30 March 2022: Snape - A
Day Two of Dr Snape, today appearing in a jacket, waistcoat, shirt and tie ensemble that celebrates the many shades of beige-brown (an older gentleman's fashionably safe option).
We're straight into the issue of recognising the infection hazards of UK blood products, as opposed to the correctly negative assumptions about commercial stuff. Good old Prof Zuckerman gets a useful name check. By the way, Dr Snape confirmed the virtual impossibility of any blood being completely safe. Again, Sir Brian intervened to claim responsibility for assessing the state of knowledge at the time rather than relying exclusively on the opinion of a witness.
The witness confirmed how fractionators were in general, and earlier, more concerned about non-A-non-B Hepatitis than haematologists. This was due to their awareness of the possibility of legal liability. The nomenclature of "fractionators" sounds like a cartoon army who would not be out of place alongside the Mighty Morphin Power Rangers on CBBC.
"Batch size" determines efficiency rather than using the term "pool size". Sir Brian sought a definition of "efficiency" and in response it was related to the proportion of the product in X number of donations in the original pool that can be recovered into vials available to the end user patient.
Pool sizes were committee decisions, certainly from 1982. Prior to this it was a smaller group in BPL meetings led by Richard Lane. There was no patient consultation (possibly apart from an annual Hepatitis Working Party liaison meeting). A 1986 letter advised DHSS of the proposal/decision to go from pool sizes of 10,000 to 25,000. It was only advisory and wasn't seeking approval. Dr Lane seems to have had ultimate decision-making authority, but the way Dr Snape describes it, it was not very definite as a management process.
When asked about unknown viruses, as a scientist, it is interesting to note how Dr Snape refers to non-A-non-B Hepatitis as an unknown virus. Yet he says they were "aware" of it. This distinction may be another example of the lingo within the scientific community he inhabited, which might be different from the every day language "normal" people use.
For illustration, between 1967 to 1975, pool sizes for FVIII were between 50 to 100 litres (250 to 500 donations). Then Sir Brian linked back to a reference from yesterday to the Blomback method using 70 litres. Regardless of the significance of the possible anomaly, the power of Sir Brian's penchant for detail is comforting to witness.
The measure of five donations to one litre of plasma was more an average "rule of thumb", but each batch was different, and this became a more loose approximation when plasmapherisis came into play.
Before a test for non-A-non-B was available, Dr Snape said the only way to try to control infection was to seek to exclude certain types of donors. But, surely having a cleaner production facility would also make a difference too. The Building 25 layout was fundamentally not fit for purpose from a design perspective. Improving it would have forced a period of "down time", which by mentioning it would have been too problematic.
Before the morning break, Sir Brian jumped in quite enthusiastically with his own very specific and detailed questions for Dr Snape. These were questions of checking and clarifying consistency of the evidence, particularly when the mathematics don't add up. Dr Snape recognised the inconsistency and could not explain it. Sir Brian offers an explanation, but it forces the witness to identify a certain quoted number simply as being wrong. Another numerical anomaly is highlighted from the Chair. The furrowing of the brow of the witness is a new look, and not really a good one, for him. Dr Snape is stumped. The numbers just don't fit together with the dates and the previously cited memos. For the first time the witness is heard to say out loud "Thank you" at the announcement of the break.
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