Trends, core barriers and systematic governance countermeasures of voluntary blood donation decline in the post-COVID-19 era: a mixed-methods longitudinal study in Jiangsu Province, China (2019–2025)

Every day, hospitals rely on a quiet, invisible lifeline: the blood donated by ordinary people. This voluntary act is not just a medical procedure; it is the foundation of public health safety, ensuring that trauma victims, cancer patients, and those undergoing surgery receive the care they need. For decades, this system has functioned on a simple premise: when people feel safe and connected, they give. However, the global landscape shifted dramatically with the arrival of the COVID-19 pandemic. The virus did more than cause illness; it altered how people view their own health, how they manage their time, and how they trust public institutions. In the years following the peak of the pandemic, a troubling pattern emerged in many parts of the world: the flow of donated blood began to dry up. While emergency responses were well-documented during the crisis itself, the long-term story of why people stopped giving, and how to bring them back, remained largely untold.

In the eastern Chinese province of Jiangsu, a team of researchers set out to solve this mystery. They focused on a region that serves as a microcosm for the broader challenges facing blood donation systems globally. By looking at 81 months of data, stretching from January 2019 through September 2025, and by listening directly to the people involved, they sought to understand not just the numbers, but the human reasons behind the decline. Their work reveals a complex picture where fear, fatigue, and ineffective policy implementation have combined to create a crisis that requires more than just a temporary fix.

The researchers began by examining the official records of blood collection and usage in Jiangsu. They tracked the volume of whole blood, which is the standard type of donation, as well as platelets, a component used to stop bleeding. The data told a clear and concerning story. Before the pandemic, in 2019, the province collected an average of about 12,353 units of whole blood per month. During the initial lockdowns in 2020, this number dipped slightly, as expected. Then, in 2021, a surge occurred, reaching a peak of 14,551 units per month, driven by a wave of patriotic enthusiasm and a return to normalcy. But this high point was short-lived. Starting in 2023, as the world moved into the post-pandemic era, the numbers began a steady and sharp decline. By 2025, the monthly average had dropped to 10,306 units. This represents a decrease of nearly 30 percent from the 2021 peak.

While whole blood collection fell, the story for platelets was different. The collection of platelets showed a steady, uninterrupted growth. It rose from about 2,375 units a month in 2019 to 3,124 units in 2025. This divergence is significant. It suggests that the decline is not due to a general lack of willingness to help, but rather specific barriers that affect the traditional whole-blood donation process. The demand for red blood cells, which are made from whole blood, has fallen in lockstep with the drop in donations, creating a rigid gap between what is needed and what is available. In contrast, the supply and demand for platelets remain tightly matched, indicating that when the process is convenient and perceived as safe, people will still give.

To understand why the numbers for whole blood dropped so significantly, the researchers moved beyond the spreadsheets. They conducted in-depth interviews with 82 individuals, representing four distinct groups: people who had donated blood before the pandemic but stopped, young people who had never donated, leaders of blood donation teams, and hospital staff who manage blood usage. Through these conversations, four core barriers emerged, each acting as a wall preventing people from returning to the donation chair.

The first barrier is a shift in how people view their own health. After years of living through a global health crisis, many former donors became hyper-aware of their physical condition. A majority of those who stopped donating expressed a fear that their fitness had declined during the pandemic and that giving blood might now pose a risk to their health. They worried about potential adverse reactions, a concern fueled by a lack of clear, reassuring information about safety standards in the post-pandemic world. This cognitive bias turned active participants into cautious observers, waiting on the sidelines rather than stepping forward.

The second barrier is the sheer pressure of daily life. The economic and social shifts following the pandemic have left many people feeling stretched thin. For young people, particularly students and new employees, the primary obstacle is time. The demands of work and study have become so intense that finding an hour to donate feels impossible. For former donors, the pressure is often financial or psychological. Many reported increased workloads, reduced income, or a general sense of social anxiety that makes the act of leaving home for a public service feel like a burden they cannot bear. When survival needs take precedence, the altruistic act of donation is often the first thing to be set aside.

The third barrier lies in the policies designed to encourage giving. The researchers found that the current incentive system is failing to motivate people. Many donors feel that the threshold to receive rewards is set too high, requiring them to donate a massive amount of blood over many years before they see any benefit. Furthermore, the process to claim these rewards is often complicated and bureaucratic, leading to frustration. Even when rewards are available, they are often spiritual in nature, such as certificates or public recognition, whereas people in the post-pandemic era are looking for tangible, material support. The gap between what is offered and what is needed has eroded the sense of value donors feel they receive.

The final barrier is the noise of negative public opinion. In an age of short videos and social media, false information spreads quickly. Many interviewees reported seeing misleading claims that blood donation is harmful to health or that the system is unfair. These narratives, often amplified by algorithms, have created a cloud of doubt that is difficult to dispel. At the same time, positive messages about the importance of donation have struggled to reach the public with the same intensity. The result is an environment where the trust required to donate is constantly under attack.

The study concludes that these four factors do not act in isolation; they reinforce one another. A person who is worried about their health is less likely to donate if they also feel they have no time, see no tangible reward, and hear rumors that the system is unsafe. To reverse this trend, the researchers propose a three-part solution that addresses each of these barriers directly.

First, they suggest a new system of incentives that is graduated and practical. Instead of waiting for a massive cumulative total, donors should receive benefits at smaller milestones, such as after their first donation, then after 1,000 milliliters, and so on. These benefits should be immediate and useful, such as free public transportation, discounts on medical fees for the donor and their family, and subsidies for health insurance. The process to claim these rewards must be simplified, moving away from paper forms to a seamless digital system that works across different regions.

Second, the approach to public communication needs a complete overhaul. Health authorities must actively combat misinformation with rapid, authoritative responses, especially on the platforms where false claims originate. Science education should be delivered in engaging formats, such as short videos and real stories from donors, to rebuild trust. Special efforts should be made to reach young people and former donors, explaining clearly that it is safe to donate now and highlighting the tangible benefits available to them.

Finally, the entire system needs a stronger legal foundation. Laws should be updated to clearly define the rights of donors and the responsibilities of hospitals and blood centers. This includes guaranteeing that donors receive free medical care if they experience any adverse reactions and ensuring that the distribution of blood is transparent and fair. By codifying these protections, the system can restore the confidence that is essential for a voluntary donation program to thrive.

The decline in blood donation is not an inevitable consequence of the pandemic; it is a solvable problem rooted in human psychology and systemic design. The data from Jiangsu shows that when the barriers of fear, time, and distrust are removed, the willingness to give returns. The path forward requires a shift from emergency measures to a sustainable, long-term strategy that respects the donor's time, protects their health, and rewards their generosity in ways that matter to their daily lives. By addressing these core issues, it is possible to rebuild the lifeline that keeps communities healthy, ensuring that the blood supply remains secure for generations to come.