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Bill Willard, a resident of St. Catharines, Ontario, faced a life-altering diagnosis shortly after retiring in late 2021. He developed worrisome symptoms, including drooping eyelids, eating difficulties, and joint pain, which led to months of medical appointments before he was diagnosed with myasthenia gravis, a rare autoimmune disorder. This condition arises when antibodies mistakenly attack the nerves, compromising muscle control. Fortunately, Willard’s treatment with immunoglobulin, a plasma-derived drug, provided him with swift relief. Energised by his recovery, he and his family have since channelled their gratitude into organising blood drives for Canadian Blood Services (CBS), significantly contributing to the plasma supply that underpins this critical medication.
Rising Demand for Plasma-Derived Treatments
Immunoglobulin therapy is part of a rapidly growing category of treatments sourced from human blood plasma, which is rich in proteins and antibodies. Demand for these therapies is surging across Canada, placing the country among the highest consumers of immunoglobulin per capita in the world. Last year, public spending on plasma and related drugs exceeded $1 billion, constituting nearly two-thirds of CBS’s annual budget, funded predominantly by provincial governments. Projections indicate that this demand could increase by an additional 50% over the next five years.
Canadian Blood Services reported a remarkable increase in plasma collection, with 328,000 litres harvested in the 2025-26 fiscal year—a 52% rise from five years prior. Despite these efforts, concerns are mounting about the sustainability of this growth, as Canada imports a large portion of its immunoglobulin, leading to the establishment of for-profit plasma collection centres in Ontario, where they were previously prohibited.
Challenges in Plasma Collection and Usage
The soaring demand for immunoglobulin has raised alarms among patients, healthcare providers, and government officials regarding whether such growth is viable. Canada’s reliance on imported immunoglobulin means that efforts to boost domestic plasma collection are critical. This need spurred a partnership between CBS and the Spanish pharmaceutical company Grifols in 2022, enabling the expansion of plasma collection sites—now numbering 17 across six provinces, with donors compensated for their contributions.
As the use of immunoglobulin surges, the question of appropriate prescribing practices has gained prominence. Dr. Jeannie Callum, a hematologist, highlighted that inappropriate usage of the drug can detract from its availability for those who rely on it as their sole treatment option. For patients with severe primary immunodeficiencies, the finite supply of immunoglobulin is a pressing concern, particularly when it is allocated for non-approved uses.
Progress and Solutions in Different Provinces
Saskatchewan has emerged as a model for managing immunoglobulin usage more effectively. The province launched a stewardship programme aimed at tracking prescriptions and ensuring standardised ordering forms for clinicians. Following the implementation of this initiative, Saskatchewan reported a significant decline in immunoglobulin use, from 204 grams per 1,000 people in 2019-20 to just 135 grams per 1,000 in the 2025-26 year.
Other provinces, however, lag behind in this regard. An Ontario Auditor-General report in 2020 indicated that the province lacked adequate tracking of blood product usage, including immunoglobulin. While the Ontario Ministry of Health asserts it has implemented many of the auditor’s recommendations, addressing inappropriate prescribing remains a challenge.
Dr. Callum emphasised the importance of data collection in resolving these issues. Without systematic tracking of immunoglobulin distribution and usage, it becomes impossible to hold prescribers accountable for inappropriate allocations, which compromises care for patients facing severe conditions.
A Personal Perspective on Alternative Treatments
After three years of immunoglobulin therapy, Willard has transitioned to Vyvgart, a new drug that is not derived from plasma. This change was facilitated by the approval of Vyvgart for public health plans the previous year. While the cost of Vyvgart can exceed $300,000 annually, its efficacy and the shorter infusion times are significant advantages for Willard. He is grateful for the public health coverage that allows him access to treatment, making it easier for him than navigating the complexities associated with pharmaceutical drugs.
“I just thank God I live in Canada,” he remarked, acknowledging the importance of equitable access to healthcare.
Why it Matters
The increasing demand for plasma-derived drugs poses a complex challenge for Canada’s healthcare system. It underscores the need for sustainable plasma collection practices and robust oversight on prescription practices. Balancing patient needs with the realities of resource availability is crucial. Willard’s story illustrates the profound impact of these treatments on individual lives while highlighting systemic issues that require urgent attention. Ensuring that patients receive necessary therapies without compromising the supply for those in dire need is a pressing issue that demands comprehensive solutions from healthcare policymakers.
