South Africa is experiencing a critical shortage of snake anti-venom, lead to bite victims receiving half the prescribed dose – if they’re treated at all – and with Eskom’s load shedding being blamed for the stockout.
Previously, the country would have five years of anti-venom in stock, but that has dwindled to almost nothing, reports Daily Maverick.
“This is not a shortage. It is a catastrophe,” said Arno Naude from Snake Bite Assist, who has been assisting doctors and veterinarians with snake bite treatment for 15 years.
He said some hospitals were rationing the few vials of snake antivenom they had left, giving minimal doses to bite victims and hoping it would be sufficient to pull them through. Vets countrywide had run out as well.
By Sunday night, Naude had received word that there was no more anti-venom that could be distributed. “So, what we have is all we have and when that is gone we are in serious trouble. It is not time to panic but it is time to avoid getting bitten at all costs,” he said.
If a patient was bitten multiple times they might need more than 20 vials of anti-venom to save them, Naude added.
“We had a guy who had been bitten by a black mamba. He was already shaking and sweating, having been bitten three times. It took 23 vials of anti-venom to save him.
“Now we are now struggling … and giving seriously sub-optimum dosages.”
Ten to 12 people die of snake bites annually in South Africa, but industry experts now fear that unless the anti-venom crisis is tackled urgently, this number will increase dramatically.
Two types of snake anti-venom are produced in this country. Polyvalent anti-venom is used to treat snake bites from the black mamba, green mamba, Jameson’s mamba, Cape cobra, forest cobra, snouted cobra, Mozambique spitting cobra, rinkhals, puff adder and the gaboon adder. The second type is the monovalent vaccine that treats a boomslang bite.
The polyvalent antivenom particularly is in short supply. Naude said rural hospitals, where snake bites are more often treated, were the worst affected.
“There isn’t any time to get doses from elsewhere. If you were bitten by a spitting cobra, for instance, and it takes six to eight hours for the antivenom to get to the hospital, it’s too late.”
‘Rolling blackouts to blame’
Spokesperson for the National Health Laboratory System (NHLS) Mzimasi Gcukumana confirmed the shortage of anti-venom, blaming Eskom. South African Vaccine Producers, the only manufacturer of snake anti-venom in the country, falls under the NHLS.
“We are aware of the shortage and are working around the clock to resolve the issues … and while some successes have been achieved, the electricity disruptions continue to have a significant impact on our output,” said Gcukumana
“The anti-venom production process requires a continuous power supply, and the switchover to generators during power outages affects our equipment. While the NHLS has generators and uninterrupted power supply (UPS) systems, we are purchasing more backup UPS systems, increasing the capacity of our backup generators, and investing in new equipment (including solar power and inverters) to help with these energy challenges.”
Clearing the backlog and resuming stockpiling will take about two months, he added. “There is stock of antivenom currently in production, and stock is always available for emergency cases.”
Anti-venom had been dispatched to 45 sites in the past week, including public and private hospitals and veterinarians, he said.
“There will be more distributed next week, and we have a large number of doses in the production phase.”
However, on Sunday, Naude said he did not know of a single vet in South Africa who could treat an animal bitten by a snake. “A large percentage of hospitals also have no anti-venom whatsoever. We are using expired anti-venom on people. Onderstepoort doesn’t have a single vial.”
He said people were importing anti-venom from India in desperation.
“Today, about two hours ago someone was bitten by a snake. We usually start with six vials of anti-venom. The hospital only had two. Yesterday in Rustenburg, a man was bitten by a snake. The hospital turned him away because they didn’t have anti-venom and they wouldn’t use the anti-venom he had in his possession.
“I paid R30 000 in August for an order of anti-venom. I still haven’t received it.”
Public health crisis
“This is a huge, urgent and pressing public health crisis,” Naude said. “People in rural areas are badly affected … If one of the Ministers’ kids got bitten tomorrow this problem would be solved in a second.”
He said that without anti-venom, patients often lost limbs. There was a high suicide rate among snake bite victims, even with mental health assistance, because of the debilitating after-effects such as phantom pains and kidney problems.
“We used to supply the sub-Saharan countries with anti-venom. Now we are struggling to get a single vial of it.”
He said although there had been sporadic stock-outs in the past few years, the real problem started in 2020. “We struggled to get anti-venom, but it was lockdown so people were not moving around much … It really started becoming a problem two years ago.
“They keep promising us stock will arrive in six to eight weeks. But it has been months.
“We are struggling for answers. We hear the load shedding story and then that they can’t access the chemicals. A few years ago the WHO flagged the quality of the anti-venom produced by the South African Vaccine Producers after a string of bad reactions. There were bad batches going out.”
‘Nobody knows what the problem is’
Snake expert and CEO of the African Snakebite Institute Johan Marais said that although they had experienced sporadic stock-outs over the past seven years, these were always short-lived. “The real trouble started eight or nine months ago.”
He said the initial story from the South African Vaccine Producers was that it was undertaking quality checks on the insistence of the WHO.
“Then they said they had sourcing problems. I don’t know what they couldn’t find to make the anti-venom but they didn’t talk to us. Then we heard … load shedding.
“The truth is nobody really knows what the problem is …
“I fully agree that this is a public health crisis. I used up the last of my anti-venom the other day. I work with poisonous snakes daily. But there was an emergency so I gave it to a doctor.
“The rural communities are the worst affected by this. We do not hear what is happening in northern KwaZulu-Natal. Nobody will say anything.
“We are getting to the end of the snake bite season at the moment, but there will be a peak of activity just before winter as the snakes get ready.”
He said some doctors and vets had, in desperation, been importing anti-venom from India.
“But these haven’t been tested clinically. Where you would need 12 to 15 vials of South African anti-venom you might need 70 to 80 vials of Indian anti-venom.
“One of the products has just been banned in Kenya after terrible results. You can bring it in, but it is not registered.
“It makes me angry that in treating a snakebite victim, the anti-venom is the cheapest part … It costs R21 000 for 10 vials compared with the R50 000 a day the person will have to spend in ICU without it.”
Mike Perry, who provides snake venom to the South African Vaccine Producers to create anti-venom, said the shortage was not from a lack of venom.
“I have supplied venom to them since 1999. They work on a five-year buffer stock, meaning if I stop production they can carry on producing anti-venom for another five years. The problem is the facilities are 50-years-old. Load shedding breaks their old machines … It takes weeks for them to find spares to fix them.”
See more from MedicalBrief archives:
Experts flag shortage of snake anti-venom stocks
Deadly risks in delaying treatment of bacterial infection after snake bite – Namibian study
Snakebite: ‘The world’s biggest hidden health crisis’
Big strides made in push for affordable, effective anti-venom