Millions of African people may start dying from next month as South Africa runs out of vital snake, scorpion and spider antivenom

0Shares

Johannesburg – Millions across sub-Saharan Africa face a dire threat as South Africa’s National Health Laboratory Service (NHLS) has ceased all production of vital snake, scorpion, and spider antivenom. The NHLS has yet to provide a timeline for the resumption of production, leaving healthcare professionals and reptile experts warning of an impending crisis that could claim countless lives.

Arno Naude of Snake Bite Assist, a leading authority on snakebites, paints a grim picture: “As of next month, people will start dying. Hospitals everywhere tell me they are running out.”

The NHLS has attributed the production halt to extensive construction work at the South African Vaccine Producers (SAVP) facility. According to Mzi Gcukumana of the NHLS, these upgrades 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.”

Gcukumana explained that the infrastructure had been further compromised by frequent operational disruptions caused by load shedding, which made it difficult to maintain the controlled-air-and-temperature conditions essential for manufacturing.

“Due to the extent of the work required, antivenom manufacturing processes had to be temporarily discontinued during the renovations,” Gcukumana said. He added that the project had experienced delays due to postponed delivery of specialised equipment and the need to maintain stringent quality standards, further complicated by the rigorous regulatory environment for sterile manufacture.

As a result, stockpiles of spider, scorpion, and polyvalent antivenoms have been depleted, leaving only boomslang antivenom available for distribution. The NHLS is now focused on commissioning the facility, which involves cleaning, validation, and quality control protocols to meet regulatory requirements for sterile pharmaceutical production.

Gcukumana assured the public that “the NHLS is doing everything possible to speed up the final stages of the process to resume snakebite antivenom production and will keep providing updates on progress.”

However, Naude remains skeptical, pointing out that a year ago, on 4 March 2023, the NHLS had assured them that they had “more than enough” antivenom. “We thought they were back on track. But the truth is their stockpile was next to nothing,” he said.

The situation is particularly alarming as South Africa enters the second peak of the snake season, with the Easter holidays traditionally seeing a surge in snakebite incidents.

The implications extend beyond South Africa’s borders, as several sub-Saharan countries, including Uganda, have historically relied on South Africa for their antivenom supply. These countries are now forced to seek alternative sources, often importing from elsewhere.

Naude highlighted the concerning trend of importing antivenom from India, which is cheaper but requires a higher dosage. “But this is only available for emergency use if you have medical aid. You can’t find this in a state hospital.” Furthermore, he raised concerns about the suitability of these imported products for treating bites from South African snakes, as the product leaflet does not list them as appropriate. “So the doctors are refusing to administer it,” Naude said.

The crisis is expected to disproportionately impact poor and rural communities, where access to healthcare is already limited. “Most state hospitals in rural areas tell me they have maybe enough left for two or three bites and after that, their antivenom will be finished,” Naude warned.

He also mentioned a cheaper and more effective product used in Swaziland, which has yielded impressive results with zero deaths out of 800 patients bitten. However, this product has not yet been approved by the World Health Organization and cannot be used on humans in South Africa, being restricted to veterinary use only.

While welcoming the upgrading of equipment at the NHLS, Naude also revealed concerns about the quality of antivenom supplied by South Africa in the past. “The quality was not what it should have been and we saw a lot of allergic reactions. Skilled people have left the NHLS and their equipment is very old.”

He expressed frustration with the lack of transparency from the NHLS, stating, “We have been assured that there was enough stock to see the upgrading project through. But then again, we are lied to all of the time.”

The consequences of this antivenom shortage are potentially catastrophic. “We have a huge crisis on hand,” Naude said. He criticised the practice of other sub-Saharan countries buying antivenom from the Middle East and India, describing it as “completely useless.” He also lamented the fact that even if available, these products are often not stocked by government hospitals, forcing individuals to purchase them themselves.

“No vets have antivenom any more,” Naude added, placing blame squarely on the NHLS for the potential deaths that may occur in South Africa and across the region. “This country should also be held responsible for the deaths that occur in sub-Saharan Africa because of what the NHLS has done.”

The crisis extends beyond snakebites, as the NHLS has also run out of antivenom for scorpion stings and spider bites. Naude cited the recent tragic death of a young child in Botswana from a scorpion sting, highlighting the ineffectiveness of antivenom designed for scorpions in North Africa.

“We are facing the prospect of hundreds if not thousands of deaths,” Naude warned. He said that while individuals with medical aid might still be able to find some form of treatment, it might be too late. “I have seen people die within 9 minutes.”

Even if victims survive, the lack of antivenom can lead to severe long-term consequences, including limb loss and kidney failure. Naude also highlighted the high suicide rate among snakebite victims, particularly those who suffer significant injuries.

Naude called on the government to take immediate action, emphasising that snakebites have been declared a neglected tropical disease but remain the most neglected. He stressed the particularly high risk of fatal thicktail scorpion stings in regions such as the Northern Western Cape, the Northern Cape, Limpopo, Botswana, and Namibia, especially among children and the elderly. Critically, there are no suitable imported alternatives for these scorpion stings.

Naude dismissed the NHLS’s claim of still having boomslang antivenom as offering little comfort. “First, what does it help to have boomslang antivenom? These bites are so rare. You almost have to apply in writing to get a bite,” he quipped, while acknowledging that boomslang bites can be excruciatingly painful and lead to death.

Steve Meighan from Deep South Reptile Rescue echoed Naude’s concerns, stating, “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 are producing antivenom.” Meighan, who has been involved with snakes since 1991, described the situation as unprecedented. He revealed that in two recent cases, snakebite victims had to be treated with veterinary products due to the shortage.

Michele Clarke from the Democratic Alliance announced that the party would question the NHLS in the parliamentary committee on health on Wednesday (5 March) about the antivenom crisis.

“We will demand clarity on how much antivenom has been produced and distributed since 2023. The NHLS must also account for reported shortages in hospitals and what is being done to address them,” Clarke said. She attributed the crisis to load shedding and renovations at the SAVP and highlighted the concerning fact that South Africa, once an exporter of antivenom, is now forced to import substandard alternatives.

Clarke emphasised the severity of the situation, noting that South Africa records approximately 4,000 snakebites annually, with around 900 hospitalisations and 100 patients requiring antivenom. “Without urgent access to treatment, severe complications or death can occur,” she warned. “A single snakebite can kill within hours—without access to antivenom, lives and limbs are being lost unnecessarily.”