I started my decade-long turn as an international blood smuggler in 2004 with a mundane task: packing. I gently stacked a dozen half-liter glass vials into two soft-sided picnic coolers. The bottles held the components of a syrupy mix, a powerful medicine made from the immune system particles collected from thousands of people. A nurse would infuse the syrup into my veins, a treatment to keep my immune system under control, to halt its potentially paralyzing attacks on my nerves.
First, I had to get all of this, plus my own needles, to China.
Shortly after learning I had a nerve disease that required these periodic infusions, I moved from the US to China, home to the world’s largest and deadliest blood plasma debacle. Early on, I learned a statistic that would guide me through nearly 15 years in China: at the time, an estimated 50% of medications sold in the country were counterfeit or compromised. This was only one symptom of a fractured system where blood was perhaps the most notoriously unsafe product of all.
The alarming data didn’t deter me from going. I was determined to work in China as a journalist. I wanted an adventure, and the country was endlessly fascinating. I was also probably in denial that my illness was chronic – that I would continue to fall sick for many years to come, perhaps even for the rest of my life.
That morning, with coolers in hand and supplies – tubing, needles, alcohol wipes – stashed in my suitcase, I boarded a series of flights to the other side of the world. On that first arrival one of China’s massive new airports, a gleaming futuristic behemoth of marble walkways, steel beams and glass ceilings, I braced for the unknown and carried the coolers through the long, crowded corridor to a customs inspection station.
On that day and many more to follow, there was never a physical inspection of my bags. In the years after liquids were banned on board, I hid the bottles inside clothing and soft coats in my checked luggage. There was no X-ray on arrival, no dogs sniffing out contraband.
At customs, I handed a neatly dressed agent two forms. One was a small square yellow entry card with my name, passport number and other personal details. The other was an entry declaration with a series of questions about my luggage.
It was there I made a quick decision that launched years of smuggling American blood parts into China. On the line, “I am bringing animals, animal and plant products, microbes, biological products, human tissues, blood and blood products,” I checked the box “no”. The agent stamped my passport and I entered the country.
The bottles, I reasoned, weren’t a danger. I wasn’t going to sell imported blood products in China or put other people in danger. The medication, a product made from blood particles and a proprietary mix of chemicals, was so outrageously expensive that when I had tried to ship it to China through proper channels the first two times, customs agents decided the declared value of $20,000 was so high it meant I was starting my own medical clinic and should be taxed several thousand dollars every time I imported the medication.
Bringing fragments of other people’s blood across borders became just something I did to make life manageable. I didn’t investigate the possible penalties, believing I could talk my way out of it if caught. After all, I had a prescription. Official documents went a long way. In those years, China had a wild west character that made it feel untamed and limitless, exactly the kind of place where you could walk into a hospital with vials of your own medication and pay the staff to infuse it into your veins.
China has more miles of borderland than any other country – and those borders, especially in the 2000s, were porous. Along the frontiers with Myanmar and Vietnam, I saw smugglers jump fences in broad daylight, carrying clothes, rice, cooking oil, booze, and even women to sell.
I was surrounded by smugglers, and I was one of them.
American blood was banned from China with reason. In the mid-1980s, just as the Aids crisis peaked and US scientists discovered the virus that caused the disease was borne by blood, American drug companies knowingly sold HIV-tainted blood products in Asia. Thousands of hemophiliacs were infected with HIV. China’s ban on foreign blood kept the pandemic at bay for a while, until the government’s insistence that Aids was a foreign disease helped create perfect conditions for a homegrown epidemic.
Only 20 years ago, China was laying the foundations of economic growth, expanding the gargantuan factories and workforces that would sweep it to global wealth and power. In the 1990s, entire villages began mobilizing around making single products. Soon, they had nicknames like “Bra Town”, “Jeans City” and “Christmas Village”.
In Henan province, the abundant raw material was human blood. Few places were poorer than farm country in Henan; Chinese urbanites today still joke about Henan the way New Yorkers might laugh at West Virginia.
In the early 1990s, government officials hatched a plan to develop a plasma economy, one that would pay farmers for their blood, then generate wealth (mostly for government officials) by using it to produce expensive biopharmaceuticals. The scheme would protect China from the perils of foreign blood and build upon a plentiful natural resource.
This bizarre plan came at exactly the moment farmers were looking for new ways to make money. China had unshackled capitalism, and if that meant selling their blood, that’s what they would do. The writer Yan Lianke, in his novel Dream of Ding Village, a fictionalized account of the plasma economy’s wreckage, describes entire villages thriving and then collapsing on their blood trade, an iron-rich scent hanging in the air.
The detail was no fiction: Yan told me he spent months researching the book and villagers described a ubiquitous smell of blood in the mid-1990s. It started as the scent of wealth; it became the odor of *****.
In the years after Aids infiltrated the plasma economy, the disease killed tens of thousands in Henan and surrounding provinces. The true number of dead remains concealed by China’s government.
A few years ago, a man who was raw material in the plasma economy described the process to me. Twenty years after the catastrophe, it was still a perilous thing for him to speak to a foreign journalist, especially in his hometown. I waited until December, when victims from Henan made their annual 450-mile train ride to Beijing for World Aids Day to protest outside the ministry of health. I sat in the backseat of a cab while the man stood outside my open door.
We talked while looking in opposite directions, pretending we weren’t speaking to each other. He was a farmer, the lowest rung of society, the people most often used as political props. When the plasma trade boomed, he could sell his cells for $8 a liter, once every two or three days. This was unheard of money in a time and place where a farmer might make a couple of hundred dollars a year after expenses. It was a mundane, easy way to earn cash – something none of the villagers had ever experienced.
He sold plasma for several years. Then in 1995 the blood stations shut down suddenly, with no explanation. By 1999, people in his village began falling ill and dying early, painful deaths, at an astounding rate. About a quarter of the 2,000 people in his village sold their plasma. In the process, they were exposed to used needles, dirty equipment and, in many cases, directly injected with the HIV virus as a side-effect of an out-of-control donation system. By the time I met him, more than 200 people in his village, a tenth of the population, had died from Aids.
At best guess, 1 million people were infected with HIV in the pay-for-plasma system. Were it not for two women, doctors of different generations, the ***** toll would have been much worse. One, Wang Shuping, discovered and exposed the debacle; the other Gao Yaojie, became a vocal, beloved public figure demanding it be addressed.
In 1999, when I first arrived in China to spend a year working and studying Mandarin, Gao and Wang blew open the Aids crisis in Henan. First Chinese media, then international journalists, published stories about the pay-for-plasma scheme gone horribly wrong. Victims began dying, leaving villages filled with widows and orphans. I read about it and, like everyone following the news, was repulsed that a government had infected its own citizens with a deadly virus.
Other countries weathered Aids catastrophes and plasma scandals, but China stands alone – operating a government-run plasma extraction program that infected and killed tens of thousands then covering it up.
Gao and Wang had little in common but geography. By the 1990s, Gao was retired, a gynecologist who still did some public education on sexually transmitted diseases. Wang was a young medical researcher, just starting her career in study of blood-borne viruses.
Wang grew up near Zhoukou, a gritty metropolis of 8 million and the 13th largest city in Henan province, which is to say, a total backwater by Chinese standards. In 1991, she was assigned to a health department in Zhoukou in an important new post: monitoring donors in the city’s first blood plasma extraction center.
Within a few weeks of the plasma center opening, 200 people a day lined up to donate their cells. The clinic, and dozens like it, rushed through donors like livestock, extracting plasma as quickly as possible to sell for profit.
Wang discovered hepatitis C in the plasma pool and braced for catastrophe should HIV breach the system. In 1995, she found it. A man who donated plasma at multiple blood stations tested positive for the virus that causes Aids.
By then, the Henan blood industry was churning, ramped up to such a level that technicians were reusing tubing and needles to save money, and chillingly, sharing between patients the centrifuges that spin blood into plasma and parts. In the rush to extract plasma, donors were often re-injected with other patients’ cells – the equivalent of a deadly biological ****.
Wang sounded the alarm, first at home, later in Beijing. Government leaders knew the clinics were spreading a virus that was a ***** sentence, yet kept the plasma banks open for another three months. Then the government abruptly shut down the whole system – without telling donors they were exposed to HIV.
In this moment, Wang Shuping understood a drive for power and money overrode the safety of society’s most vulnerable. She continued working on the fringes of the system for several years, watching closely as Aids began to kill. At the same time, Gao Yaojie discovered Aids in a patient a few hundred miles away. Together the two women started a campaign – Wang behind the scenes with facts and information and Gao out front with a steely resolve and charisma – that shook China’s faith in its health system and government.
The skin on the back of both my hands is riddled with tiny white scars, a map stitched in needle marks made by nurses from Shanghai and Beijing to different US states. In those hundreds of sticks, I’ve never once watched the needle puncture its target; just feeling the sting is enough to make my brain twitch.
The needle, encased in the tiny plastic tube, slid through my skin, piercing a vein on the back of my hand, and I sucked in my breath. I’ve learned to keep the gasp silent, aware that if I startle the nurse she’ll take longer, struggle with the needle or, worse, shoot through the vein. I’ve had around 300 of these and I still gasp every time. It doesn’t hurt; it’s something more primal – an invasion in a place not meant to be touched by sharp metal and hard plastic.
After years of blood smuggling, I started having infusions in the US, but not because I got stopped at the Chinese border with potential contraband. The US healthcare system changed in recent years in such a way that insurance companies micromanage ongoing treatment of chronic conditions, so my infusions are now rationed out, every six weeks.
The procedure takes place in an office suite that doubles as an infusion clinic. There’s a TV bolted to one of the paper-thin walls, a metal sink and a cushy recliner I can sink into and almost fall asleep. I’ll be in the chair for five hours, bored and groggy, glancing impatiently at the plastic bag of thick, pale yellow liquid dripping, always too slowly, into my vein.
Unlike a lot of nurses who stabbed my veins across two continents, this one almost never misses. It’s a skill she refined in years of drawing blood out of veins and putting other things into them. She’s punctured my hands and arms more than 100 times, with this gift for finding a spot that isn’t already hardened from scar tissue.
She is a few years younger than I, a mother of two. Inside the crook of her arm, there is a deep crater, a barely closed hole. It reminds me of a long-ago reporting trip in China where I saw rescued moon bears that had been caged and placed with permanent open spigot drilled directly to their gall bladders to be milked of bile for traditional Chinese medicine that is neither traditional nor necessary. The bears never quite healed.
The nurse and I are two sides of the same story. She is a donor. I am a recipient. Twice a week, a technician draws blood to later extract her plasma, which is distilled and mixed into compounds and preparations, biopharmaceuticals that make up the $9bn American plasma economy, an industry so massive that the US now exports blood products to China.
She gets about $300 a month for her plasma twice a week, a number determined by a formula that targets people just on the edge of getting by, where a few hundred dollars makes a major difference. The pay scale in China 23 years ago was calculated much the same way; enough to make life easier, not enough to earn your way out of selling blood.
Over many days in that chair, I’ve spent hours thinking about the cells of other people entering my body. The cells keep my own immune system in check, but I wonder, do I take on other things from the thousands of donors whose particles I’ve melded seamlessly into my own? What does it mean to depend on the blood of other people, especially when most of the people who donate this substance do it for the money?
For decades, medical researchers have worked with blood and its parts to unearth lifesaving and life-extending treatments. In a pay-for-plasma system, innovation often leads to great exploitation and widening the gap between rich and poor.
Nowhere is this more visible than the Silicon Valley startup world, where a series of clinical trials now under way is investigating the use of young blood, specifically plasma, as an elixir for people 35 and over. It’s impossible to imagine the end result – paying young people for blood to keep the wealthy youthful – won’t widen the gap.
Today, plasma products are used with varying success for everything from recurrent miscarriages to immune disorders and rare childhood illnesses. American clinics collect more than 31,000 tons of plasma every year and blood products account for 1.6% of US exports.
The United States is one of a handful of countries that allow companies and hospitals to pay plasma donors. China is another. Whole blood donations – overseen in America by the Red Cross – are unpaid, but regulators have decided that profit-making biopharmaceutical companies can pay donors for the time it takes to give plasma.
More than half of these plasma centers, which collect 60% of the world’s plasma supply, reside in low-income US neighborhoods. You’ll find them in college towns, in former factory hubs, in cities where the economy lags. You won’t find them in wealthy suburbs or gentrified neighborhoods. Privately run plasma extraction centers set up shop in places where residents sell blood for gas money or college textbooks. They are sparse on the upper east coast, abundant in the rust belt and on the US-Mexico border. Though screening is tight and today’s heat treatment kills viruses, low-paid donation creates its own problems.
I can give you these statistics, but there’s another way I know there’s a socioeconomic divide when it comes to plasma donation in America. I grew up in a fairly broke household but my family is now solidly middle class. No one in my immediate family has ever donated plasma.
Apart from economic exploitation, the risk to long-term donors is unknown. The product insert that comes with my Baxter-branded Gammagard immunoglobin stretches several feet long and lists everything from blood clots to fever and chills as possible side-effects. For me, an infusion means feeling, at best, like I have the flu for a few days every six weeks. I don’t know what happens to people who give raw materials, so I watch my infusion nurse – the donor – as much as she watches me.
After scouring medical journals for evidence of what happens to the health of long-term plasma donors, I found Xi Chen, a professor in global health and economics at Yale University. He’s been monitoring the health of 6,000 plasma donors in China for the past 14 years. China’s plasma extraction centers still flourish in poorer parts of the country, where people are more likely to sell their blood. Xi describes how donors suffer from fatigue and often give up farm work. American donors, he speculates, have access to better nutrition and probably don’t suffer the same effects from giving plasma twice a week.
But there’s no evidence to tell us what happens to long-term American plasma donors. When he first published his research, several US biopharmaceutical companies contacted Xi. He never responded. The practice of drawing plasma to make medicine should be innocuous, but when it targets people living on the margins, people in need of cash, turning their cells into commodities, can it be?
This year, I travelled to Salt Lake City to finally meet Wang Shuping, the doctor who unearthed the crisis and rarely talks about it. I rounded the corner in a quiet neighborhood to Wang’s home late one evening, just as the shade from nearby Mount Olympus started to cool the valley.
We had emailed a few times over the years but never spoken. She is in her early 60s, nearly 30 years younger than Gao Yaojie, and fully immersed in American society. She speaks perfect English, is married to a midwesterner and works in a cancer research lab at the University of Utah.
When I arrived at her home, she had plans. We would take a drive to Park City, tour around downtown Salt Lake at the Mormon temple and a few other historic sites – and, she said, there was something else she wanted to show me.
Wang is perplexed by my interest in a decades-old medical scandal half a world away. As we chat late into the evening, she stops to ask if I’m tired. She noticed my left hand is trembling, something that happens when I don’t get enough sleep. Few people ask me about the tremor; Wang spotted it within a few hours.
The next morning, we drove to Park City. Along the way, we talk about China, American politics, and the blood trade. We stopped for beet salads at a local tavern, where two women at the next table discussed the difficulty of finding good nannies in South America. I wondered what people around us would think if they knew this cheerful woman across the table from me, dressed in white capri pants and rainbow-striped socks with articulated toes, discovered and exposed a health crisis that shook the highest reaches of the Chinese government. How is it that someone who took on the Chinese power structure so seamlessly fell into a quiet American life, leaving that blood-stained past two decades behind?
Over lunch it became clear Wang hasn’t forgotten. There’s something near her house she wanted to show me, she reminded me, in an unremarkable strip mall.
Just outside the entrance, a man sat in his open car, pressing a bandage into the crook of his arm as he smoked a cigarette, the aftermath of having his plasma extracted by white-coated technicians and hi-tech machinery just beyond the door.
In the car, we decided to ask a series of questions as though we might donate, in the hope they would let us see the equipment. She wanted to inspect the process, the machinery, the safety protocols. I was along for the ride, a reporter who will ask the questions, but also a patient seeing how my medication is made. I came to Utah to talk with Wang about what happened in China. Now she was leading me right back into the unknown, in my own backyard.
A fresh-faced technician in a white lab coat wouldn’t let us see the machinery, but described the process – the needle stick won’t hurt, there’s no contamination, he assured us, and the payment scheme outlined on a blackboard offers cash bonuses for first-timers. The more often someone returns, up to twice a week, the higher the pay. Wang nodded along as he explained extensive safety protocols. She had one question: “Which day of the week do you close?”
“We don’t,” he said brightly. “We’re open seven days a week.”
As we drove home, Wang said she wasn’t upset to find a plasma bank so close by. What troubles her is the brazen pursuit of profit in other people’s cells. She shakes her head, saying the center doesn’t even close one day a week, in a city where religion shutters many businesses on Sunday.
She’s seen this incessant rush to blood money before. It spiraled into catastrophe.