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.
The plasma scandal
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.
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.
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?”
