Why isn’t good quality antivenom getting to the people who need it?

The neglect of snake bites as a public health crisis has created what experts call a "wild west" of antivenom production, where unregulated practices and questionable products have flourished. The problem goes far beyond simply making and distributing medicine – it’s a combination of market failure, local mismanagement, and global systemic neglect.

Sub-Saharan Africa has access to just 2.5% of the snake antivenom treatments it needs. This goes some way to explain why an estimated 20,000 people die from snake bites there each year.

Why are there shortages of antivenom?

In the 1990s, Behringwerke, a German pharmaceutical company, stopped making its popular antivenom. A few years later, it was clear that sub-Saharan Africa was experiencing a shortage of reasonably priced and efficient antivenom.

Then in 2016, the French company Sanofi Pasteur stopped making one of Africa’s most trusted antivenoms, FavAfrique. Another company, South African Vaccine Producers, raised prices beyond what most healthcare systems could afford and became increasingly difficult to find.

Indian manufacturers moved to fill the gaps others left behind, offering products much cheaper than FavAfrique. There were deadly consequences.

In Ghana, fatality rates jumped. The death rate went from less than 2% to more than 10% in 2004 after hospitals switched to a cheaper antivenom.

In 2023, Kenya's medical authorities were forced to recall ineffective antivenom imported from India, leaving hospitals scrambling for alternatives. When the Bureau of Investigative Journalism tested Indian antivenoms, most were ineffective for African snakes, although one performed relatively well.

Why have governments bought ineffective antivenoms?

Weak regulation has played a role. Some countries lack the ability to properly assess the quality and appropriateness of antivenoms. This has let poor-quality products enter the market, and doctors, health managers and patients have all lost confidence in some of the medicines available to them.

Sub-Saharan Africa has come to depend on antivenoms manufactured in other parts of the world, most of which are marketed with no evidence of their safety or effectiveness.

Other antivenoms have dramatically increased in price in the past 20 years, making treatment unaffordable for the majority of those who need it in sub-Saharan Africa.

What is the World Health Organization doing about snake bites?

Concerns about shortages forced the World Health Organization (WHO) to step in 2015. It launched its first assessment programme for antivenom manufacturers and two years later declared snake bites as the highest priority neglected tropical disease.

Today, only three antivenom products have received WHO approval as safe and effective for sub-Saharan Africa:

• PANAF-Premium, made by Premium Serums and Vaccines in India
• EchiTAbG, produced by MicroPharm in Britain
• Antivipmyn Africa, manufactured by Laboratorios Silanes in Mexico

EchiTAbG specifically treats bites from the carpet viper, found in about 20 countries across sub-Saharan Africa. The WHO has deemed it the deadliest snake in the world for sheer number of people killed.

Ten other products are under assessment. But despite not being fully approved, they are marketed and sold in the region.

The WHO pledged to halve deaths and disabilities from snake bites by 2030, but some experts fear there isn’t enough funding to meet that goal.

The Wellcome Trust’s £80m commitment, which runs out next year, was meant to catalyze broader support. But no other major donors have stepped in, and a BMJ analysis showed that 90% of this funding is going to institutions in wealthy countries. No institution in the WHO African region received any of the money.

Are any antivenoms made in sub-Saharan Africa?

The only country in sub-Saharan Africa that currently produces antivenom is South Africa.

However, there are projects making antivenoms specifically from the venom of local snakes, which is an important factor in ensuring the medicine is effective.

One success story comes from Eswatini. There, a local organisation, the Eswatini Antivenom Foundation, has partnered with Costa Rica’s Instituto Clodomiro Picado to produce treatments using venom from snakes they catch and milk themselves.

In October 2023, Atlantic Lifesciences, a Ghanaian company, and Vins Bioproducts, an Indian business, signed a memorandum of understanding to produce antivenom locally.

A similar initiative was agreed in August last year between AMA Medical Manufacturing Company, Echitab Study Group from Nigeria, and Micropharm from the UK to produce Anti-Snake Venom (ASV) drugs in Nigeria.