The National Health Laboratory Service has admitted that construction work at its specialised facility has halted all manufacturing of snake, scorpion and spider anti-venom, leaving it with no stock at all except for boomslang anti-venom – which is rarely needed.
It is unable to say when it will start manufacturing again, leaving millions of people in sub-Saharan Africa at extreme risk.
“As of next month people will start dying,” Arno Naude of Snake Bite Assist told Daily Maverick.
“Hospitals everywhere are running out.
“Today, a year ago (4 March 2023), we were assured by the NHLS that they have ‘more than enough’ anti-venom,” he said. “We thought they were back on track. But the truth is their stockpile was next to nothing.”
Upgrades
This week, the NHLS’ Mzi Gcukumana said that late last year, the South African Vaccine Producers (SAVP) facility had undergone extensive infrastructure and equipment upgrades.
“These were planned and necessary due to the deterioration of ageing infrastructure, which had hampered compliance with Good Manufacturing Practices (GMP) within the SAVP sterile manufacturing unit.
“This deterioration became more apparent during significant load shedding, resulting in frequent disruptions. A steady power supply is important for manufacturing controlled-air-and-temperature conditions,” Gcukumana said.
“Due to the extent of the work required, manufacturing processes had to be temporarily discontinued during the renovations. Then, there were delays in delivery of specialised equipment … aggravated by the rigorous regulatory environment vital for sterile manufacture.
“During this period, the stockpiles of spider, scorpion, and polyvalent anti-venoms were depleted. Only boomslang anti-venom remains available. The NHLS is now concentrating on the commissioning of the facility… which entails cleaning, validation and quality control protocols to meet regulatory requirements.
“The NHLS is doing everything possible to speed up the final stages of the process.”
Venom types
There are two types of anti-venom in South Africa. Polyvalent anti-venom is made from the poison of 10 types of snakes found in southern Africa – puff adder, Gaboon adder, rinkhals, green mamba, Jameson’s mamba, black mamba, Cape cobra, forest cobra, snouted cobra and the Mozambique spitting cobra.
Boomslang anti-venom can be used to treat only boomslang bites.
Naude said the failure of the NHLS to provide sufficient anti-venom should cause outrage as thousands of lives, of both humans and animals, are at risk.
“We are going into the second peak of the snake season. During the Easter holidays, we always see a huge increase in bites,” he said.
Several sub-Saharan countries, including Uganda, had also been buying anti-venom from South Africa and now have to import it from elsewhere.
“South Africa is importing a product from India. It is a little cheaper, but you have to use more. But this is only available for emergencies if you have medical aid. You can’t find this in a state hospital. And even if you did, it was never intended to be used in SA, so it doesn’t state on the leaflet that it can be used for … South African snakes. So doctors are refusing to administer it,” he said.
“Poor and rural people will be hit hard by this. Most state hospitals in rural areas have maybe enough left for two or three bites and after that, their anti-venom will be finished.”
Naude said a product currently being used in Swaziland was cheaper and worked better than the imported product, but in South Africa, it could be used only by vets.
“They had good results there with this product. Out of 800 patients bitten, they did not have one death. But it has not yet been approved by the World Health Organisation,” he said, “and it can’t be used on humans in South Africa.”
Naude welcomed the upgrading of the equipment at the NHLS and said it also had become clear that in the recent past, the anti-venom supplied in this country was not up to standard.
“The quality was not what it should have been and we saw lots of allergic reactions. Skilled people have left the NHLS and their equipment is old.”
‘Huge crisis’
Naude described the issue as a huge crisis. “Other sub-Saharan countries are buying anti-venom from the Middle East and India. But they might as well buy distilled water. It is completely useless. Also, it isn’t stocked by government hospitals so you have to go and buy it yourself.
“No vets have anti-venom any more, either,” he added.
Apart from running out of polyvalent anti-venom, the NHLS also no longer has anti-venom for scorpion stings and spiders.
“Two weeks ago, a child died in Botswana after a scorpion sting. Their family sold everything they had to buy vials of anti-venom, but this was made for a scorpion in North Africa so it didn’t help.”
He said if a person with medical aid were bitten by a snake today, they could still scramble to find something to use. “But [it] might be too late. I have seen people die within nine minutes.”
“The other problem is that people might survive, but without anti-venom they will probably lose an arm or need a kidney transplant.”
Naude said it didn’t help for the NHLS to declare that it still had boomslang venom.
“These bites are so rare – you almost have to apply in writing to get a bite.”
Steve Meighan from Deep South Reptile Rescue said it could not be overstated how much trouble the country was in. “And even if they start working today it will still take months before they produce the anti-venom.
“I have been involved with snakes since 1991 and this is the first time this (has) happened.”
He said in two recent cases, snakebite victims had to be treated with products from a vet.
Michele Clarke from the DA said the party would question the NHLS this week in the parliamentary Health Committee.
“The country records 4 000 snakebites annually, with around 900 hospitalisations and 100 patients requiring anti-venom.
“A single snakebite can kill within hours – without access to anti-venom, lives and limbs are being lost unnecessarily.”
See more from MedicalBrief archives:
SA snakebite anti-venom shortage resolved
Snakebite anti-venom stocks dwindle to ‘almost nothing’
Snake anti-venom stocks dry up again