Africa makes strides in local snakebite antivenom manufacturing

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Dr. Benno Kreuels, lead for the Snakebite Envenoming Research Group at the Bernhard Nocht Institute for Tropical Medicine in Hamburg, Germany, has explained that although most of the true burden of snakebite envenoming is experienced by low middle-income countries (LMICs), very little data from these areas contribute to the global discussion.

He said the data collected from Africa is not a true reflection of what is happening on the ground.

“Most of the snakebite cases are under-reported. Data collected is largely from hospitals and these hospitals are under-resourced to manage these venomous bites.

“Victims of snakebite envenoming often do not make it to the hospital.  While some would prefer to report to the traditional healers due to lack of antivenoms in their hospitals, others simply stop breathing before they arrive at the hospital,” he explained.

Dr Kreuels, while speaking at a snakebite envenoming webinar, encouraged African researchers to take an interest in snakebite research and publish more on the matter to avoid having their voices drowned out by the majority who are not experts on the subject matter.

The webinar was organized by The Global Health Network – Ghana snakebite community of practice and engaged experts on strategies to address the challenges of snakebite envenoming in Sub-Saharan Africa and globally.

Fangs of Africa

Snakebite envenoming presents a formidable global health challenge. Annually, an estimated 5.4 million cases of snakebite occur, with 1.8 to 2.7 million resulting in envenoming, leading to over 100,000 fatalities and numerous permanent disabilities.

Snakebite envenoming is a potentially life-threatening disease from toxins injected through the bite of venomous snakes. Certain snake species possess the ability to spray venom as a defensive measure, further contributing to envenoming.

Dr. Melvin Agbogbatey, a medical doctor and public health specialist with a peculiar interest in snakebite research explained, “Previous endeavors to mitigate snakebite envenoming have resulted in fragmented and inaccurate epidemiological data due to insufficient efforts.

“Sub-Saharan Africa (SSA) bears a disproportionate burden, home to some of the deadliest snakes and grappling with challenges in accessing antivenom, healthcare infrastructure, and education.

“These factors contribute to higher mortality rates and severe, long-term disabilities, exacerbating socioeconomic disparities.”

The vulnerable populations at heightened risk comprise rural agricultural workers, herders, fishermen, hunters, working children, individuals residing in inadequately constructed dwellings, and those encountering barriers to education and healthcare.

According to the WHO, disease and death disproportionately affect young individuals, with children experiencing high death rates associated with snakebites.

Additionally, women encounter heightened obstacles in accessing medical assistance in certain cultural contexts, rendering pregnant women particularly vulnerable to the impacts of snakebite envenoming.

Innovations against snakebite envenoming

Ms. Valentine Musabyimana, a research fellow at the Kenya Snakebite Research and Intervention Centre, highlights Kenya’s efforts to combat snakebite envenoming through various innovative efforts.

“We participate in a lot of community engagement exercises with locals and health workers. This involves training and educating communities on coexisting with snakes, prevention, control, and snakebite first aid methods using mobile phones.

“We observed that employing the use of motorcycle ambulances has been cost and medically effective for most locals,” Ms. Musabyimana shared.

She went on to show Kenya’s progress in developing local expertise and capacity in anti-snake venom research.

“We are actively involved in developing safer and more effective antivenoms by carefully studying the venom we harvest from snakes common in the sub-region. Our focus is ensuring that treatment is affordable and accessible to all.

“This is why as an institution we are thrilled to collaborate and partner with other organizations involved in snakebite research like the Kumasi Centre for Collaborative Research in Tropical Medicine,” she said.

The Role of Collaboration

Snakebite envenomation, unlike several neglected tropical diseases, cannot be eliminated.

Dr John Amuasi, lead for the Global Health and Infectious Diseases Research Group and Executive Director for the African Research Network for Tropical Diseases explained, “Venomous snakes play crucial roles in complex ecosystems, including naturally controlling agricultural pest populations, such as rats.

“The WHO’s strategy for prevention and control of venomous snakebites focuses on empowering and engaging communities, strengthening health systems, ensuring safe effective treatment, and increased partnerships, coordination and resources,” he added.

Dr Amuasi addressed the long-term health effects and cost of snakebite envenoming.

He said, “Early and appropriate treatment is necessary to reduce mortality and adverse outcomes.

“These require updated comprehensive, and context-appropriate clinical treatment protocols and guidelines.

“Where do we start from? We need to collect the right data in the right way.

“Poor-quality data leads to poor-quality results and invariably poor-quality decisions.”

The 2019 WHO roadmap sets a clear target of halving snakebite deaths and disabilities worldwide by 2030, yet the lack of robust research evidence poses a significant obstacle to achieving this goal.

To tackle this obstacle, the African Snakebite Alliance and Research Hubs were launched in 2023 with support from the Wellcome Trust.

The African Snakebite Alliance endeavors to improve snakebite research by creating strong south-south collaborations and drawing on rigorous efforts from African institutions to understand the true burden of snakebite envenoming.

It also fosters collaborations between the international scientific community and local policymakers and community stakeholders.

This coordinated effort is imperative to ensure the success of achieving the WHO’s targets.

Home-Grown snakebite solutions

Dr John Amuasi and Ms Musabyimana both agree that Africa needs locally manufactured snakebite antivenom which are cheaper, safer, and more productive for the sub-region.

“Some imported antivenoms on the market do not cover the snakes we have here, and the ones that do, may not even be efficacious or safe enough for our people,” Dr Amuasi raised.

Mr. Tripathi Dhananjay, Executive Chairman of Pharmanova Ltd. in Accra, and CEO of Atlantic Lifesciences Ltd. spoke about Ghana’s plans to shift from importation of antivenom to local production.

“Intermittent shortages of anti-snake-venom (ASM) on the market triggered a paradigm shift from importation to local production considerations.

“Atlantic Lifesciences Limited was established in 2017 to produce sterile products including biological products such as sera and vaccines.

“Atlanic’s fill and finish facility is now operationalized for anti-snake-venom production with an annual installed capacity of 150 million doses per year,” he said.

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