Treating snake bites—a call for partnership

Abstract

1 The Lancet. Snake bite—the neglected tropical disease. Lancet 2015; 386: 1110. 2 Mechanisms to reverse the public health neglect of snakebite victims; Wellcome Trust Genome Campus, Hinxton, Cambridge, UK; Sept 22–23, 2015. 3 WHO. WHO model list of essential medicines. 15th list, March 2007. http://www.who.int/ medicines/publications/essentialmedicines/ en/ (accessed Nov 10, 2015). 4 WHO. Rabies and envonomings: a neglected public health issue. Report of a consultative meeting. Jan 10, 2007. http://www.who.int/ bloodproducts/animal_sera/Rabies.pdf (accessed Sept 20, 2015). 5 WHO. Venomous snakes distribution and species risk categories. http://apps.who.int/ bloodproducts/snakeantivenoms/database/ (accessed Sept 20, 2015). 6 WHO. WHO guidelines for the production, control and regulation of snake antivenom immunoglobulins. http://www.who.int/ bloodproducts/snake_antivenoms/ snakeantivenomguideline.pdf (accessed Sept 20, 2015). together key players to identify mechanisms to “reverse the public health neglect of tropical snakebite victims”. But we do not agree with the Editors that snake bites are “largely invisible to WHO”. Antivenoms are highly eff ective in treating snake bite envenoming and were therefore included in the WHO Essential Medicines List in 2007. Also in 2007, WHO convened stakeholders to identify what should be done next; many of their recommendations are still valid. In 2009, WHO published Rabies and envenomings: a neglected public health issue and launched a global database with up-to-date information on venomous snake distribution and species risk categories, available antivenoms, and antivenom producers. In 2010, a WHO guideline to support production, control, and regulation of antivenoms (adopted by the WHO Expert Committee on Biological Standardization) was published. In brief, WHO developed— consensually—a clear vision on how to move this area of public health forward. An obvious next step would be to include antivenoms in the products invited for WHO prequalification. As shown with fixed-dose combination drugs for HIV/AIDS, WHO prequalification facilitates market penetration and increases the availability of quality-assured health products where they are needed most. The WHO Prequalification Team has considerable experience in working with manufacturers and regulators to get needed products onto the market and maintain supply. The team has worked closely with African regulators to help with assessment of complex products. In the longer term, more advanced products—for example, based on monoclonal antibodies—should be developed, but this will need investment and time. Unfortunately, despite all eff orts, we have failed to attract the attention of the donor community and support and implemented to meet the goal of providing 15 million individuals with basic, life-saving needs. WHO received less than 20% of the fi nancial support needed to deal with the crisis in Yemen, leaving a funding gap of 80%. Agencies such as WHO and UNICEF should work in collaboration to avoid duplication of eff orts and to provide frequent, updated reports to allow for adjustment of existing plans.