Critical shortage of snake antivenom in South Africa

Medical and trauma practitioners have called for the intervention of health minister Dr Joe Phaahla to alleviate a critical shortage of antivenom in South Africa.

An open letter has been signed by 27 experts in snakebite treatment, including medical and trauma practitioners as well as anti-venom and snake handling experts.

“Antivenom is a critical life-saving treatment in patients bitten by venomous snakes and has excellent outcomes when used timeously and correctly,” says trauma surgeon Prof Timothy Hardcastle, who is a member of the National Snakebite Advisory Group (NSAG) and the Trauma Society of South Africa.

NSAG offers a free national advisory support service to medical personnel, clinicians and centres in the public and private sectors who may need to treat snakebite victims.

“Our greatest concern and challenge is the unreliable production of the South African Vaccine Producers’ [SAVP] products due to management, staffing constraints, animal welfare, unreliable generator capacity, machine breakdowns and refrigeration issues,” Hardcastle said.

“There has been a promise of product since December 2022. However, more than four months have passed and now extremely limited numbers of polyvalent vials are left in the South African Vaccine Producers stores, while a large backlog of orders have yet to be filled.

“Certain public and private hospitals — many of which are situated in high snakebite areas — have already run out of stock, while others have preciously little antivenom on hand.

“There is also a shortage of antivenom among veterinarians, who are now unable to acquire antivenom. There is no sign that these will be replenished any time soon.

“Patient medical management, hospital length of stay, morbidity and mortality are all adversely affected without early and appropriate administration of antivenom. The inability and lack of expected delivery of antivenom pose a major health risk.”

Hardcastle said the main source of reliable cost-effective antivenom against the common major venomous snakes in South Africa and other parts of the continent is the SAVP group of products, namely the 10-snake polyvalent, the Echis monovalent and the Boomslang monovalent antivenoms.

“Unfortunately there is no suitable alternative product approved for use in South Africa.”

The advisory group's appeal is for the health minister's intervention for funding and approving emergency upgrades to allow improved functionality at the Johannesburg-based SAVP production plant.

The signatories have also implored Phaahla to ensure procurement processes are effectively and compliantly performed so appropriate equipment, back-up generators, reagents and other essential production items can be procured to improve production that will ensure a sufficient volume of antivenom to restock the country.

An investigation into the possible outsourcing of production to recently built drug production operations established in other parts of the country, as a longer-term solution, was also mooted. In addition, the potential identification of alternative products covering South African snakes could be tested to provide another option until the shortage is resolved.

Hardcastle advised the public to be careful when in the natural environment and to take the necessary precautionary measures.

The African Snakebite Institute offers a free information app from its website.

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