Senator is not a vampire

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By PAULO CAPEL NARVAI*

Open letter to the president of the Senate about the Blood PEC

Dear Senator Rodrigo Pacheco,

I am writing, and allow me to use a colloquial tone, but always respectful, as the Federal Senate is about to make a mistake, in my opinion very serious, that will mark it for a long time. Mark with blood. I am certainly referring to the Constitutional Amendment Proposal No. 10/2022, PEC-10/22, which has been called PEC of Plasma and PEC of Blood. This PEC-10, Dr. Pacheco, there's nothing out of ten, you know? It is a zero grade PEC.

Proposed in 2022 by senator Nelsinho Trad (PSD/MS), PEC-10 was approved on 4/10/23 by the Constitution and Justice Committee (CCJ) of the Senate and now goes to the plenary for deliberation. In the CCJ, there were 11 votes against, but 15 senators, certainly mistaken, considered it acceptable to change the art. 199 of the Constitution of the Republic, precisely in the part where it brought order and civility to that savagery into which the blood trade had become in Brazil, back in the 1970s and 1980s.

I know, Dr. Pacheco, at that time Senator Nelsinho was still quite young, he hadn't even reached the age of Christ, and he didn't know about the dramas that followed, for many families, the blood transfusions that led to death, or the queues of miserable people who sold their blood in the morning to, with the money, buy food for lunch and, who knows, dinner.

But I witnessed all of this and I say that it was with great joy and hope that I received the news that the Constituent Assembly, in its session on May 17, 1988, approved the end of the sale of blood in Brazil. By the way, Dr. Pacheco, this decision was made, look what a coincidence, in the same session of the Constituent Assembly which created the Unified Health System (SUS). Of course it wasn't a coincidence, right President?

About selling blood to eat, Dr. Pacheco, it’s not a rhetorical exaggeration, right? The documentary Until the Last Drop, debut film in 1980 by filmmaker Sérgio Rezende, the same man who directed Straw War, tells of the death of Juvenil Navarro de Souza, who sold his blood to support his family. The film also shows the intricacies of the commercialization of blood by those interested in human plasma in Latin American countries in the second half of the last century. A time that, we thought, would only remain in memory and history.

Since that Tuesday in May 1988, Dr. Pacheco, Brazil has made notable advances in this area. We radically changed the course of things and soon the blood began to have a previously unknown credibility, such was the risk, until then, of receiving some blood, anywhere in the country. A decisive aspect for this was the prohibition of sales, the affirmation of voluntary donations and the organization of a network of blood centers throughout Brazil, with sanitary control of blood.

But in Brazil in the 2020s, in the 10st century, Dr. Pacheco, people who understand blood and public health, are very concerned, warning that PEC-XNUMX is being justified with beautiful promises, but only aims to serve commercial interests of companies that want turn blood into merchandise.

Between us, Dr. Pacheco, I tell you that I was told that the blood of Brazilians, valued in Europe, the United States and other powerful economic centers, can even be treated as a kind of commodity, he knows? It might even be a bit exaggerated to talk about red blood cells and plasma like that, but that's quite serious, isn't it?

Many entities are also speaking out against PEC-10. The Brazilian Public Health Association (Abrasco), listed seven reasons so that the senators do not move forward with the aim of disrupting blood control in Brazil. Are they:

(i) The SUS guarantees transfusion and other treatments free of charge and very safely, both for the public and private networks;

(ii) Brazil's National Blood, Components and Blood Products Policy is a global reference;

(iii) Currently, blood donated in the country exclusively serves the Brazilian population. If the service is privatized, Brazilian plasma becomes a commodity for the global market;

(iv) The export of blood will deplete national banks, leaving the Brazilian population more vulnerable;

(v) Privatization compromises Hemobrás, strategic for self-sufficiency in the production of medicines in Brazil;

(vi) The proposal violates human dignity: the most vulnerable parts of the population will be exploited; It is,

(vii) Voluntary and altruistic blood donation is citizen conscience!

The problem with PEC-10 is so serious, Dr. Pacheco, that on April 13 of this year, the plenary of the National Health Council approved the Recommendation No. 5/2023, which suggests to the National Congress the rejection and shelving of the proposal.

PEC-10 proposes to change paragraph 4 of art. 199 of the Constitution: wants the word “research” to be excluded from the section that says “the law will provide for the conditions and requirements that facilitate the removal of human organs, tissues and substances for the purposes of transplantation, research and treatment”. And regarding research, it proposes inclusion in art. 199 of the Constitution in a 5th paragraph, stating that “the law will provide for the conditions and requirements for the collection and processing of human plasma by public initiative [so] and private for the purposes of developing new technologies and producing biopharmaceuticals intended to provide the unified health system”, which is spelled like this in lowercase letters. Our SUS reduced, symbolically, with lowercase initials. Significant, no?

See also, senator, that the Brazilian State is referred to as the “public initiative”. What a thing, isn't that Dr. Pacheco? It is regrettable to see the Republic being placed on an equal footing with the “private initiative”. Perhaps out of modesty they did not write “Private Initiative” in capital letters. What would they say about this, the State as a “public initiative”, among others, senators of the ilk of Ruy Barbosa, Caetano Munhoz da Rocha, Delfim Moreira, Felipe Schmidt, Afonso Arinos de Melo Franco, Gustavo Capanema, Paulo Brossard, Lauro Campos and Mário Caves?

The problem with this PEC-10, Dr. Pacheco, is that the simple fact that it has prospered so far in the Federal Senate, has been approved by the CCJ, and is going to be voted on in the Plenary, speaks against the institution. This could not have happened, because if the Constitution is changed, the Blood Law (Law No. 10.205, of 21/03/2001) which, sanctioned by Fernando Henrique Cardoso, regulates paragraph 4 of art. 199 of the 1988 Constitution, will simply be thrown in the trash. And it was the Law of Blood that brought order to the house, in this savagery of blood.

Today, the Blood Law prohibits “the donation or export of blood, components and blood products, except in cases of international solidarity or when there is a surplus in national needs in finished products, or upon medical indication for the purpose of diagnostic elucidation, or even in agreements authorized by the SINASAN management body to process or obtain derivatives using high technology, not accessible or available in the country” (art. 14, XII, § 1).

Once this fence is broken, Dr. Pacheco, the Brazilian blood binge will return, as companies that produce blood products will be able to sell them, both in Brazil and abroad. Brazil – and I don't even need to remind the illustrious senator of this – is a signatory to trade agreements that will allow these companies to sell, as they wish, without satisfying anyone, their products on the global market.

It is also worth mentioning, Dr. Pacheco, that in 2004 President Lula created the Brazilian Company of Blood Products and Biotechnology (Hemobrás) with the aim of achieving self-sufficiency in the production of blood products. Since then, defenders of the SUS and blood safety have been fighting hard battles to develop Hemobrás, as the same segments that support PEC-10 have been doing everything since 2004 to make this strategic public company unfeasible for the SUS and the health of the population. But the company resists and develops and will now receive resources from the PAC for new investments, with the aim of ensuring, in the very short term, Brazil's self-sufficiency in this area, providing at production cost, all the needs of the SUS and the private sector that works in health in Brazil.

In this sector, Dr. Pacheco, Brazil does not need commercial companies to operate. They, in fact, are more of a hindrance than a help, because as they aim to make a profit, their interests often collide with the public interest in health.

According to Dr. Ana Paula Soter, former executive secretary of the Ministry of Health, in interview to journalist Gabriel Brito, from the portal Other Health, by the end of this year “Hemobrás will inaugurate a factory that will produce Recombinant Factor VIII, using an innovative technology: it will not be produced by plasma but by genetic engineering”. Recombinant Factor VIII is a medication used to prevent and control bleeding episodes in pediatric and adult patients with hemophilia. Still in this interview, the doctor, currently technical advisor to the National Council of Health Secretaries (Conass), spoke about another blood products factory, which is “in the final phase of completing technological incorporation” and explained that, in this new phase, Hemobrás It is a self-sufficient state-owned company, having even recorded a surplus that reached around 190 million reais.

Another important aspect, which connects with this PEC-10, senator, is the breaking of the current impossibility of selling organs for transplants. As Dr. Pacheco is not unaware, blood is a tissue, equivalent, in biological and ethical terms, to any other tissue or organ, such as a kidney, lung, heart. The possibility of purchasing blood opens the floodgates for purchasing any organ. Therefore, there is a high risk of breaking the Brazilian transplant system, one of the best, most effective and efficient in the world. When you can, Dr. Pacheco, talk to Faustão about this. He will certainly be very pleased to explain how he was saved by the Brazilian transplant system, coordinated by the SUS.

I do not want to abuse your time, Senator Rodrigo Pacheco, so I conclude by asking you to kindly inform this Open Letter to the Senators of the Republic and warn them that the 1988 Constitution says, in its article 198, that “Health actions and services are of public relevance, and it is up to the Public Power to decide, in accordance with the law, on their regulation, supervision and control”. Public relevance; public relevance, don't forget.

I reiterate the Constitution, senator, to say that I have heard, here and there, that vampires were “keeping an eye” on the blood of Brazilian men and women and that PEC-10 is “a vampire thing”.

I've been saying that I don't believe that, that senators are not vampires. For this opportunity, I express my solidarity with Senator Nelsinho Trad, whom I learned to respect during the difficult days of the pandemic. This opposition to PEC-10 should not affect you, as I have never doubted that your actions are driven by the public interest, not by concessions to the vampires who await your approval. Nothing personal, Senator Trad.

So, President Pacheco, don't let me be wrong. Confirm that no, that senators are not vampires, and that the Federal Senate, our upper house, will not allow the approval of this nonsense that is this zero-rated PEC, this infamous Blood PEC.

*Paulo Capel Narvai is senior professor of Public Health at USP. Author, among other books, of SUS: a revolutionary reform (authentic). [https://amzn.to/45IhkhQ]


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