Snakebite Management: The Need of Reassessment, International Relations, and Effective Economic Measures to Reduce the Considerable SBE Burden

Abstract

The sole treatment for snakebite envenomation (SBE), the anti-snake venom (ASV), suffers from considerable drawbacks, including side effects and limited species specificity. Additionally, despite its existence for more than a century, uniform availability of good quality ASV does not yet exist. The present review describes the journey of a SBE victim and highlights the global crisis of SBE management. A detailed analysis of the current ASV market has also been presented along with the worldwide snake distribution. The current production of country specific licensed ASV throughout the globe along with their manufacturers has been examined at the snake species level. Furthermore, a detailed analysis of on-ground situation of SBE management in antivenom manufacturing countries has been done using the most recent literature. Additionally, the export and import of different ASVs have been discussed in terms of procurement policies of individual countries, their shortcomings, along with the possible solution at the species level. It is interesting to note that in most countries, the existence of ASV is really either neglected or overstated, implying that it is there but unsuitable for use, or that it is not present but can be obtained from other countries. This highlights the urgent need of significant reassessment and international collaborations not just for development and production, but also for procurement, distribution, availability, and awareness. A PROMISE (Practical ROutes for Managing Indigenous Snakebite Envenoming) approach has also been introduced, offering simple, economical, and easy to adopt steps to efficiently alleviate the worldwide SBE burden.

Keywords: Anti-snake venom; Anti-snake venom manufacturing; Export and import; Global policy; PROMISE approach; Snakebite envenoming management.

Fig. 1

The journey of a SBE victim. The coloured boxes indicate the major hurdles in ASV therapy. The outcome of the antivenom therapy can be lifesaving or fatal depending upon the quality, specificity, efficacy, dosage, time of administration, and side effects of the antivenom administered. Note that affordability includes ASV cost as well as other hospital expenses

Fig. 2

Geographical distribution of snakes, snakebites, anti-snake venom production, the targeted genera, and species. a Global snakebite cases, snake distribution, ASV production, its distribution, and the targeted genera. Numbers in white boxes represent the number of snake genera followed by number of species found in respective countries. Each symbol represents a genus targeted by the antivenom(s) produced in each country. The number of targeted species of a genus is written inside the corresponding symbol. Numbers in parentheses represent the total number of antivenoms produced by the manufacturing country against the given genus. * represents investigational product. G/S correspond, respectively, to the number of genera and species present in a country. Note: Ecuador shut down ASV manufacturing in 2012, and the last batch of Croatia ASV expired in 2019. Both countries are now dependent on imports [24] [25]. b Antivenom manufacturers and import/export. Numbers inside the circles represent the number of antivenom manufacturers in the corresponding country. Note: Kenya recalled Indian antivenoms in 2023 due to inefficacy and is aiming self-manufacturing [26] [27]. Based on published data and WHO [23, 28]

Fig. 3

The PROMISE approach for SBE management. The PROMISE (Practical ROutes for Managing Indigenous Snakebite Envenoming) approach is an amalgamation of economical and easy remedies whose implementation can significantly reduce the SBE burden