What the Department has revealed about the Blood Ban #FOI

I have this afternoon received a response to my Freedom of Information Request about the retention of the lifetime ban on Men who have sex with Men (MSM) donating blood. Here is the reply:

Q 1. For minutes of any meetings that the Minister has had pertaining to the SaBTO report "Donation selection criteria review - men who have had sex with men" 8-Sep-11

A:  No minutes held.

    

Q 2. For details of any information that the Minister has received that conflicts with or supports the quantitative and qualitative substance of the above report. Especially that of the two pieces of the evidence that the Minister announced on 17-Jun-12 that he had received in recent weeks.

A:  Two pieces of information may be released.  Please see relevant attachment to this letter and appropriate links later in this reply (overleaf).

    

Q 3. Minutes of any meetings the Minister has had with professionals in the health and LGBT fields, since receiving this new information, regarding their contents.

A: No meetings have taken place.

    

Q 4. Minutes of any meetings or information that the Minister has had regarding people who have had sex with prostitutes or someone from Africa that has led to his conclusion to lift their 12 month deferral period for blood donations to a lifetime ban.

A: No meetings have taken place and no information held.  

FREEDOM OF INFORMATION ACT 2000 You wrote to this Department on 17th June 2012 seeking information under the Freedom of Information Act.  Your requests for information are copied below with specific italicised responses.      Q 1. For minutes of any meetings that the Minister has had pertaining to the SaBTO report "Donation selection criteria review - men who have had sex with men" 8-Sep-11 A:  No minutes held.      Q 2. For details of any information that the Minister has received that conflicts with or supports the quantitative and qualitative substance of the above report. Especially that of the two pieces of the evidence that the Minister announced on 17-Jun-12 that he had received in recent weeks. A:  Two pieces of information may be released.  Please see relevant attachment to this letter and appropriate links later in this reply.      Q 3. Minutes of any meetings the Minister has had with professionals in the health and LGBT fields, since receiving this new information, regarding their contents. A: No meetings have taken place.      Q 4. Minutes of any meetings or information that the Minister has had regarding people who have had sex with prostitutes or someone from Africa that has led to his conclusion to lift their 12 month deferral period for blood donations to a lifetime ban. A: No meetings have taken place and no information held.  Q 5. The number of meetings or conversations that the Minister has had regarding their positions and actions on MSM blood donations both before these two new pieces of evidence arose and since with his counterparts in: a) Westminster – none b) Edinburgh - none c) Cardiff – none d) Dublin – no formal meeting however Minister had a conversation with James Reilly, TD at a North/South Ministerial meeting.  Information requested in Q.2 is referred to below and a copy of a letter from Mr Reilly TD, is attached to this letter.      Q 6. Minutes of any meetings or information that the Minister has had regarding as yet undiscovered or undisclosed blood borne diseases that the Minister alluded to on 22-Sep-11. A:  No information held.

I wish to advise you that no Ministerial decision has been made as yet on the lifetime ban on blood donations by men who have had sex with men, and the position remains the same as when you were advised in a previous letter dated 15 November 2011 (FOI 140/2011 refers). Therefore Section 35 1(a) (Formulation of Government Policy) still applies.

It may be helpful if I advise that Section 35 is a qualified exemption, and we are required to assess as objectively as possible whether the balance of public interest favours disclosing or withholding information under this provision.  The Department recognises the general public interest in making this information available for the sake of greater transparency and openness.  However, final decisions have not yet been taken and the Department believes that in this instance, the public interest lies in protecting the policy-making process, and preserving the ability of officials to engage in free and candid discussion of policy options without apprehension that potential courses of action may be held up to scrutiny before they have been fully developed or evaluated.  A copy of the applied Public Interest Test is appended to this letter.

We can however release some information pertaining to your request and to which the Minister referred in a recent interview for the Sunday Politics show, broadcasted on the 17^th June 2012.  These are:

1.      Copy of a letter dated 31 May 2012 from Dr James Reilly T.D. Minister for Health (ROI)

2.      Link to the technical memorandum outlining the results of the study by the Council of Europe

Here is the text of the meat of that letter from the Irish Minister for Health:

The Irish Blood Transfusion Service (IBTS) remit is to provide a safe, reliable and  robust blood service to the Irish health system. Blood, and the products derived from it, are an integral part of healthcare delivery. A major objective of the organisation is to ensure that is always has the necessary programmes and procedures in place to protect both the donors of bl;ood and the recipients of blood and blood products.

 The IBTS has the responsibility to ensure that there is a sufficient supply of safe blood to meet the needs of patients.  In order to supply blood for transfusion all decisions on donation criteria are based on a review of the evidence bearing in mind the desire of individuals, the safety of the recipient, and the tolerance of society in general of any transfusion infection occurring. The exclusion of men who have/or had sex with other men (MSM) from donation is based not only on risk factors from HIV but on other blood borne agents known to be associated with MSM behaviour.

For Ireland, the view of IBTS, is that taking all of these aspects into account, a permanent deferral for men with a history of MSM behaviour should remain in place. This and donor deferral policy in general will be kept under constant review.

So I am somewhat bemused that once again the Minister appears to have announced that he has come to a decision, yet the Department are saying that he has yet to come to one. However, I am grateful that the Department have realised that the public interest in how he has come about his own (if not the department's decision) deems a necessity to have some form of response.

It appears that the Minister has had no meeting with Health Care professionals about the decision comments he has made. He also appears not to have talked to or consulted with the other UK health ministers but has had a brief conversation which led to the above letter with the Republic of Ireland minister. This appears to match the NI Health Minister's earlier utterances about other blood borne infection. But the SaBTO report took those into consideration in its findings.

First up look at the proportion of new diagnosis by groups

Taken from the SaBTO report April 2011

Then consider the incubation and detection periods:

• HBV - 4-6 weeks
• HCV - 50-60 days
• HIV - 1 to 4 weeks (9 day window period 99.9% accurate)

Currently all the tests above ask you to come back after 6 months if you feel you have been exposed to infection to check whether there is infection or not. Of course the new occurence of new HIV infection are out of proportion with the size of that population but look at the rest of the breakdown; fairly in proportion. Then look at some of the detail in that report.

MSM who have Hep C are usually co-diagnosed with HIV which has a shorter window period, indeed the figure is as high as 96%. Hep B new detection is prevalent among migrants from high endemicity indeed this figure also occurs in 96% of cases, so there is some credence to the Minister's earlier comments about people coming from African countries where Hep B epidemic levels exist. So the chances of anyone having any of those infections after a 12 month deferral period is small to impossible and indeed the chance of MSM slipping through the hoop is even less due to concurrency of the majority of Hep C infection with HIV detection.

Also as I have mentioned before MSM, or indeed anyone who visits a GUM clinic, who have regular blood tests are offered a course of Hep B & C inoculation so those who look after themselves are even less likely to have the other infections. Yet this behaviour is not taken into consideration with the ban in place. Nor the fact that those sexually active who have their blood regularly checked are also included in the blanket ban.

The evidence from the SaBTO report has been enough to convince England, Wales and Scotland that a 12 month deferral period is the best option as non-compliance is more likely to happen if MSM have a lifetime ban. But Northern Ireland's health minister appears not to have discussed this issue with any of his counterparts. He is however, happy to take his advice from the IBTS whose quantitative .