Africa Braced for Snakebite Crisis Health Specialists Warn That Stocks of Antivenom Will Run out in 2016

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GLOBAL HEALTH Africa braced for snakebite crisis Health specialists warn that stocks of antivenom will run out in 2016.

BY QUIRIN SCHIERMEIER spokesman. Sanofi Pasteur is working to enable the transfer of know-how to companies willing ural Africa is facing a resurgence of to take over production of Fav-Afrique, he says. a persistent plague that rarely makes Pharmaceutical companies in South Africa, headlines: snakebite. India, Mexico and Costa Rica are among those

RBy June next year, stockpiles of the anti- marketing cheaper products — some of which STAROSTA/CORBIS PAUL venom that is most effective against Africa’s work well against snakes in their host nations. vipers, mambas and cobras are expected to run But their safety and effectiveness against the out because the only company that makes the large variety of species in Africa have not yet medicine has stopped production. With no been established in clinical trials. To speed up adequate replacement in sight, the death toll the process, MSF is offering two of its hospi- from bites is set to rise, specialists warned at a tals in the Central African Republic (CAR) tropical-medicine congress last week in Basel, and South Sudan as study sites. But it will take Switzerland. at least two years to validate the products in “We’re dealing with a neglected health crisis development, and none is as broadly efficient that is turning into a tragedy for Africa,” says as Fav-Afrique, Alcoba says. Gabriel Alcoba, a medical adviser with the international humanitarian group Médecins NEGLECTED THREAT Sans Frontières (MSF; also known as Doctors The deadly carpet viper (Echis ocellatus). Although just now becoming critical, Africa’s Without Borders). snakebite problem has been smouldering for Venomous snakes might seem an archaic snake venom, the serum neutralizes the venom years, says tropical-medicine specialist David menace in such a rapidly urbanizing world. of many of Africa’s most dangerous snakes. Warrell of the University of Oxford, UK, who Yet by cautious estimates, snakebites kill more The antidote has saved many people from consults for the World Health Organization than 100,000 people worldwide every year bites by deadly species such as the carpet viper (WHO). Snakebite fatalities have been rising (see ‘Death toll’) — more, on average, than (Echis ocellatus), common in West Africa, over the past decade in the CAR, Ghana and lose their lives in natural disasters. And survi- and the black mamba (Dendroaspis polylepis), Chad — in part owing to a failure to train vors often experience permanent physical and found across the sub-Saharan region. But the enough medical staff, ignorance from health mental disabilities. high costs — US$250–500 per person — and a ministries and “unscrupulous marketing” of In 2010, the French drug firm Sanofi Pasteur supply shortage mean that only about 10% of inappropriate antivenoms, he says. “War-torn in Lyon ceased production of Fav-Afrique, an snakebite victims in Africa get treatment, and countries have many other problems. But antibody serum that reduces the quantity of the company says that producing the antidote is the millions of children, poor farmers and venom circulating in the blood of a snakebite no longer profitable. Cheaper products by com- nomadic people at risk of snakebites just don’t victim. Made from the purified plasma of horses petitors have forced Sanofi Pasteur out of the have the ear of politicians in capital cities.” previously injected with small quantities of African market, says Alain Bernal, a company And according to Warrell, the WHO has done little to help. To improve the safety and efficacy of antibodies, the agency has released DEATH TOLL guidelines for producing antivenoms. But it has no formal programme for improving Fuzzy estimates of snakebite fatalities treatment by training medical workers, advis- ing ministries or educating communities, as it It is uncertain how many people are bitten or Under-reporting is not limited to Africa. does for 17 other neglected tropical diseases, die from snakebites in sub-Saharan Africa. The authors of a nationally representative including dengue and sleeping sickness. And But according to Médecins Sans Frontières snakebite-mortality survey, published in yet, says Warrell, snakebites cause more deaths (MSF; also known as Doctors Without 2011, deduced that, despite the availability than do all 17 diseases put together. Borders), whose health-care workers treat of antidotes, around 46,000 people in India Warrell says that, while waiting for clinical snakebites through field programmes in the die of snakebites every year (B. Mohapatra trials to bring replacements for Fav-Afrique Central African Republic and South Sudan, an et al. PLoS Negl. Trop. Dis. 5, e1018; 2011). to the market, the keys to reducing the risk of estimated 30,000 people die each year and at India’s Central Bureau of Health Intelligence snakebite are education and preventive meas- least 8,000 more undergo amputations. reported merely 1,219 and 985 fatal bites ures — such as wearing proper shoes, using But snakebite mortality could be much for 2009 and 2010, respectively. One a light when walking home from the fields higher than anecdotal reports suggest. For reason for the discrepancy, says Warrell, and sleeping above ground level, beneath a some countries, including the Democratic who co-authored the study, is that many mosquito net. Republic of Congo — home to an enormous victims of snakebites die before they reach Thankfully, says Alcoba, the global-health number of venomous snakes — there are no a hospital, or waste precious time with community is starting to grasp the urgency of reliable data, says tropical-medicine specialist traditional healers before seeking more- the situation. “People used to laugh when we David Warrell at the University of Oxford, UK. conventional medical help. Q.S. talked about snakebites,” he says. “They don’t laugh any more.” ■