Access to antivenoms in the developing world: A multidisciplinary analysis

Abstract

Access to safe, effective, quality-assured antivenom products that are tailored to endemic venomous snake species is a crucial component of recent coordinated efforts to reduce the global burden of snakebite envenoming. Multiple access barriers may affect the journey of antivenoms from manufacturers to the bedsides of patients. Our review describes the antivenom ecosystem at different levels and identifies solutions to overcome these challenges. At the global level, there is insufficient manufacturing output to meet clinical needs, notably for antivenoms intended for use in regions with a scarcity of producers. At national level, variable funding and deficient regulation of certain antivenom markets can lead to the procurement of substandard antivenom. This is particularly true when producers fail to seek registration of their products in the countries where they should be used, or where weak assessment frameworks allow registration without local clinical evaluation. Out-of-pocket expenses by snakebite victims are often the main source of financing antivenoms, which results in the underuse or under-dosing of antivenoms, and a preference for low-cost products regardless of efficacy. In resource-constrained rural areas, where the majority of victims are bitten, supply of antivenom in peripheral health facilities is often unreliable. Misconceptions about treatment of snakebite envenoming are common, further reducing demand for antivenom and exacerbating delays in reaching facilities equipped for antivenom use. Multifaceted interventions are needed to improve antivenom access in resource-limited settings. Particular attention should be paid to the comprehensive list of actions proposed within the WHO Strategy for Prevention and Control of Snakebite Envenoming.

Situation of snakebite, antivenom market and access to antivenoms in ASEAN countries

“…Moreover, the exact effective dose of antivenoms is hard to determine due to several challenges, including variability in the amount of venom injected when snakes bite humans, and lack of clinical evidence of effective dose and safety of antivenoms. Thereby, the recommended doses of antivenom are mostly based on preclinical studies of neutralisation and are considered as initial or starting doses where subsequent doses might be needed based on clinical responses of victims 32 33…”

Two snakebite antivenoms have potential to reduce Eswatini’s dependency upon a single, increasingly unavailable product: Results of preclinical efficacy testing

“…The dependency of a country or region on a single antivenom product poses a high risk to the security of antivenom supply and consequent risk to victims of snake envenoming [ 26 ]. There are numerous causes of such fragile antivenom markets, including manufacturing issues (inefficient and expensive production methods resulting in low production volumes [ 27 ]); logistical, technical and financial issues in procurement by, and distribution to, the communities that need the products; and low end-user product confidence [ 27 ].…”

Snakebite envenoming in humanitarian crises and migration: A scoping review and the Médecins Sans Frontières experience

“…Regarding snakebite and humanitarian crisis in Africa, the National Geographic showed one more example of a snakebite envenoming occurring in Mbandaka, D.R.Congo, in an isolated area, affected by the Ebola humanitarian crisis, other epidemics, and chronic access issues ( Nicolon, 2020 ). In areas affected by humanitarian crises (conflicts, epidemics, natural disasters), timely access to antivenom seems even more complex due to the disruption of supply, of logistic chains, and of health priorities ( Potet et al, 2021 ), whereas the risk could be increased in these situations.…”