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On returning from college recently, Kolkata-based Anusha (name changed) — a thalassaemia patient who contracted HIV through a blood transfusion a few years ago — read a headline that gave her pause.Two years after 14 children in Uttar Pradesh reportedly contracted HIV and hepatitis after blood transfusions, five children with thalassaemia tested HIV-positive after receiving blood at Jharkhand’s Chaibasa Sadar Hospital last month, with a sixth case emerging at another facility in the state.“At least I can afford treatment,” says Anusha. “Many who visit rural centres and govt hospitals can’t.”Opposition leaders have claimed that six more children in Ranchi and one child in Koderma have been affected.For thalassaemia patients — dependent on lifelong transfusions — the Jharkhand case has reopened an old wound.“We are sick and tired,” says lawyer Anubha Taneja Mukherjee. A thalassaemia patient herself, she is member-secretary of Thalassemia Patients Advocacy Group (TPAG), which has long been seeking a uniform national blood law and mandatory upgrade of screening technologies. “This isn’t just a system failure. It’s a violation of the right to safe, life-saving care.”A system under scrutinyInitial investigation indicates that the Chaibasa blood bank used fourth-generation ELISA tests, but not nucleic-acid amplification testing (NAAT), which can detect infections during the “window period” when ELISA may fail.Five cases have been traced to this facility, whose licence — according to local media reports — lapsed in 2023. While hospitals often operate under “deemed-continuation” rules during renewal, the case has raised questions about accountability, oversight and quality control.Jharkhand health authorities have suspended senior officers and ordered statewide inspections of blood banks, while the high court has taken suo motu cognizance, asking for data on monitoring, donor-camp protocols, and blood-availability practices.Following statewide inspections, the Jharkhand high court — on Nov 19 — noted that licences of 17 blood banks have been cancelled, and directed the state to set a clear timeline for adopting NAAT for blood screening. The court also found that although the inquiry into the Chaibasa incident is complete, the report has not yet been placed on record.“It’s not an isolated incident,” says Dr Ishwar Gilada, secretarygeneral, People’s Health Organisation (PHO), an NGO known for its work in HIV/AIDS awareness, prevention, and treatment advocacy. “They reflect policy paralysis and administrative collapse.”Lessons from other statesThe tragedy comes even as some states have attempted to build stronger shields around vulnerable patients.In Rajasthan, a health official says the state follows a two-layer protocol for those needing frequent transfusions.“For patients requiring frequent transfusions, we first test by ELISA and then use NAAT to prevent transfusion-transmitted infections,” the official says. “We have been using NAAT for four years.” Rajasthan has begun extending NAAT to general patients in Jaipur and Udaipur, with phased expansion planned across districts still reliant only on ELISA. “NAAT must become universal for high-risk groups,” the official adds.In UP, transfusion oversight is managed by the State Blood Transfusion Council, led by Dr Geeta Agarwal. “No case of contaminated blood transfusion has come to the council’s notice in the past 10 years,” she says, adding that UP follows guidelines and SOPs issued by National Blood Transfusion Council (NBTC, the central body that coordinates state blood transfusion councils) and cross-checks compliance. “We reinforce rational use of blood every three weeks across all blood banks, mandate testing for HIV, hepatitis B and C, malaria and syphilis, review data monthly, and conduct quarterly quality assessments.”UP has also created a digital monitoring tool with nearly 200 parameters, she says, adding that the Food and Drug Administration conducts at least one physical inspection a year.This is in stark contrast to the gaps exposed in Jharkhand.A decades-long battleIndia’s fight for safe blood began in the late 1980s, when PHO’s public-interest petition spurred early HIV screening in Maharashtra and Goa. A landmark Supreme Court ruling in 1998 mandated national screening and empowered NACO (National Aids Control Organization, under the ministry of health and family welfare) to overhaul blood banks. The reforms worked: transfusion-linked HIV transmission in formal systems dropped from nearly 10% of infections to under 1%. According to NACO’s 2024 report, there are now 2.5 million Indians living with HIV.“While progress has been made, a blood market exists,” says Dr Sanghamitra Ghosh of the Indian Public Health Association. Informal networks, untrained staff and patchy supervision create unsafe pockets, especially in states with limited resources.Thalassaemics are the most vulnerable as they require regular transfusions. India has one of the world’s largest burdens of thalassaemia: of the 12,000 such patients born each year, nearly half don’t reach adulthood.A 2011-2018 study of 1,087 patients across five Indian centres found mortality up to seven times higher in children under five, with transfusion-transmitted infections significantly increasing risk.Tech debate: ELISA Vs NAATGlobally, NAAT is a gold-standard test because it detects viruses during the earliest phase of infection. It is, however, expensive and requires trained personnel. ELISA is mandated in India; NAAT is optional: “Why is NAAT testing only mandated in certain hospitals in certain states when it should be available to all?” Anusha asks.This safety gap is particularly dangerous in Jharkhand, where tribals constitute over 26% of the population. Experts, as cited in a media report, note that the prevalence of beta-thalassaemia traits is alarmingly high (11%) in these communities because of genetic clustering, historical malaria prevalence, and intra-community marriages, making the need for advanced screening critical.“What we call technology gaps are also governance and capacity gaps,” says Dr Yazdi Italia, Padma Shri awardee and blood-safety advocate. “Machines are only as good as the people running them.”A warning ignoredIn June, TPAG convened transfusion experts, policymakers and patient groups in Delhi for a strategic dialogue on strengthening blood safety. The group released a white paper shared exclusively with TOI, noting that India’s blood-safety system remains “complex and fragmented”, with varied practices across states and institutions.“Despite its proven effectiveness, NAAT is not yet mandatory or uniformly implemented across India, especially in govt-run or rural facilities,” the paper states.Mukherjee calls the tragedy a wake-up call. “This is not merely a medical systems issue. It is about dignity, equity and the right to safe care.” Transfusion-medicine specialist Dr Sangeeta Pathak told the forum that safety isn’t only about screening: “Any lapse in the chain — from improper cold storage to outdated transport protocols — can waste units and endanger lives.”She called for real-time coldchain trackers, digitised inventories, and geo-tagged traceability from donor to recipient.Still alive, a black marketDespite progress, a shadow market persists. In some pockets, up to 30% of blood still comes from paid donors, who often use false identities to bypass screening.“The blood market still exists,” says Dr Ghosh. “Donors must be traced in this case — otherwise, the chain of infection will continue.”Most banks test only for HIV, hepatitis B and C, syphilis, and malaria. Donors aren’t always notified of positive results, enabling repeat donation elsewhere.Atul Gera, called the ‘Blood Man of Jharkhand’, told a media outlet that the only guaranteed way to prevent such incidents is to stop the acceptance of “replacement blood” (where a patient’s family must provide a donor) and mandate reliance solely on voluntary blood donation.A hub-and-spoke fixExperts argue that universal NAAT is unrealistic for every small centre. Instead, they recommend a hub-andspoke model: centralised high-tech hubs that perform advanced screening, with peripheral centres handling storage and distribution. Countries like Canada and the UK already follow this model. “It removes dependence on local equipment or staffing,” says Dr Italia.Why it mattersIndia has the science, infrastructure and experience to build a safe transfusion system. What it needs, experts say, is political will and urgency. “We owe the kids in Jharkhand — and every citizen — a system where every drop of blood is safe,” Dr Gilada says.Inputs from Shailvee Sharda & Intishab Ali Go to Source