"Despite all the technological marvels that humanity is experiencing, a reliable and safe blood supply is still out of reach for untold millions of people around the world", says Dr Gro Harlem Brundtland, WHO Director-General, on the occasion of this year�s World Health Day dedicated to blood safety. "The primary reasons for this are lack of commitment and support on the part of many governments, resulting in chronic shortages of safe blood donors in developing countries, as well as absence of quality control and testing of blood products."

WHO has issued a telling new set of facts and figures on the state of the world�s blood supply in conjunction with World Health Day (WHD). This year�s WHD theme � Safe blood starts with me � highlights the highly unbalanced situation in the world today with regard to blood supply. Specialists believe that blood supply and blood transfusion services are still very low on the agenda of national public health authorities in many countries.

World Health Day, observed on 7 April, marks the day in 1948 when WHO was founded.

Between 5% and 10% of HIV infections worldwide are transmitted through the transfusion of infected blood and blood products. WHO/UNAIDS estimate that 5.6 million new HIV infections occur annually. "A diagnostic test for the HIV antibody became commercially available 15 years ago but there are still many countries that cannot guarantee 100% testing of donated blood", says Dr Jean Emmanuel, Director of Blood Safety and Clinical Technology at WHO. "Many countries still have no organized blood transfusion services and continue to rely on family or paid donors; on the other hand, in developed countries 98% of the blood supply comes from safe voluntary unpaid donors. All countries should have well-organized blood transfusion services that provide a safe and reliable supply of blood for all those in need."

Another important issue is the inappropriate and unnecessary use of blood especially where clear clinical guidelines are not available. As most blood in developing countries is donated by a family member or by paid donors, even if the attending physician were to decide that the patient did not require blood transfusion, there are compelling social and financial pressures for its use.

Major diseases, other than HIV, that can be transmitted by infected blood include the hepatitis B and C viruses, syphilis, malaria and Chagas disease. Each year, unsafe transfusion and injection practices cause an estimated 8 to 16 million hepatitis B virus infections, 2.3-4.7 million hepatitis C virus infections, and 80 000 to 160 000 HIV infections.

Both developed and developing countries face a blood shortage. In developing countries, it is women and children, especially among the poor, who are affected most of all. Worldwide, about 500 000 women die of pregnancy-related causes every year. Approximately 25% of these maternal deaths are associated with the loss of blood. Many of these lives could be saved if enough safe blood was available. Children with severe anaemia constitute another large group that needs safe blood transfusions, as was shown in a joint WHO/CDC study in Kenya.

Out of 191 WHO Member States, fewer than 70 countries meet WHO recommendations required for a national blood programme. "There are three main points in the recommendations," explains Dr Yasuhiro Suzuki, WHO Executive Director, Health Technologies and Pharmaceuticals. "Individual countries should develop a national blood policy and create a relevant legal framework to support that policy. On top of that, there should be either one specific organization with an overall responsibility or a coordinated national blood programme."

Even fewer Member States test adequately for diseases that can be transmitted in blood, or store blood safely before it is used. Nearly all of the countries with unsafe blood are in the developing world.

Some 75 million units (1 unit generally equals 450 millilitres) of blood are donated each year throughout the world. More than 13 million of those units, or nearly 20% of all donated blood, are not tested for all transfusion-transmissible infections. Testing, which costs US$40 to US$50 per unit, is also sometimes unreliable, particularly when performed by inadequately trained staff or when there are shortages of suitable equipment or erratic supplies of test kits.

The reasons for the unsafe blood supply include:

• Health care providers lack training and the financial resources to ensure quality and safety procedures;
• Supplies of test kits for screening blood are sometimes interrupted in poor countries;
• Lack of safe blood donors;
• Inappropriate clinical use of blood;
• National commitment and support backed by financing and legal framework are lacking in many countries to ensure safety of a country�s blood supply.

In 1975, the World Health Assembly passed a resolution urging WHO Member States to "promote development of national blood services based on voluntary non-remunerated donation of blood".

Remarkably little has changed in the last twenty-five years on a global scale. WHO calls on its Member States and on the international community to address urgently this glaring inequality. "We have to help countries, especially those in greatest need, to create an infrastructure and to train personnel," explains Dr Emmanuel. "We are aiming at creating a global environment whereby safe donors give blood regularly and 100% of donated blood is tested before transfusion. It is a case of three As. Blood should be available when needed at affordable costs and used appropriately."

For further information, journalists can contact Mr Valery Abramov (abramovv@who.int) or Mr Gregory Hartl, (hartlg@who.int) Spokesperson�s Office, WHO, Geneva. Telephone (+41 22) 791 2599/4458/2543. Fax (+41 22) 791 4858.

Radios stations can download audio clips in english and spanish at http://www.who.int/multimedia/whd2000/index.html