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SNAKEBITE-KENYA-AFRICA-ANTIVENOM,FACTS
The battle to bring antivenoms to Africa
WATAMU, Kenya, March 19, 2019 (BSS/AFP) – Snake antivenoms have been
around for 125 years, are effective and can be produced cheaply at scale. Yet
Africa, with its abundance of deadly snakes, has an alarming shortage of the
life-saving medicine.
Experts and campaigners blame a combination of weak production capacity,
feeble policy and oversight, high prices and a general lack of concern for
the plight of people in poor, remote areas of the world.
– Complex process –
The method of antivenom production has changed very little since it was
first developed by French immunologist Albert Calmette in the late 19th
century. It remains a painstaking, time-consuming process, although
researchers are working to develop synthetic alternatives.
First, a technician has to milk a snake’s venom in a dangerous manoeuvre
that sees it holding the animal’s head still while it bites a cup covered in
plastic film, releasing its poison — a small amount each time — into the
container.
Small venom doses are then injected into a large domestic animal,
usually a horse, to trigger an immune response and the production of toxin-
attacking antibodies.
After several doses over a period of about a year, the horse produces so
many antibodies that it becomes immune to the venom, at which point blood can
be taken from the animal.
In a lab, antibodies are then separated from the blood, to be given to
snakebite victims — who may need several doses.
An antivenom usually works only for a specific species, or small group
of species of snake.
A key challenge, especially in poor, remote areas of the world where
most snakebites occur, is that most antivenoms need to be refrigerated.
– A ‘shameful failure’ –
Already patchy, availability of antivenoms in Africa was thrown into
disarray when French laboratory SANOFI stopped production in 2014 of its FAV-
Afrique drug, which was effective against a number of species, including some
of the most dangerous on the continent.
The last available doses expired mid-2016.
SANOFI was moved mainly by financial considerations. The prohibitive
price of a single dose — more than $100 — rendered sales in Africa
unprofitable.
The failure to use antivenom “to save tens of millions of lives… is a
shameful failure. Nowhere in the world is this more confronting than in
Africa,” says the Global Snakebite Initiative, adding in a report on its
website that the “collapse of the snake antivenom market in Africa” was a
“medical tragedy”.
The cause is multifold.
In a vicious circle, unaffordability leads to lower demand and falling
sales, which result in reduced production, higher costs, and raised prices
for consumers.
Even an antivenom produced on the continent and effective against
multiple snake species, is nigh impossible to find further north than South
Africa, where it is made, a 2018 study by the Liverpool School of Tropical
Medicine found.
“The market remains volatile because they are small producers and the
African antivenom market is limited,” said Julien Potet, an expert in
neglected tropical diseases with aid group Doctors Without Borders.
Inconsistent quality standards and lacking oversight have also seen an
infiltration of counterfeit and “inappropriate” antivenoms developed for
different snake types in other countries. Using the wrong antivenom can be
dangerous, even deadly.
Doctors Without Borders, which describes Africa’s antivenom shortage as
a public health crisis, has launched its own survey of available antivenoms.
Most were brought to the market “without any clinical information,
without any data on their efficacy or safety in humans,” said Potet.
A further problem: even if antivenoms were available, people most likely
to be bitten by a venomous snake live prohibitively far from a clinic or
hospital, some of which have no refrigeration capacity, and with medical
staff that have never been trained in treating snakebites.
– Half a million bites –
“We are losing around 1,000 people in Kenya each year from snakebites,”
said Royjan Taylor, director of the Bio-Ken snake farm and research centre on
the country’s east coast.
This is out of 81,000-138,000 worldwide.
Africa alone sees about half a million snakebites that need treatment
every year, according to the World Health Organization (WHO).
“Governments and the international community therefore should really
pick that up… What I would like to see over the next five to 10 years,
maybe even 15 years, is for an antivenom to be produced for each area of the
world that has a problem and that antivenom should be provided to those
people free of charge,” Royjan said.
The WHO has launched a massive review of the availability, efficacy and
safety of snakebite serum available in Africa, where the majority of
countries have no effective or affordable antivenom at all.
BSS/AFP/IJ/1748 hrs