The Misguided Idealism Behind France’s Tainted-Blood Affair

BOSTON â€”  The trial and acquittal in France of three former ministers for manslaughter in the “tainted bloodâ€� AIDS scandal seem to represent the depths of cynicism. The officials, including a former prime minister, were accused of favoring French business interests over the lives of French citizens. They allegedly did so by delaying, for several months, the use of a U.S. blood test for HIV while a French company prepared its own test for the marketplace. The three also faced charges of allowing distribution of clotting factor they knew to be contaminated to the nation’s hemophiliacs, again for commercial reasons. The hearing was a follow-up to the infamous 1992 trials of four senior public-health officials, who were found guilty of similar charges, and a preview, perhaps, of more trials to come.

The fact that just one minister was convicted of a lesser charge only reinforces the cynicism: The French public widely believes the prosecution was half-hearted and the judging incompetent.

Yet, the truth behind the French blood scandal has been largely ignored. The nation’s AIDS-related blood scandal is not the product of greed or commercialism but, ironically, idealism. An idealized notion of the purity of French-blood donors blinded doctors to the tainting of their blood supply. Thus self-deluded, they neglected basic measures that could have slowed the spread of AIDS.

It is hard to imagine from a U.S. perspective how fervently the French feel about their blood. To us, blood is a vital pharmaceutical, given for free by well-meaning donors, then sold to hospitals like many other components of medical care. But to the French, blood is special, a symbol of the nation’s purity of purpose and its citizens’ enduring social contract with each other.

This belief originated during the greatest moral crusade of modern times: World War II. During that conflict, blood and its derivatives became a global resource that the Allies used effectively and the Nazis, for ideological reasons, virtually ignored. With the Germans occupying Paris, the Free French set up a system of blood banks in North Africa to provide blood and plasma to their troops. In the latter part of the war, French doctors reestablished the system at a headquarters in Paris. They prided themselves on the fact that, in contrast to the Vichy government’s, their system was based entirely on volunteerism. They saw the entire process, from donation to infusion, as an act of patriotic solidarity.

After the war, blood banking became woven into the social fabric of France as in few other nations. This was a time when the United States, Britain and many other countries established national blood-banking systems. The French established a government-run system, with an unusual idealistic twist. The law that set up their network also mandated a principle called benevolat. The word, which has no direct English translation, means that blood should be freely given for the good of all citizens.

Most nations believe that blood sharing should be charitable, but in few has the notion been as publicly celebrated as in France. In the years following the war, “Days of Blood� became part of the nation’s lexicon, in which communities would be mobilized en masse to give. Later, a national blood-giving club, the French Federation of Blood Donors, was formed. The group grew to include hundreds of thousands of members, with their own social functions, a magazine and considerable political influence.

The French saw blood giving as an ennobling experience, not only for the recipient but for society as a whole. They encouraged the practice in the marginal neighborhoods of Paris, places that, for health reasons, one would wish to avoid. They even targeted prisons for blood-collection efforts, since French officials thought giving blood had a “redemptive� effect, by making prisoners part of the larger social contract.

Technologically speaking, France has always been among world leaders in transfusion and blood testing. But there are times when technology lags and common sense must quickly be brought to bear. Such was the case with the AIDS epidemic, when a retrovirus began to spread through the world’s blood systems before anyone could gauge its effects.

When AIDS cases first began appearing in France, some doctors questioned the country’s blood-collection philosophy, only to be pushed aside. In 1983, the chief of the transfusion system proposed that French blood banks begin using the kind of personal questionnaires adopted in the United States to screen out high-risk people such as drug users and gays. These questionnaires proved highly effective in reducing contamination of blood supplies both before and after the laboratory HIV test. But French officials were so convinced of the purity of benevolat blood they did not follow his counsel for a year and a half, a critical period in the AIDS epidemic. As a French transfusion official explained, “Donors were like gods. No one would have wanted to offend them.�

Doctors who warned about blood collections from prisons met similar resistance. For several years, doctors who worked with prison populations tried to raise alarms about high rates of HIV and hepatitis. Yet, by 1985, just as the AIDS epidemic crested and broke in France, the nation’s collections in prison reached an all-time high. It was not until the late 1980s that the nation eliminated its prison collections of whole blood.

This is not to say that French prosecutors have pursued the wrong culprits in the trials. Highly placed transfusion officials did favor dollars over lives when they delayed the introduction of the U.S.-developed HIV test to give a French company a toehold in the market. It is also true that, in order to save money, officials knowingly distributed untreated clotting factors to the nation’s hemophilia population when safer products were available. But the real damage came from their blind belief in the purity of French donors rather than a cynical devotion to French commercial interests.

One French government study that has gotten little press play estimated that, in 1985 alone, prisons accounted for 25% of the nation’s HIV-tainted blood, even though inmates provided less than 1% of the total supply. Hundreds of infections may have resulted. Another study showed that even though the contamination rate of French plasma products was comparable to that of other European nations, the rate in whole blood was many times higher. (The whole-blood rate could have been lowered by donor questionnaires or eliminating collections from prisons and marginal neighborhoods.) According to social scientists who conducted the study, the HIV rate in French blood was second only to that of Romania, whose health system was a wreck. Yet, in the wake of France’s national catharsis, such information, he said, was “systematically forgotten.�

Fortunately, the French have modified their system. It is now more responsive to changing realities and less ideologically driven. But officials decline to acknowledge the underlying tragedy of their “contaminated blood affair�: that in the early days of an emerging epidemic, the nation was let down by an entire philosophy, not just the cynicism of a few.