Snakebites will kill as many as 100,000 people around the world this year, but a looming shortage of a popular anti-venom treatment has sparked concern about the potential for an increase in victims in the coming years.
The anti-venom Fav-Afrique, which is popular across Sub-Saharan Africa, was manufactured by French pharmaceutical company Sanofi, but when the company ceased production at the end of 2014 only a limited stockpile of the treatment remained. Those reserves will reportedly dry up by next June, leaving even more people at risk of death or paralysis due to untreated snakebites, according to a statement on Monday from the international medical charity Médecins Sans Frontières/Doctors Without Borders (MSF).
With no suitable replacement expected until 2018, MSF's snakebite medical advisor Dr. Gabriel Alcoba highlighted the importance of sufficient treatment.
"We are now facing a real crisis, so why do governments, pharmaceutical companies, and global health bodies walk away when we need them most?" Alcoba said. "Imagine how frightening it must be to be bitten by a snake — to feel the pain and venom spread through your body — knowing it may kill you and there is no treatment available or that you can't afford to pay for it."
A majority of the world's snakebites occur in Asia and Sub-Saharan Africa, which records around 30,000 deaths a year. India records the most snakebites annually of any other country with 11,000 mortalities.
In addition to the tens of thousands of deaths from snakebites that likely occur annually, anywhere from 400,000 to 1.8 million are left with detectable amounts of venom and require anti-venom, an effect known as an envenoming. Envenoming can leave victims disabled or disfigured if not treated properly.
Snakes are one of the world's deadliest animals, and according to pharmacologist Zoltan Takacs, what makes the impact of snakebites alarming is that there is no question of how to treat it.
'It's a neglected disease, it's a disease from the poor. It just doesn't really pay off to make anti-venom'
"Snakes are one of the deadliest group of animals… yet we have the perfect knowledge and the technology how to make anti-venom," Takacs said.
The only way to combat envenoming is to create a treatment by extracting venom from a specific poisonous snake and injecting that substance into a horse. After the horse has an immune reaction to the venom, you extract the blood and put it through a process to make it injectable, thus turning it into an anti-venom.
This treatment can consist of venom from different snakes, in order to combat the bites from multiple species in one anti-venom, but the strength against one specific snake is reduced for every additional species that is included.
As Takacs explained, the most effective anti-venom would not only target a specific species, but it would also target a geographical range. For example, it would not be enough to make an anti-venom against the Russell's viper, a major cause of snake bite envenoming in Asia, instead it would require an effective anti-venom for the different geographical regions within the range of this viper species.
"I hear endless complaints from physicians in tropical hospitals treating snake bites that the anti-venom at hand, if they have one, it is not working or they need to inject way too many vials to get results," Takacs said.
Despite this longstanding knowledge of how to treat a snakebite, the Fav-Afrique anti-venom shortage is still looming and the World Health Organization continues to categorize snakebites as a neglected disease.
Experts like Takacs point to the economics of the pharmaceutical industry and inefficiency of health care systems as main factors behind the lack of available anti-venoms. With the market for anti-venoms relatively small, and the effected countries and populations poor, the financial incentive — perceived or real — isn't high for a company to invest in its production, Takacs explained.
"It's a neglected disease, it's a disease from the poor. It just doesn't really pay off to make anti-venom," Takacs explained. "At the end of the day it really comes down to money and sound management. Science [and the] drug industry have the technology, [they have] the know-how to make excellent anti-venoms."
"We have planes, cars, boats that could distribute them anywhere on the planet. Yet there is a chronic shortage or lack of anti-venom," he added.
The economics on the supply side are also a problem. The cost of the treatment ranges from US$200-$500, according to MSF. Herpetologist Johan Marais used the case of Swaziland as an example. Anti-venom is virtually non-existent and children are a common victim in the small African kingdom. In some cases, those who survive experience severe health complications that requires hospital treatment and even amputation — problems that could have likely been prevented if an anti-venom was administered.
Marais estimated it would cost $100,000 annually to fund a sufficient supply for Swaziland. "It's pure economics," he said of efforts to combat snakebites.
In addition to the cost, Marais highlighted the general lack of availability for anti-venom across Sub-Saharan Africa, and potential problems with doctors being trained to administer the treatment. Additionally, as MSF pointed out this week, most people who are at risk for being bitten by a snake live in rural areas that can be far away from healthcare facilities equipped with anti-venom. And again, even if they reach a hospital, the cost of the treatment is hundreds of dollars, an amount that can equal years' worth of wages.
Unlike other common diseases, like malaria or HIV, where death rates are much higher, what makes the continued prevalence of snakebites concerning is that the tools exist to stem the problem. As Takacs explained, the scientific community fully understands how to implement treatment that can lead to a full recovery.
"In snake bites, overall, you know exactly what is the problem, you know exactly how to treat it, you know exactly how to make an anti-venom," he reiterated. "It's unfortunate on us, the human species, that we can't just put all of this together to ensure the availability of effective and affordable anti-venom so people in need do not have to die or face permanent disability."