Needs and Availability of Snake Antivenoms: Relevance and Application of International Guidelines

Document Type: Original Article


Athena Institute, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands


Snakebite has recently been declared a global public health emergency. Empirical data showing the true burden of snakebite is lacking. Treatment with specific antivenoms is considered the only cure. However, several factors have led to an ongoing antivenom crisis. This study offers recommendations concerning the improvement of antivenom access and control, by providing an overview of the factors limiting the successful implementation of international guidelines within the international industry and state institutions. It further investigates the reasons for the epidemiological knowledge gap regarding snakebites.
Data for this study was collected using surveys with closed- and open-ended questions, which allowed for descriptive and thematic analysis, respectively. Participants for this study were selected as follows: 46 manufacturers were contacted from the open-access World Health Organization (WHO) Database for antivenom producers; 23 National Health Authorities (NHAs) of high-burden countries were contacted; and 11 poison centers or experts were randomly contacted.
In total, responses from 6/46 (13%) manufacturers, 10/23 (43%) NHAs, and 3/11 (27%) poison centers were received. The low response rates had a limiting effect on the coverage of this study, allowing only exploratory conclusions to be drawn. Based on the gathered information, a probable reason for the epidemiological knowledge gap is the low priority given to snakebites on public health agendas, driving interest and funding away from research in this field. As a consequence, the ensuing lack in funding is preventing state institutions and manufacturers from implementing international guidelines to the highest standards. Furthermore, manufacturers indicated that international guidelines were often not applicable in the field, lacking technical information and protocols.
Snakebite ranks low on international public health agendas, and partially due to this low priority, NHAs have shown limited efforts in conducting epidemiological studies, training health workers on snakebite management and creating national snakebite management strategies. The lack of NHA involvement is reflected in poor access to appropriate antivenoms as well as a lack of antivenom regulation. Manufacturers are taking positive steps toward full implementation of international guidelines and are improving quality control procedures. However, in order for international guidelines to become truly useful in the field, more technical guidance is required. This study reflects that there is a general lack of knowledge transfer amongst various actors: most producers, health authorities, and experts expect increased and improved communication and guidance from leading international bodies. Due to the low response rates observed in this study, conclusions drawn herein are not representative of the global situation; yet provide an exploratory insight on the difficulties facing antivenom management.


Main Subjects

Additional File 1 (Download)

Additional File 2 (Download)

Additional File 3 (Download)

  1. Chippaux J. Snakebites: appraisal of the global situation. Bull World Health Organ 1998; 76: 515-24.
  2. Kasturiratne A, Wickremasinghe AR, de Silva N, Gunawardena NK, Pathmeswaran A, Premaratna R, et al. The global burden of snakebite: a literature analysis and modelling based on regional estimates of envenoming and deaths. PLoS Med 2008; 5: e218. doi: 10.1371/journal.pmed.0050218
  3. World Health Organization (WHO). Rabies and Envenomings - A neglected public health issue. Geneva: WHO; 2007. p. 1-38.
  4. Harrison RA, Hargreaves A, Wagstaff SC, Faragher B, Lalloo DG. Snake envenoming: a disease of poverty. PLoS Negl Trop Dis 2009; 3: e569. doi: 10.1371/journal.pntd.0000569
  5. Mohapatra B, Warrell DA, Suraweera W, Bhatia P, Dhingra N, Jotkar RM, et al. Snakebite mortality in India: a nationally representative mortality survey. PLoS Negl Trop Dis 2011; 5: e1018. doi: 10.1371/journal.pntd.0001018
  6. Gutiérrez JM, Theakston RDG, Warrell DA. Confronting the neglected problem of snake bite envenoming: the need for a global partnership. PLoS Med 2006; 3: e150. doi: 10.1371/journal.pmed.0030150
  7. Calvete JJ, Sanz L, Pla D, Lomonte B, Gutiérrez JM. Omics meets biology: application to the design and preclinical assessment of antivenoms. Toxins (Basel) 2014; 6: 3388-405. doi: 10.3390/toxins6123388
  8. Theakston RD, Warrel DA. Crisis in snake antivenom supply for Africa. Lancet 2000; 356: 2104. doi: 10.1016/s0140-6736(05)74319-1
  9. Chippaux J. Estimating the global burden of snakebite can help to improve management. PLoS Med 2008; 5: e221. doi: 10.1371/journal.pmed.0050221
  10. Gutiérrez JM, Williams D, Fan HW, Warrell DA. Snakebite envenoming from a global perspective: Towards an integrated approach. Toxicon 2010; 56: 1223-35. doi: 10.1016/j.toxicon.2009.11.020
  11. Gutiérrez JM, Burnouf T, Harrison RA, Calvete JJ, Kuch U, Warrell DA. A multicomponent strategy to improve the availability of antivenom for treating snakebite envenoming. Bull World Health Organ 2014; 92: 526-32. doi: 10.2471/blt.13.132431
  12. Williams DJ, Gutiérrez J-M, Calvete JJ, Wüster W, Ratanabanangkoon K, Paiva O, et al. Ending the drought: new strategies for improving the flow of affordable, effective antivenoms in Asia and Africa. J Proteomics 2011; 74: 1735-67. doi: 10.1016/j.jprot.2011.05.027
  13. Gutiérrez JM, Warrell DA, Williams DJ, Jensen S, Brown N, Calvete JJ, et al. The need for full integration of snakebite envenoming within a global strategy to combat the neglected tropical diseases: the way forward. PLoS Negl Trop Dis 2013; 7: e2162. doi: 10.1371/journal.pntd.0002162
  14. Gutiérrez JM, León G, Burnouf T. Antivenoms for the treatment of snakebite envenomings: the road ahead. Biologicals 2011; 39: 129-42. doi: 10.1016/j.biologicals.2011.02.005
  15. Morals V, Massaldi H. Snake Antivenoms: Adverse Reactions and Production Technology. J Venom Anim Toxins incl Trop Dis 2008; 15: 3. doi: 10.1590/s1678-91992009000100002
  16. Bawaskar HS. Snake venoms and antivenoms: critical supply issues. J Assoc Physicians India 2004; 52: 11-3.
  17. Brown NI. Consequences of neglect: analysis of the sub-Saharan African snake antivenom market and the global context. PLoS Negl Trop Dis 2012; 6: e1670. doi: 10.1371/journal.pntd.0001670
  18. World Health Organization (WHO). Guidelines for the production control and regulation of snake antivenom immunoglobulins. Geneva: WHO; 2008.
  19. World Health Organization (WHO). Venomous snakes distribution and species risk categories [Internet]. 2010. Available from:
  20. León G, Segura Á, Gómez A, Hernandez A, Navarro D, Villalta M, et al. Industrial Production and Quality Control of Snake Antivenoms. In: Gopalakrishnakone P, Calvete JJ, editors. Toxinology. Dordrecht: Springer; 2021. p. 1-22.
  21. Isbister GK. Snake antivenom research: the importance of case definition. Emerg Med J 2005; 22: 399-400. doi: 10.1136/emj.2004.022251
  22. Warrell DA. Snake bite. Lancet 2010; 375: 77-88. doi: 10.1016/s0140-6736(09)61754-2