Marking a Year of Fundamental Change

Our first year of operation has clearly demonstrated to us that many of the challenges we face remain highly charged and often volatile public issues. This regularly drives home the point to us that a significant portion of our role involves the management of risk.

Of course, when it comes to risk, there can be no guarantees. There may never be a time when blood will be absolutely 100-per-cent safe. But there must be vigilance and systems in place to minimise the risk. At CBS, our operating assumption is that there will always be potential threats to the blood supply.

Safety is our "prime directive"-the first of the stated principles on which we were founded and new tests are being added to the roster of testing requirements as we continue to meet accepted international standards. Nucleic Acid Amplification Testing is a good example. NAT is being used to test for Hepatitis C, HIV by the end of 1999 and testing for Hepatitis B is anticipated for the third quarter of the year 2000.

Our regulatory environment also imposes the stringent regulations of the Canadian Food and Drugs Act. CBS is subject to the onerous good manufacturing practices requirements of this federal statute, similar to the binding practices that are imposed on the pharmaceutical industry.

Even though CBS is only a year old, we've already had to deal with several major issues that put our organisation to the test, including our commitment of transparency.

One of these, variant Creutzfeldt-Jakob disease-the human equivalent of mad-cow disease-surfaced as an issue late last year. It's a particularly revealing case in point as it illustrates well the need to deal promptly with an issue that is both complex and enigmatic and with a potential to have a direct impact on our blood donor deferral policy. -

It's also a striking example of a global impact arising from a local phenomenon. Here we see a seemingly unrelated issue that began with cows in the U.K. ultimately creating a direct impact on the blood systems of Canada, the United States and elsewhere.

To date, the threat of variant CJD remains only a theoretical risk; there is no proof that it can, or that it cannot, be transmitted through transfusion. As such, it was a very difficult issue to deal with. In our handling of the issue however, we were guided by the basic principle of safety and by Justice Krever's recommendation that preventative action should be taken in the interests of all Canadians.

The bottom line is that for the blood system to work as it should, trust is essential and we must regain the confidence of Canadians. Safety-and the perception that we are doing everything in our power to create the safest possible system-is essential to achieving trust.

We are encouraged by recent public opinion research results indicating that 65 per cent of Canadians think the problems of the past have been fixed and 69 per cent say we are managing the system well. While we have made clear progress, we remain plagued with lingering perceptions regarding the safety of receiving a transfusion: only 12 per cent believe that it is "completely safe" and a further 46 per cent believe it is "somewhat safe."

Part of what appears to be driving this concern is a mistaken belief by almost half (48 per cent) of the population that not all donated blood is tested, when in fact each and every unit of donated blood is tested for safety. Perhaps one of the most troubling findings from our point of view at CBS, is the belief among only one-half (50 per cent) of the population that donating blood is "completely safe." Clearly, we have many hurdles to overcome before we truly regain the full confidence of Canadians.

Some may say we really have little choice and others say we are placing too much emphasis on safety. We do have a choice and the choice we have made, and will stand accountable for, is to operate a blood system that is deemed to meet accepted international standards. Our goal is simply to ensure that we have the safest and most reliable blood system in the world.

Clearly, we are in the process of fundamentally changing the configuration of the blood system in this country.

One thing that will not change however is our reliance on volunteer donations as the cornerstone of the system. Without blood donors there is no blood, there is no blood system and the health-care system as a whole would grind to a halt without it.

One of our major concerns leading up to transition was the potential loss of blood donors; in fact, other countries had experienced sharp declines in their donor base as a result of similar transitions. We realised that this was a situation that demanded urgent attention. A comprehensive national communications plan was put in place, including a major advertising campaign; letters were sent to l.3 million donors as well as outreach through the news media.

We believe that this concerted effort led to the current stabilisation of our donor base; in fact, it increased by 2.4 per cent in our first six months. This is an accomplishment that is absolutely crucial to the ongoing stability of the blood supply. Only 3 per cent of adult Canadians donate blood while virtually all Canadians will need blood or blood products in their lifetime.

Unfortunately, our donation record does not compare favourably with many other industrialised countries. Over 5 per cent of the population donates blood in Australia, England and Sweden. Even the United States, at 3.6 per cent, surpasses Canada in per-capita blood donations.

This is our situation even as our aging population is creating a "double-whammy" for us. Not only are we facing the increased demand of an aging population, we are at the same time losing many of our lifelong donors due to age limitations.

Today we are in a situation where we must plan for a very different future, because as a group:

- Over one-half of our donors are now over the age of 40;

- About nine out of 10 are repeat donors; and

- Nearly three out of four started donating when they were under 25 years of age.

Another factor having a direct impact on the blood supply is our increasingly sophisticated blood-screening technologies and a zero-tolerance public attitude towards risk leading to an ever-increasing number of potential blood donors being either temporarily or permanently deferred from giving blood.

Clearly we need to attract new generations of blood donors as well as encourage lapsed donors to return. Our research has told us that if Canadians knew just how vital their gift of life is they would donate blood. But we've never really told them the critical importance of their gift-or done so in ways they could truly appreciate its many uses and our critical supply needs. Well we're starting now. This fall marks the launch of the largest-ever campaign to recruit blood donors in Canadian history.

This campaign has been in development for quite some time-and it comes at a time of great need in the blood system. We have just instituted a new deferral policy for people who have visited the U.K. for a total of six months or more since 1980 which is expected to reduce our active donor base by at least 3 per cent. And we are entering our traditional times of high demand for blood over the duration of this campaign: Thanksgiving weekend, Remembrance Day, Christmas Day, Boxing Day and the New Year's holiday.

The theme of the campaign is: "If you knew ... would you?" If you knew that your blood would improve the quality of life of a cancer patient ... would you give? If you knew that a life-saving organ transplant-a liver, heart or lungs-mould not take place without your blood ... then, would you give? We're putting these questions to Canadians as I have to you in the hopes that they will answer the call and give blood.

In fact, we think we know at least part of the answer to the question. We are encouraged because our latest research says over two-thirds of lapsed donors-those who have not donated in the past two years-report that they will consider donating again.

There are also fundamental changes that must be made to the organisation itself.

We are currently reviewing the structure of the organisation to determine the best model to meet our vision of a safe, secure, reliable and cost-effective supply of blood, blood products and their alternatives.

There are two fundamental drivers for the development of our new organisational model. The first is to design a system that will bring us closer to our principal customers-the blood donors, volunteers and hospitals without which the system could not function. The second driver is the need to tailor the organisation to deal with the impact of new technologies and more sophisticated blood-testing techniques.

The safety and efficiency of the system, including overall cost effectiveness and the need for Canada to become more self-sufficient in plasma, will be defining factors as we move to develop a new structure for the organisation.

The process that we have initiated to achieve this goal will involve widespread consultation with all stakeholders in order to design the most effective and efficient system possible. It will also involve research into best practices and lessons learned from other major blood agencies.

In essence, everything that we have done and everything we are in the process of creating is for the purpose of positioning CBS to be able to tackle the challenges that will inevitably come our way in the future.

As we move towards the third and final phase of the Change Management Plan, re-engineering the blood supply, CBS is committed to:

- Restoring public confidence in the blood supply,

- Improving our operational efficiencies and cost effectiveness;

- Improving our infrastructure to optimise operations and meet the needs of our customers; and

- Working with our customers and partners on joint initiatives to optimise the utilisation of blood products.

At CBS, we are acutely aware that blood is a precious resource, and we take very seriously our responsibility for its efficient and safe use. We intend to create a new blood system for Canadians that is effective, efficient and worthy of your trust. We cannot sustain another upheaval or public health disaster in our blood system. It is ;an integral part of our health system. We have an obligation to those who worked tirelessly to put the blood system on a new track.

This has been the first year of what promises to be a long journey for CBS. Yet, even looking back over the past year, we have made progress:

- A clear strategic direction has been set by management.

- New safety measures have been implemented. o The donor base has been stabilised.

- We have introduced many innovations that are helping to regain the trust of Canadians.

- We also successfully managed our way through the variant CJD issue-and did so in a manner consistent with our policy of openness, transparency, consultation and participation.

I look forward to meeting the challenges of our second year.

Thank you for your attention.

The appreciation of the meeting was expressed by Gareth S. Seltze Private Wealth Management Professional and a Past President, The Empire Club of Canada.