The KwaZulu-Natal (KZN) Health Department has sought to allay public fears regarding a potential shortage of snake antivenom in the province. This assurance comes on the heels of increased concerns from the community about the availability of product following reports suggesting a crisis in the supply chain.
The warm weather makes it an active season for snakes in South Africa and the panic was fueled by reports that the country had no supplies of antivenom because the National Health Laboratory Service had stopped production, for now.
However the province’s health department was quick to respond to the growing alarm.
“There is no dire shortage of anti-venom currently,” said spokesman, Ntokozo Maphisa.
He said it was compulsory for public hospitals to have antivenom so that they could treat snakebite victims immediately.
“We stock anti-venom in hospitals and Community Health Centres (CHC) with more stock allocated to rural district facilities where the incidence of snakebites is higher. If we have stock nearing its expiry date, we exchange it with facilities where demand is greater.”
Maphisa said that currently there were sufficient supplies in the province.
“The available stock has been distributed to where it is most needed, and in cases of challenges, we have intervened and communicated with the National Department of Health to ensure availability. We consistently process orders to maintain adequate stock levels,” said Maphisa.
He urged parents and caregivers to ensure that their children were safe.
"We urge people who live in rural areas, work outdoors to be particularly more vigilant because they are at a higher risk of being bitten by a snake.”
The Independent on Saturday was first to raise the issue of looming shortages last September.
Then in December the South African Vaccine Producers (SAVP) which falls under the National Health Laboratory Service (NHLS) said that was a “depletion of reserves” and that production of snake antivenom was on hold due to facility upgrades.
“The NHLS initiated a renovation project for SAVP’s facilities to improve production efficiency. The initiative intends to address previous concerns related to machine breakdowns, which are mostly caused by ageing equipment and inadequate infrastructure.”
Johan Marais from the African Snakebite Institute (ASI) believes that government facilities are using Pan African Premium, an antivenom produced overseas. “What we do have is an imported product, but we're not 100% sure how well it's going to work on all the snake species in the long run. And in many cases, it's going to be far more expensive because you might need a few more vials than you would have with SAVP.”
Marais said the situation was a disaster for several countries in Africa including Kenya, Tanzania, Mozambique and even Senegal which got their supplies from the SAVP.
"So all of those countries are now without SAVP antivenom, because it also covers a lot of their snakes. So what happened next is that the Indian antivenom manufacturers very aggressively started marketing their products all over Africa. But these products have not all been subjected to clinical trials. And there's no public data on how effective they are,” said Marais.
He believed that most of these antivenoms were “absolutely useless". “Some of these antivenoms are so ineffective. With SAVP polyvalent, if you have a black mamba patient, we'll start with 12 vials of antivenom. With the Indian antivenom, you're going to have to start with 80 vials,” he said.
According to the African Snakebite Institute at least 4000 snakebites are recorded in South Africa, mostly in the evening, and everyone is at risk no matter in which part of the country they are based.
Marais said that most of the serious snakebites in KZN came from the Mozambique spitting cobra, puff adders and stiletto snakes.
“What you must also remember is every patient that goes to a hospital with a snake bite does not get antivenom. Only 1 out of 10 get antivenom, the others don't need it.”
He previously explained that researchers hyperimmunised horses with snake venom to manufacture antivenom. “The hyperimmunisation takes about nine months. We draw blood from the horse, we squeeze the serum out and that serum is then purified and that is what neutralises the snake venom. So anti-venom is horse serum.”
Donald Schultz the founder of Snake Pharm a privately owned biotech company based in KZN said that they had developed an antivenom which had been tested in the US and was currently being tested in South Africa. He said the company was established to address the global shortage of antivenom.
“We're still in the research stage. But you know, with biologics and drug development, it takes years and lots of money to get things approved and we're hoping that this can get all fast-tracked based on the shortage that's happening.”
He said the big difference between Snake Pharms antivenom and others was the time it took to develop. “Instead of taking one year, like the horse product takes, we actually use the snake blood. It takes one hour so you can imagine in a logistical world, that makes a massive difference,” said Schultz.
The National Department of Health had not responded to questions at the time of going to press.