The tragedy of 1,200 haemophiliacs infected with HIV from contaminated Factor VIII used in the early 1980s, and around 3000 - out of a total of 5,000 haemophiliacs in the UK - infected with Hepatitis C to date, has failed to move either the Department of Health, which has rejected central funding for the genetically-engineered recombinant version, or the majority of health authorities.
Doctors are largely unaminous in their view that recombinant Factor VIII, is preferable on clinical grounds to plasma-derived Factor VIII, made from treated human blood, for all haemophiliacs but especially for children.
The UK Haemophilac Centre Directors' Organisation will this week publish guidelines recommending that the recombinant form should be used for everybody, pointing out that it is cheaper here than in the the rest of Europe.
The UK's use of recombinant is between 4-10 per cent of all Factor VIII given, compared with 50 per cent in Germany.
However, recombinant Factor VIII costs 52p per unit compared with 20- 28p per unit for plasma-derived product, and if a health authority refuses to pay for it, then a doctor has little choice but to prescribe the less safe product. Two viruses, Hepatitis A and parvo-virus, are resistant to all sterilisation techniques in use, and there is also the danger posed by viruses yet to be identified.
Following inquiries by The Independent this week, the Royal Free Hospital in London announced that all haemophiliac children in its care will now receive the recombinant form because it is the "preferred method of treatment" and that health authorities would be expected to "co-operate".
But Dr Paul Giangrande, director of the Oxford Haemophilia Centre, the largest in the country, says that the situation nationally is serious for both haemophiliac adults and children.
Dr Giangrande has managed to persuade health authorities to pay for recombinant Factor VIII for all boys under 10 in his care since April 1995, except for one.
Swindon Health Authority is reluctant to fund it, he said, and so plasma- derived product is administered to a child in its care instead.
Graham Barker, director of services at the Haemophilia Society, said that health ministers had so far ignored medical advice and pressure from the Society to make recombinant Factor VIII universally available to haemophiliacs. He said the decision to add VAT to the recombinant product was deplorable.
A spokesman for the Department said last night that it was a matter for purchasers and providers to come to an agreement on how to treat patients.
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