The WHO strategy for prevention and control of snakebite envenoming: a sub-Saharan Africa plan

Abstract

Snakebite is a critical public health issue in tropical countries, particularly in Africa, where 20% of snakebites globally occur. In 2017, the WHO added snakebite envenoming to the category A of neglected tropical diseases. In 2019, thanks to broad institutional and international NGO support, including strong mobilization of African experts and governments, WHO launched a strategy for prevention and control of snakebite envenoming with more ambitious goals. In sub-Saharan Africa, accessibility of antivenoms and symptomatic, adjuvant or replacement therapy is a priority. Several antivenoms are available but their evaluation has not been properly carried out and they remain expensive. To date, there are no manufacturers of antivenom in sub-Saharan Africa (except in South Africa), which requires their importation from other continents. The lack of experience in antivenom choice and its use by health authorities, health personnel and population largely explains the shortage in sub-Saharan Africa. The deficiency of epidemiological data does not allow the implementation of appropriate and efficient care. It is crucial to strengthen the health system which does not have the necessary means for emergency management in general and envenoming in particular. Providing peripheral health centers with antivenoms would decrease complications and deaths. The motivation of communities at risk, identified through the epidemiological data, would be to reduce the delay in consultation that is detrimental to the efficiency of treatment. Partnerships need to be coordinated to optimize resources from international institutions, particularly African ones, and share the burden of treatment costs among all stakeholders. We propose here a project of progressive implementation of antivenom manufacturing in sub-Saharan Africa. The various steps, from the supply of appropriate venoms to the production of purified specific antibodies and vial filling, would be financed by international, regional and local funding promoting technology transfer from current manufacturers compensated by interest on the sale of antivenoms.

Challenges and prospects of snake antivenom supply in sub-Saharan Africa

“…In addition to the financial investments needed for local AV production, there is the technical complexity of establishing and sustaining production locally. Therefore, other pragmatic approaches should be considered, such as implementing a gradual strategy or step-by-step approach as recently suggested by these authors [32]. This may entail an initial development of serpentarium to collect high quality venoms that could be provided to regulatory agencies for quality control and to manufacturers.…”

A brief review on the natural history, venomics and the medical importance of bushmaster (Lachesis) pit viper snakes

“…Snakebites by front-fanged snakes is an occupational disease that cause envenomings to at least 1.8–2.7 million people worldwide per year, with combined upper WHO estimates of mortality ranging from 81,000 to 138,000 deaths, and maims >400,000 people every year ( Chippaux et al, 2019 ; Chippaux, 1998 ; Gutiérrez et al, 2017 ; Williams et al, 2019 ). The only scientific validated treatment of snakebite envenoming is the timely administration of an effective antivenoms ( Gutiérrez, 2014 ; Gutiérrez et al, 2011a , 2011b ).…”

A painful journey to antivenom: The therapeutic itinerary of snakebite patients in the Brazilian Amazon (The QUALISnake Study)

“…Despite technological improvements in the manufacture of antivenoms, several bottlenecks still exist in access to these immunobiologicals in poor regions in Africa [6][7][8], Asia [9] and Latin America [10,11]. In Brazil, antivenom availability and accessibility is not uniform to the most vulnerable parts of the populations, i.e., populations that inhabit the remote areas of the Brazilian Amazon region.…”