Governments step up the snakebite battle

GENEVA — Health experts and campaigners working to help save some of the 100,000 people killed each year by snakebite are celebrating, after a World Health Organization resolution saw 194 countries affirm the need to boost access to quality antivenoms and prevention efforts.

A working group from the United Nations health agency is aiming to report by the end of November with recommendations to governments on how to provide higher quality, affordable antivenoms, better training for health care workers, more effective prevention efforts, and more data on the scale of the problem.

An estimated 2.7 million people are bitten by venomous snakes each year. In addition to those killed, around 400,000 people are left permanently disabled. Disadvantaged countries suffer the most, with 16 low- and middle-income countries in West Africa seeing at least 3,500 to 5,350 deaths annually.

“In relation to the size of the problem, there hasn’t been the amount of investment needed to develop solutions that would change the landscape,” David Williams, chair of the WHO Working Group on Snakebite Envenoming, told Devex.

Elayne Whyte Gómez, U.N. ambassador for Costa Rica, one of the countries championing the resolution, told Devex that a “market failure” meant that “antivenoms are not something which is attractive to industry — so it is public institutions that are right now generating the product.”

In some cases, treatment can require multiple doses of the antivenom, with costs running into hundreds of dollars, according to Médecins Sans Frontières. As a result, the NGO said, people often cut their treatment short, visit traditional healers, or seek cheaper substandard products. Williams praised the approach of governments in Burkina Faso, which subsidizes part of the cost of antivenoms, and Papua New Guinea, which pays the entire amount.

Poor regulation on potency and dosage, combined with weak health systems, has also seen the spread of poor quality antivenoms.

“One of the consequences of these fragile systems is that inferior products have become pervasive, particularly in sub-Saharan Africa and Asia, forcing competitors in well-regulated environments to abandon production,” according to WHO. However, with better technical support and regulation, Williams said: “I think we can lift the quality of antivenom products in a relatively short period of time”

Another way forward, Whyte suggested, was “cooperation agreements between countries that do and don’t produce antivenoms.” Costa Rica has shared its experience in starting its own production with countries in Africa and the Pacific, as well as Sri Lanka, she said.

The decision to put snakebite on the agenda of the World Health Assembly in Geneva, Switzerland, last week drew titters of laughter among other health professionals at the event. The resolution affirmed that snakebite “has to-date been largely overlooked by the global health community even though it can induce catastrophic health expenditure and exacerbate poverty.” Passionate scientists were the driving force in bringing the issue to countries’ attention, Whyte said, and last year WHO put snakebite envenoming on the list of neglected tropical diseases.

Williams said about $6 million was needed in 2018-2019 to prepare the recommendations, improve surveillance, deliver antivenoms, and address other technical and medical challenges. The funding arrangements for the next decade are still under discussion. A private corporate foundation that wished to remain anonymous has contributed $500,000, Williams said, adding that the group wants to see this amount matched by other donors.

One of the challenges is that different species require different antivenoms, Julien Potet, a neglected tropical diseases adviser at MSF, told Devex.

There is not yet a universal antivenom targeting common enzymes and toxins between different species, but Potet said work is underway and “it’s not so much of a dream now.” Still, Williams estimated a universal antivenom is more than a decade away.

Williams told Devex a public consultation will be held in late August and September, with a stakeholder meeting planned in Geneva in November to present the recommendations to development partners.