A Forgotten Tropical ‘Disease’

ADDRESSING A THERAPEUTIC “BLACK HOLE”: THE WORLDWIDE CRISIS IN ANTIVENOM SUPPLY AND MEDICAL TRAINING FOR SNAKEBITE TREATMENT

The burden of human suffering caused by snake bites has been greatly underestimated, ignored and neglected for far too long. Snake bites, common in rural areas of many tropical developing countries, mainly affect children or agricultural workers who lack the political voice adequately to protest their needs.

THE ESSENTIAL DRUGS: ANTIVENOMS

Snake bites are readily curable with well proven remedies – antivenoms, provided that these essential drugs are efficiently distributed to where they are most needed and medical staff are trained to use them appropriately. Especially in sub-Saharan Africa and in New Guinea, deficiencies in the quality, quantity, specificity, distribution and application of antivenoms are responsible for the unnecessary deaths or permanent mutilation of tens of thousands of people each year.

THE COMMERCIAL IMPERATIVE: UNSCRUPULOUS DISTRIBUTION OF INEFFECTIVE ANTIVENOMS AND POOR REGULATORY POLICIES

Into the therapeutic void created by chronically inadequate supply, ineffective non-specific antivenoms have been introduced by unscrupulous manufacturers, marketeers, entrepreneurs and “middle-man” distributors. In many countries, this problem is closely linked to a lack of regulations for the control of the efficacy and safety of available antivenoms.

ANTIVENOMS: FORGOTTEN AND ABANDONED THERAPEUTIC AGENTS

Over the last 100 years, standards of design, manufacture, quality control and clinical testing of antivenoms have fallen well below those demanded for all other therapeutic agents. New thought and new action must be stimulated by the clinical, scientific and business communities to deal with this neglected contemporary public health crisis.

The best modern techniques for antivenom manufacture are in the public domain and can, therefore, be transferred from one country to another in order to increase local production of effective and safe antivenoms. However, this demands an international collaborative effort involving a number of different partners.

SOLVING THE CRISIS

Expert advice and encouragement must be offered to national health authorities, regulatory agencies, antivenom producers and medical personnel to improve every aspect of the treatment of snake bite.

  • Antivenom manufacturers must be helped in practical ways to improve the safety and efficacy of their products. This demands the design and implementation of long term technology transfer programmes involving both North-South and South-South partnerships.
  • National health authorities must be helped to select and purchase antivenoms appropriate to their national needs.
  • Adequate policies for antivenom distribution must be developed in each country and region in order to provide antivenoms where they are most needed.
  • Medical personnel must be trained in the modern management of snake bites and, most crucially, in the selective use of antivenoms.
  • Communities must be informed and educated about snake bite risks and offered realistic solutions that ameliorate the hazards and empower the people themselves to help manage the problem in practical and sustainable ways.
  • Research directed at improving the available methods of first aid, primary clinical care and patient rehabilitation must be accorded priority and funded at national, regional and global levels.
  • Surveillance and reporting systems that enable collation of reliable epidemiological and clinical data need to be developed, tested and implemented, and the data used to support rational resource allocation and distribution, and appropriate prioritization of snake bite as a neglected tropical disease at all levels.

We call on the international community to to join the Global Snakebite Initiative, an endeavour devoted solely to coordinating a strategically focused and multi-disciplinary solution to this important public health crisis.

Professor David A Warrell
Nuffield Department of Clinical Medicine,
University of Oxford,
John Radcliffe Hospital, Headington,
Oxford OX3 9DU, UK
Professor José María Gutiérrez
Facultad de Microbiologia, Instituto Clodomiro Picado,
Universidad de Costa Rica
San José, Costa Rica