Like injecting water

_{Editor: Rick van Mechelen
Adapted from: https://www.thebureauinvestigates.com/stories/2025-02-13/the-new-snake-oil-antivenoms-that-are-as-useless-as-water/}

According to the Bureau of Investigative Journalism, snakebite patients in sub-Saharan Africa are often given treatments that are badly made, badly marketed and badly regulated. The Bureau bought antivenoms in three countries and, after testing, revealed that some antivenoms required more than 70 dosages to be an effective treatment. Antivenoms are not easily available to patients. Most healthcare providers don’t stock enough, and most patients can’t afford the amount of dosages (one dosage can cost more than the average monthly salary in some countries) needed. Not to mention the fraudulent practices followed by some antivenom producers. One company was discovered to have exported antivenom for Indian snakes to west Africa.

What are antivenoms?

Antivenoms for snakebites are old medicines that are still produced the same way they were a century ago. Horses or sheep are injected with small amounts of snake venom. This causes their bodies to develop antibodies (these are molecules produced by the immune system to neutralize viruses, toxins, and other infections), which are then extracted from the animal’s blood. This method was first used in the 1890s and has remained unchanged since. Because the production method is so old, antivenoms aren’t required to pass clinical trials and testing on humans. This means that there is no reliable and objective method to test new antivenoms before they are released on the market. 

A poor man’s disease

According to the WHO, around 5.4 million people are bitten by a venomous snake each year, with 80,000 to 140,000 deaths as a result. But these numbers are not evenly divided around the globe. Snakebite deaths occur more often in poorer countries. For comparison, in wealthy countries like Australia, with high-quality antivenoms that are free to patients, only one or two snakebite deaths occur each year. However, in sub-Saharan Africa, a staggering 20,000 snakebite deaths occur each year. 

“It’s a poor man’s disease,” according to Thea Litschka-Koen, a snakebite expert based in Eswatini. “Snakebite has devastating economic consequences on the individual, the family, as well as the entire country.” Due to the lack of high-quality and affordable antivenoms, many snakebite victims can’t afford treatment. Even if the patients survive, the chances they’ll be able to work again are slim, as they might lose limbs or end up with other long-term complications. If you add the healthcare cost to the loss of income that occurs when a snakebite patient can no longer work, entire families, and even communities, can be affected.

As useless as water

Besides antivenoms being unavailable or unaffordable, there’s another problem affecting the snakebite crisis in sub-Saharan Africa. Many antivenoms available to patients are highly inefficient or simply ineffective. “It’s a cowboy show out there,” according to Litschka-Koen. “Some of them are selling stuff that honestly, you may as well just pour down the drain.”

The Bureau of Investigative Journalism bought vials of antivenom in sub-Saharan Africa and had them examined by Professor Juan Calvete, a respected expert in snake antivenoms. Before even examining the contents of the vial, it was clear that the antivenom inside was not made for the snakes that live in sub-Saharan Africa. The label was written in Bengali, with a price tag in Indian rupees. Why is an antivenom from India, for snakes in India, available for purchase in sub-Saharan Africa? And would it have any effect if used as a treatment for the bite of, let’s say, a black mamba?

Professor Calvete had a blunt, but accurate, answer to the second question. “You can do two things. One, is to take the phone and say goodbye to your mother. And the other, if you have an ice cream shop nearby and you find the one flavour that you like, take it. Because it will be the last thing that you eat.”

Scientific research has long shown that Indian snake antivenoms are completely ineffective for treating bites by African snakes. But antivenoms from the wrong continent are not the only problem affecting antivenoms in sub-Saharan Africa. The Bureau bought five different antivenoms in Nigeria, Tanzania and Uganda, which were then brought to Professor Calvete for testing.

First, each antivenom was weighed and diluted to measure how much of the key ingredients were in the antivenom. Next, they tested the binding capacity of each antivenom. The antibodies found in the antivenom neutralise snake venom by binding to the venom, removing its ability to damage cells. The more the antivenom can bind, the better it is at neutralizing. They tested this on venoms of four dangerous and widespread snakes in sub-Saharan Africa – the puff adder (Bities arietans), black-necked spitting cobra (Naja nigricollis), black mamba (Dendroaspis polylepis) and West African carpet viper (Echis ocellatus). The results of these tests were anything but positive. 

Even antivenoms made specifically for African snake don’t often deliver high quality treatments. Inoserp Pan-Africa claims to have developed an antivenom that can neutralize toxins from 18 species of snakes. However, Calvete’s testing proved that Inoserp performed the worst out of all African antivenoms tested, even worse than one of the antivenoms created for Indian snakes. This is because the binding capacity is so low that more than 70 vials of this antivenom would be needed to treat a single bite, an amount that doctors cannot administer, and patients cannot afford. Professor Calvete said this about this antivenom: “Giving a patient this antivenom will be almost as if you inject distilled water in the body.” 

Unethical business practices

According to Dr. David Williams, a top expert at the World Health Organization (WHO), officials often buy the cheapest product available without knowing if it works against the snakes in their country. The problem is usually only discovered when a doctor tries to use the antivenom and realizes it doesn’t work for the local snake species.

One company, BSV, has been involved in selling antivenoms that are ineffective for the regions where they are being used. BSV has been making antivenoms for years, but it only produces antivenom for Indian snake species. It does not manufacture antivenom for Africa. However, there have been cases where BSV’s antivenoms were sent to African countries where they would not be effective.

A major issue occurred in 2004 when BSV sold an antivenom in Ghana that contained venom from an Indian viper instead of the common African viper. This mistake had deadly consequences—research found that patients who received this antivenom had a nearly seven-fold increase in death rates compared to those treated with another antivenom. Despite this, the company continued to make shipments of its Indian antivenom to Mali, where it also could not work against local snakebites. BSV denied sending its products to Somalia, Tanzania, and Uganda, but it did admit to exporting them to Mali. However, Mali’s health ministry claimed they never approved these shipments, raising questions about how the antivenom reached the country.

Regulatory issues

Regulating antivenoms and ensuring their effectiveness is challenging. The WHO has its own approval process to act as a safety net for countries that cannot thoroughly test the antivenoms themselves. However, this system is not perfect. The WHO rejected an application from Inosan, another company that makes antivenom, because there wasn’t enough proof that its product’s benefits outweighed the risks. Despite this, Inosan is currently trying to get approval again.

Another issue is that some health workers have to give patients much higher doses of antivenom than recommended, just to have a chance at saving their lives. One of these antivenoms is made by the Indian company Vins, which has also had regulatory problems. The WHO stopped its assessment of Vins’ antivenoms for sub-Saharan Africa in 2017 due to concerns about their effectiveness.

Vins had originally applied for a WHO recommendation in 2016, but its application was cancelled after several issues were discovered. One major problem was that Vins submitted a research paper about its antivenom that was supposedly written by two respected scientists. However, both scientists denied having any connection to the study. One of them, Professor Kate Jackson, stated that she never collected the snakes mentioned in the paper and that they don’t even exist in the Republic of Congo, where the study claimed they were found. She also did not recall Vins ever contacting her about the paper, raising serious doubts about the company’s research and credibility.

Conclusion

The lack of reliable research on antivenoms makes it difficult for doctors and health workers to know whether the treatments they are using will actually help patients. Many doctors are forced to try whatever antivenom is available and hope for the best. They are never completely sure if the medicine itself is effective or if the patient simply got lucky.

This situation highlights major flaws in the way antivenoms are regulated, tested, and distributed. When companies sell ineffective or improperly tested antivenoms, it puts people’s lives at risk. Without stricter regulations and better research, doctors and health workers will continue to struggle to provide the right treatment for snakebite victims. The WHO’s approval process is an important safeguard, but it needs to be stronger to prevent companies from selling dangerous or ineffective products. More transparency and accountability from antivenom manufacturers are necessary to ensure that people receive the correct treatment when they need it most.