “bad image” attached to Henan’s “plasma economy,” local governments in Yunnan, Sichuan and Guizhou – mountainous southwestern provinces that followed Henan’s lead in embracing the sector – had been trying to distance themselves from the blood industry, pursuing investments in other fields, according to Yale University’s Chen, drawing on his fieldwork between 2004 and 2017.

The stigma from the past scandal still colors public perceptions of plasma donation as “dangerous” today, despite significantly improved safety and regulatory standards, according to a veteran industry executive in China, who talked to CNN on condition of anonymity as they weren’t authorized to speak publicly.

Beyond reputational damage, Beijing’s tight regulatory grip over the past three decades – designed to prevent another blood contamination disaster – has also constrained manufacturers’ ability to produce lifesaving medicines, industry analysts say.

This concern remained largely under the public radar until a Covid-era crunch thrust it into the spotlight.

CFOTO/Future Publishing/Getty Images

During the pandemic, plasma-based therapies like human albumin and intravenous immunoglobulin were widely used in treating critical Covid cases in China.

A surge in demand then sparked a wave of panic buying, pushing up prices and leaving many patients with chronic conditions struggling to access supplies, according to a representative for a patient community impacted by inherited immune disorders. The person requested anonymity due to the sensitivity in speaking with foreign media.

Since that time, calls for self-sufficiency in blood products have grown louder among industry stakeholders , academics , and political advisers – and efforts to address the plasma shortfalls have accelerated.

After opening 32 new plasma collection centers in 2023, taking the total number to 302, China’s drug regulator approved the country’s first rice-derived recombinant human albumin, part of leader Xi Jinping’s broader push for China to seize the “commanding heights” in key technologies and industries.

Yang Daichang, chairman of the drug’s developer Healthgen Biotechnology, said it’s expected to eventually replace around a quarter of China’s imported plasma-derived albumin, in an interview with state news agency Xinhua.

However, the rice-based albumin’s market adoption may be challenging, the veteran Chinese industry source believed, because it can only be used to treat liver cirrhosis – and the cost of production could be comparatively high.

If China wants to increase its self-sufficiency, the source believes, the country needs to fundamentally update its decades-old regulatory regime.

“China’s regulation of most other products has been getting closer and closer to international standards,” the source said. “But when it comes to blood products, regulation is still lagging far behind… It’s basically stuck at the level of the 1980s and 1990s.”

Industry insiders say rules that restrict plasma collection centers to certain geographical areas, and only allow locally registered residents to donate, has left the world’s second-largest population with just 1.5 million to 3 million active plasma donors, according to estimates from Yale University’s Chen.

By comparison, the US – with only a quarter of China’s population – has a larger pool of around 4 million, roughly estimated by Peter Jaworski, a professor at Georgetown University who studies the ethics and economics of the plasma business.

China’s tightly constrained plasma industry has stood in contrast to a booming US collection system – propelled in part by financially strained Americans facing soaring prices and a weakening job market – which ultimately underpins China’s imports of human albumin.

The number of US plasma centers more than doubled from 601 in 2016 to more than 1,200 last year, according to historical data compiled by Jaworski, who leads the Georgetown Blood and Plasma Research Group. For comparison, that’s roughly the same number of Denny’s restaurants in the US and nearly double the number of Costco stores.

The collection volume also jumped from over 35 million liters in 2015 to an estimated 62.5 million liters last year, according to Jaworski.

“The industry is growing 6-8% every single year, and it doesn’t look like there’s anything to slow it down over the next 5 to 10 years,” Jaworski added, citing rising global demand for plasma-derived medicines.

Michele Goodwin was once part of the American backbone of the $43 billion global industry.

The 60-year-old single mother, raising two college students in Northampton, Massachusetts, said plasma provided a temporary lifeline after she left a stable job to pursue a nursing degree, only to find her post-graduation pay was insufficient.

Over a year of twice-weekly donations since the autumn of 2023, she earned more than $8,000 before stopping in 2024 because she felt the process was too “time consuming,” “exhausting” and left with her with an “ugly scar” that she didn’t want to worsen.

When she was selling plasma to pay the bills, Goodwin said she was too embarrassed to tell anyone. “I didn’t want my kids to know that… I’m literally selling blood from my arm to help put you through school.”

Yet she was also grateful for the financial cushion it provided.

Those mixed feelings were echoed among over 100 plasma donors Kathleen McLaughlin interviewed for her 2023 book, “Blood Money: The Story of Life, Death, and Profit Inside America’s Blood Industry ” – a decade-long investigation into the US plasma industry sparked by her question about where her own life-sustaining medication came from.

“Our economy fails people who aren’t wealthy and leads them to take actions that they might not take otherwise,” she said.

Most of the people who sell their plasma tend to be under 35, unemployed, without a college degree, Black and male, according to a 2021 study based on two proprietary national surveys conducted between 2018 and 2021.

Whether the US paid-plasma industry exploits or alleviates financial hardship remains unsettled in public debate.

China also pays plasma donors, but caps donations at every fortnight, up to 24 times a year – far fewer times than the US, where donors can roll up their sleeves up to twice a week, 104 times a year.

The World Health Organization advocates for unpaid plasma collection for ethical reasons, arguing in part that it helps protect disadvantaged communities from possible coercion. However, Jaworski, who has donated plasma four times, says payment helps to ensure a sustainable supply of the raw material for lifesaving medicines.

For Chinese patients – at least those who can afford the product – the question is less ethical than existential.

Until China can produce or replace enough plasma of its own, tens of millions of patients needing human albumin, like Ge’s family, will remain heavily reliant on the vital fluid typically drawn from hard-up Americans.

And that reliance begs an uncomfortable question for experts and the author McLaughlin:

“If something happens in that country and that system needs to be shut down, where do you get the medication from?”

CNN’s Joyce Jiang, Simone McCarthy, Shuai Zhang, and Sonya King contributed to the story.

葛兰看着淡黄色的液体滴入母亲的血管，感受到了每一滴液体的重量。

她的母亲正在从胃癌手术中恢复，需要每天输注人血白蛋白来恢复血液蛋白水平。这种进口血液制品每瓶10克，售价约46美元，是她母亲治疗中最昂贵的药物。

这位44岁的男子告诉CNN：“我只希望她早日康复。我也担心钱的问题，但我别无选择。”

两个多月的时间里，她母亲用了72瓶药，这相当于葛女士七个月的收入。葛女士是河南一家商店的店员。她说，如果没有姐姐的帮助，她根本负担不起这笔治疗费用——而没有治疗，她母亲的病情可能会恶化。

中国是世界上最大的人类白蛋白消费国，人类白蛋白是血浆中最丰富的蛋白质，广泛用于治疗烧伤等严重创伤，以及恢复肝病等慢性疾病引起的血液蛋白质水平。

但长期以来，该国一直面临国内血浆短缺的问题，这主要是由于血浆采集的严格规定——这是上世纪 90 年代艾滋病毒感染丑闻的遗留问题——而且该国仍然严重依赖其最大的地缘政治对手美国提供的血浆来获取大部分人血白蛋白。

美国供应全球约70%的血浆，也是少数几个向献血者支付报酬的国家之一。每年，数百万美国人献出自己的血浆来支付日常开销——25岁的斯凯·塔克就是其中之一。

“虽然我知道这可以救人一命，但大多数时候，我只是担心下一顿饭吃不上，或者能不能养活我的猫，”这位社区大学学生说道，她为了维持生计，每周卖两次血浆，持续了七年。

根据中国国家药品检验局和浙江省药品检验局的研究人员共同撰写的一项 2024 年研究，中国 60% 以上的白蛋白市场由外国制造商供应，而这些白蛋白全部由在美国采集的血浆制成。

这种依赖给中国患者带来了越来越大的风险。

研究人员告诉 CNN，如果美国主导的供应渠道因地缘政治紧张局势或新冠疫情等全球卫生紧急事件而中断，中国国内血浆短缺可能会使患者面临药品短缺和价格飙升的风险。

北京似乎越来越意识到这种脆弱性。

“这就是为什么他们想要提高中国市场血浆采集能力的原因，”耶鲁大学公共卫生学院副教授陈曦说。

2023 年，该国开设了数十家新的持证血浆采集中心。去年 7 月，该国批准了首个以大米为基础的白蛋白上市，这是该国为减少对美国血浆的依赖而采取的更广泛举措的一部分。

尽管做出了种种努力，但据美国有线电视新闻网（CNN）根据行业数据和中国官方媒体援引的国内需求估算计算得出，中国每年仍面临约6000吨血浆缺口。

对于一个仍然深受上世纪 90 年代“血浆经济”丑闻困扰的国家来说，彻底摆脱对美国血浆的依赖是非常复杂的。当时，不安全的血液和血浆采集导致中国中部数万名农村居民感染了艾滋病毒。

据中国官方媒体存档报道，上世纪90年代，贫困的河南省地方政府将经济发展寄托于血浆贸易，号召数十万资金短缺的农民出售血浆。

据2004年《新京报》报道，一句“伸出胳膊，露出血管；伸一次胳膊，握一次拳——挣50元”的口号在中国中部农村广为流传。当时，50元对许多农村居民来说，大约相当于一个月的收入。

上世纪80年代中期，北京决定禁止进口几乎所有血液制品（人血白蛋白除外），原因是全球艾滋病危机日益严重。此举引发了一场血液制品热潮。中国试图建立自己的血浆产业，但这场热潮最终以灾难告终。

中国图片社/盖蒂图片社

这场血浆采集热潮被发现充斥着不安全和不卫生的做法，例如重复使用针头，最终导致中国历史上最严重的艾滋病疫情之一爆发。河南于1995年报告了首例艾滋病病例，促使当地政府关闭了全省的血库。

九年后，河南省官员承认，根据中国中央电视台报道的2004年官方省级人口普查数据，该省有2.5万名曾从事血浆交易的人员感染了艾滋病毒。包括已故医生兼举报人高耀杰在内的独立调查人员则认为，实际感染人数可能远高于此。

这场毁灭性的疫情重塑了中国的血液制品行业，促使政府从血浆采集到临床应用的整个产业链出台了全面的监管措施。它也给公众留下了难以磨灭的不信任感。

由于河南的“血浆经济”形象不佳，云南、四川和贵州等西南山区省份的地方政府，都效仿河南发展血浆产业，试图与血液产业划清界限，转而投资其他领域。耶鲁大学的陈教授根据他2004年至2017年的实地调查得出了这一结论。

据一位中国资深行业高管透露，尽管安全和监管标准已显著提高，但过去丑闻留下的污名仍然影响着公众对血浆捐献的看法，认为其“危险”。这位高管因未获授权公开谈论此事，故要求匿名接受 CNN 采访。

行业分析人士表示，除了声誉受损之外，北京过去三十年来为防止再次发生血液污染灾难而采取的严格监管措施，也限制了制造商生产救命药物的能力。

这种担忧此前一直鲜为人知，直到新冠疫情带来的危机才将其推到了风口浪尖。

CFOTO/Future Publishing/Getty Images

疫情期间，中国广泛使用血浆疗法（如人血白蛋白和静脉注射免疫球蛋白）治疗新冠肺炎重症患者。

据一位受遗传性免疫系统疾病影响的患者群体代表称，需求激增引发了恐慌性抢购，推高了价格，导致许多慢性病患者难以获得所需物资。由于与外国媒体交谈涉及敏感信息，该代表要求匿名。

自那时以来，行业利益相关者、学者和政治顾问对血液制品自给自足的呼声越来越高，解决血浆短缺问题的努力也加快了步伐。

继 2023 年开设 32 个新的血浆采集中心，使总数达到 302 个之后，中国药品监管机构批准了该国首个大米来源的重组人血清白蛋白，这是领导人习近平推动中国在关键技术和产业中占据“制高点”的更广泛举措的一部分。

该药物研发公司Healthgen Biotechnology董事长杨代昌在接受新华社采访时表示，该药物预计最终将取代中国进口血浆衍生白蛋白的约四分之一。

然而，这位资深的中国业内人士认为，米基白蛋白的市场推广可能面临挑战，因为它只能用于治疗肝硬化，而且生产成本可能相对较高。

消息人士认为，如果中国想要提高自给自足能力，就需要从根本上更新其沿用了几十年的监管体系。

消息人士称：“中国对其他大多数产品的监管已经越来越接近国际标准，但血液制品的监管仍然远远落后……基本上还停留在上世纪八九十年代的水平。”

业内人士表示，由于规定血浆采集中心只能设在某些地理区域，并且只允许当地注册居民捐献，导致世界第二大人口国仅有 150 万至 300 万活跃血浆捐献者，耶鲁大学的陈教授估计了这一数字。

相比之下，美国人口只有中国的四分之一，但其血浆库却有大约 400 万，这是乔治城大学研究血浆产业伦理和经济的教授彼得·贾沃斯基粗略估计的。

中国血浆产业受到严格限制，这与美国蓬勃发展的血浆采集系统形成了鲜明对比——美国血浆采集系统的部分原因是经济拮据的美国人面临物价飞涨和就业市场疲软——而这最终支撑了中国的人血白蛋白进口。

据乔治城大学血液和血浆研究小组负责人贾沃斯基（Jaworski）汇编的历史数据显示，美国血浆中心的数量从2016年的601家增加到去年的1200多家，增长了一倍多。作为对比，这大致相当于美国丹尼餐厅（Denny's）的数量，几乎是好市多（Costco）门店数量的两倍。

据 Jaworski 称，收集量也从 2015 年的 3500 多万升跃升至去年的约 6250 万升。

“该行业每年增长 6-8%，而且在未来 5 到 10 年内，似乎没有任何因素会减缓其增长速度，” Jaworski 补充道，并指出全球对血浆衍生药物的需求不断增长。

米歇尔·古德温曾是价值 430 亿美元的全球产业中美国中坚力量的一部分。

这位 60 岁的单身母亲在马萨诸塞州北安普顿抚养两个大学生，她说，在她放弃一份稳定的工作去攻读护理学位后，却发现毕业后的工资不够，血浆疗法为她提供了一条暂时的生命线。

自 2023 年秋季以来，她每周捐款两次，一年多来共赚了 8000 多美元。但在 2024 年，她停止了捐款，因为她觉得这个过程太“耗时”、“令人筋疲力尽”，而且给她留下了一道“难看的疤痕”，她不想让疤痕恶化。

古德温说，为了维持生计，她不得不卖血浆，但她羞于启齿。“我不想让孩子们知道……我竟然要卖掉自己手臂上的血来供你们上学。”

但她也对这份工作提供的经济保障心存感激。

凯瑟琳·麦克劳克林 (Kathleen McLaughlin) 为她 2023 年出版的《血钱：美国血液行业内的生命、死亡和利润的故事》一书采访了 100 多名血浆捐献者，这些捐献者也表达了类似的复杂感受。这本书是她对美国血浆行业长达十年的调查，起因是她想知道自己赖以生存的药物来自哪里。

“我们的经济体系辜负了那些不富裕的人，导致他们采取一些他们原本可能不会采取的行动，”她说。

根据 2021 年一项基于 2018 年至 2021 年间进行的两项专有全国调查的研究，大多数出售血浆的人往往是 35 岁以下、失业、没有大学学位、黑人男性。

美国付费血浆产业究竟是在剥削还是在缓解经济困难，在公众辩论中仍未有定论。

中国也向血浆捐献者支付报酬，但限制捐献次数为每两周一次，每年最多 24 次——远少于美国，在美国，捐献者每周最多可以捐献两次，每年最多 104 次。

世界卫生组织出于伦理原因倡导无偿采集血浆，认为这有助于保护弱势群体免受可能的胁迫。然而，曾四次捐献血浆的贾沃斯基表示，支付报酬有助于确保救命药物所需原材料的可持续供应。

对于中国患者——至少是那些买得起这种药物的患者——来说，这与其说是伦理问题，不如说是生存问题。

在中国能够生产或替代足够的血浆之前，数千万需要人血白蛋白的患者（如葛家）将继续严重依赖这种通常从经济拮据的美国人身上抽取的生命之液。

而这种依赖性引出了一个令专家和作者麦克劳克林感到不安的问题：

“如果那个国家发生什么事，需要关闭那个系统，那么你从哪里获得药物？”

CNN的Joyce Jiang、Simone McCarthy、Shuai Zhang和Sonya King对这篇报道亦有贡献。