Revisiting Convalescent Plasma – Again: Ethical Stewardship of Immunology’s “Holy Grail”

Convalescent plasma was one of the first investigational treatments available for COVID-19 during the darkest days of the pandemic when few alternatives were available. The premise is thus: blood plasma rich in antibodies donated by people recovering from COVID-19 is transfused into recently infected people to help the latter fight off an active infection. Theoretically, this approach provides a cheap, accessible, and up-to-date treatment for emerging infectious diseases anywhere in the world. Yet, convalescent plasma, or serotherapy more broadly, is nothing new; clinicians advocated for its use since at least 1890 when it was tested for diphtheria and tetanus, followed by measles, the 1918 flu, two Ebola epidemics, swine flu, SARS, and, recently, COVID-19, to name a few. Following each outbreak, convalescent plasma generated political drama and ‘mixed evidence’ before again becoming the subject of pandemic amnesia. COVID-19 offers an opportunity to reflect on a longstanding ethical debate about physician autonomy in pandemic medicine. This panel, moderated by an ethicist-implementation scientist, brings together four voices in patient advocacy, immunology, clinical medicine, and drug development to explore what ethical stewardship of convalescent plasma would look like given its lack of a traditional corporate sponsor, and what this practically and symbolically means for medical regulation. The panel will discuss market (dis)incentives for developing government-sponsored medical technologies like convalescent plasma and weigh the pros and cons of standardizing and commercializing convalescent plasma (drawing links to recently FDA-approved fecal transplant therapy) to debate who or what is responsible for the future of convalescent plasma.