Challenges and prospects of snake antivenom supply in sub-Saharan Africa

Snake bite envenoming (SBE) is a major public health problem in many tropical countries in the developing world [1]. Conventional antivenom (AV) remains the main therapy and has been shown to reduce mortality in observational studies in several countries within sub-Saharan Africa (SSA) [2].While it is relatively available in other endemic settings in Asia and Latin America, for many years there have been major challenges with reliable supply of effective products within SSA. In 2016, the cessation of production of an excellent AV used in the region was announced, serving to galvanize the global health community into action towards the control of SBE, especially in the developing world. Since then, the World Health Organization (WHO) has recognized SBE as a category “A” neglected tropical disease (NTD) in 2017, adopted resolutions towards its control in 2018, and, in 2019, launched an ambitious “roadmap” towards control with the set targets of halving burden by 2030 [3,4]. In this Policy Appraisal, the challenges of AV supply are explored using the parameters of “security of supply,” a concept traditionally applied to food, energy, military, weapons, and,recently, medicines (e.g., insulin supply) [5,6]. The potential impact of expanding AV availability and supply in SSA is also be explored, building on our previous findings and cognizant of WHO Roadmap targets [4,7,8,9,10]. The financial resources needed to sustain AV supplies to achieve WHO Roadmap goals is estimated. Recommendations are offered towards attaining the targets.