On a former slave owner’s cotton plantation in Arkansas, the sprawling Cummins state farm prison covers 6,700 hectares (16,500 acres) and can house nearly 1,900 inmates.
It is a working farm with vegetable crops, a dairy and livestock, but for more than two decades its most lucrative product was the blood plasma harvested from the convicts.
Prisoners were paid between $5 and $7 each time, and the plasma was sold for about $100 into the drug industry supply chain from the early 1960s to the early 1980s.
Cummins was one in a network of prisons across America that provided plasma and its extracts in products shipped around the world, including Britain. Other paid donors were recruited from deprived neighbourhoods of the US, including drug addicts and people with sexual diseases.
Cara McGoogan, author of The Poison Line: A True Story of Death, Deception and Infected Blood, said: “The plasma was so profitable it was called liquid gold. From the prisons in America to the UK, mistakes were made all along the chain that created this deadly product.”
Shocking accounts have been uncovered of the “bleeders” who donated at Cummins. It was claimed there were no sinks in the bleeding area, no clinical scrubs or gloves. The bleeding rooms were dirty with blood on the floor. It is claimed the screening procedures were regularly flouted.
At another prison in Louisiana, there were even more appalling claims. One witness claimed seeing people “shooting intravenous drugs” while waiting to donate, while others allegedly had sex in the bathroom before “going on the table to bleed”.
Clotting agents extracted from the plasma were used to treat people in Britain who suffer from haemophilia, a medical condition in which the ability of the blood to clot is severely reduced.
Typically, about 10,000 donors would have contributed to a product batch, from inmates in a chain of prisons in the American south to homeless people in Los Angeles. Just one person infected with HIV or hepatitis C could contaminate the entire product.
The infected blood inquiry in London, which opened in 2018 and has heard from 370 witnesses and examined tens of thousands of documents, will report next month on the worst treatment scandal in NHS history. More than 3,000 people have died from the dirty blood infected with HIV and hepatitis viruses.
Ministers insisted for years that patients had been given the “best available treatment” at the time. They claimed clinicians and health officials did not have the knowledge to prevent the tragedy.
The Observer has seen documents submitted to the inquiry that demolish this claim, revealing UK officials were told in the 1970s that blood plasma was procured from convicts and could not be properly checked.
One of the products was Koate, manufactured by Cutter Laboratories, owned by drugs firm Bayer. Cutter Laboratories had been a key client of the plasma being traded by Cummins prison since the 1960s.
Drug executives were candid about the risks in their application for a licence in October 1975 from the UK regulators. It said: “Since the presence or absence of hepatitis virus in Koate cannot be proven with absolute certainty the presence of a virus should be assumed.”
Officials on the UK’s Committee on Safety of Medicines were also told the “raw material” was obtained from various sources, including “American state prisons”.
Officials should have realised paid convicts were more likely to be drug users and at risk of infection, but the licence was granted by the then Department of Health and Social Security.
“It’s horrific that the government knew these products were infected and that the donors included prisoners, but allowed them to be licensed without people being given informed consent,” said Jason Evans, founder of the Factor 8 campaign group, whose father Jonathan died in October 1993 after contracting HIV and hepatitis C from contaminated blood. “The licensing documents are critical because they show the level of knowledge in the government.”
Haemophilia is an inherited bleeding disorder caused by low levels of clotting proteins known as factor VIII (the most common deficiency associated with haemophilia A) and factor IX. It is predominantly a male disease.
The condition was treated for several years with intravenously administered fresh frozen plasma, but by the early 1970s manufacturers were able to extract the proteins from pooled plasma, producing a freeze-dried concentrate of powder for soluble injection.
Commercial protein products were considered a “miracle” treatment, but there was a short supply of blood plasma. The World Health Organization urged countries to become self-sufficient in blood supplies, and avoid paid donors because of the higher risk of infected blood. Dr Joseph Garrott Allen, an American clinician, warned the UK’s Blood Products Laboratory in January 1975 that the US supply chain with paid donors was “extraordinarily hazardous”.
Despite the warning, the UK started to licence commercial factor VIII products from the early 1970s. The contaminated product led to outbreaks of hepatitis B in haemophiliacs in the 1970s, but clinicians considered the benefits of treatment outweighed the risk.
In January 1983, the Observer reported that the products might be a conduit for a far more deadly virus: HIV. “A commercial blood product imported into Britain from the United States may pose a grave threat to the health of haemophiliacs,” the newspaper reported.
Four months later, the Mail on Sunday warned in a front-page article of “hospitals using killer blood”, and correctly warned that the lives of thousands of British people could be threatened.
Cutter Laboratories had started screening its donors in February 1983 because of the risk of Aids, but in the UK ministers, clinicians and health officials insisted there was no conclusive evidence of risk and failed to halt treatments.
In November 1983, Kenneth Clarke, then a health minister, told parliament there was no “conclusive evidence” that Aids was transmitted by blood products. The contaminated products were not phased out until 1985, when heat-treated products were introduced.
Over the years, as the scale of the disaster emerged, ministers have been accused of compounding the tragedy by failing to acknowledge the failures. Campaigners say the destruction of documents and misleading statements amounted to a cover-up. Documents also show children with haemophilia were experimented on by doctors with treatments that could infect them with HIV.
The inquiry into infected blood, chaired by Sir Brian Langstaff, has examined how 30,000 people were infected with HIV and hepatitis C. Patients were infected from commercial blood products for haemophilia and blood transfusions that were not routinely screened for hepatitis C before September 1991. The genetic sequence of hepatitis C, which was previously known as “non-A, non-B” hepatitis, was isolated in 1989.
An interim report published in July 2022 recommended interim compensation payments of no less than £100,000 should be paid to all those infected and all bereaved partners. In a second interim report in April 2023, Langstaff found that “wrongs were done at individual, collective and systemic levels”.
The government says it has paid more than £400m in interim compensation, but that it is not in a position to make a final decision on further payouts until it has seen the report.
Bayer said it had fully co-operated with the infected blood inquiry. The firm said in a statement: “Bayer expresses deep sympathy for people who contracted HIV or hepatitis infection through use of blood therapies in the 1970s and 1980s and for the family members of those that were infected.
“Bayer is truly sorry that this tragic situation occurred and that therapies that were developed by Bayer Group companies, and were prescribed by doctors to save and improve lives, in fact ended up causing so much suffering.”
