Could Australia have done more?
A key debate is whether Australian blood services could have done more to minimise the impact of hepatitis C virus before the specific test was developed.
Tests for “surrogate markers” could have been used. These are tests that pick up an indicator of an infection in donated blood. But these tests had serious limits.
One candidate measures liver function by testing for the key enzyme known as ALT or alanine aminotransferase.
However, elevated levels are also associated with factors such as alcohol use and taking common drugs, such as paracetamol and statins. So this test may have led to many people being excluded from giving blood unnecessarily.
Surrogate marker tests also miss a lot of infections. So, at best, they could reduce but not remove the risk, and may have led to a reduced blood supply.
Implementation of ALT-based testing was initially rejected in both the US and Canada.
Then another surrogate marker, anti-HBc, a marker of prior exposure to hepatitis B, was proposed in 1984.
Within two years, the US had recommended all blood donations and plasma products be screened for both ALT and anti-HBc.
The Canadian Red Cross Blood Transfusion Service did not. The then state-based Red Cross Blood Transfusion Services in Australia also did not recommend the surrogate screening in 1987, apart from the Queensland branch.
State-based services managed risk differently
A key issue that led to the newly announced Senate inquiry is the question of fairness. There were various financial settlements for people who acquired hepatitis C through blood or blood products.
Before the national unification of the Red Cross Blood Transfusion Services in the mid-90s, each state and territory had its own policy about managing risk.
This is why Queensland was able to introduce surrogate marker tests that other states did not. There is no way of knowing whether this had any impact on hepatitis C virus infection rates in this period.
Financial settlements were made for people who had acquired hepatitis C virus through a blood transfusion between 1986 and 1990, as long as the transfusion could be traced to a specific facility and donor.
However, people who acquired the virus via a blood product such as factor VIII, a product derived from thousands of donations, were not eligible for financial settlements as it was not possible to trace the source of infection.
Good manufacturing practice?
New evidence aired on the ABC’s Australian Story has suggested poor manufacturing practices may have also contributed to infections.
During the 1980s, Australian blood clotting products were made at the Commonwealth Serum Laboratories in Victoria.
The ABC has published federal cabinet minutes from 1985 that allege practices at CSL did not meet good manufacturing standards and that batches of blood products “failed to reach the appropriate sterility standards”.
This charge was repeated in cabinet minutes in 1988. Failure to adhere to regulatory standards would provide further evidence to support claims that the lack of compensation for blood product recipients has been unfair.
Why a new inquiry matters
In 2004, a previous Senate inquiry into contaminated blood found that improving access to health services, education of health professionals and supporting research to develop better hepatitis C treatments was preferable to further financial settlements for those with hepatitis C acquired through blood or blood products.
In contrast, Canada and the United Kingdom have started broad-brush compensation schemes after their national enquiries.
Australia’s 2004 Senate inquiry also recommended a formal national apology to those affected, but to date, there has not been one.
This new Senate inquiry may help to address a lingering sense of injustice.![]()
Bridget Haire is Associate Professor of Public Health Ethics and John Kaldor is Professor of Epidemiology at UNSW











