Tackling persistent scarcity of anti-snake venom in Nigeria

A recent report indicated that hundreds of Nigerians have died of snake bite in the last few weeks, following an acute scarcity of Anti-Snake Venom (ASV) in the country.

The report, quoting statistics obtained from just three snake treatment centres – General Hospital, Kaltungo, Ali Mega Pharmacy, Gombe and Comprehensive Medical Centre, Zamko, Plateau State – stated that 250 victims died of the menace in the last three weeks.

It said that the figure only captured those who died at the treatment centres, noting that more might have died at traditional healers’ houses, or even in their homes after resigning to fate.

The report stated that the figure was steadily on the rise with many victims in critical situations left on bare floors at the treatment centres as the doctors said they were helpless without the ASV.

Medics at the snake treatment centres, who related their experiences to newsmen lats week, described the situation as “a huge crisis that is both embarrassing and scary’’.

“We receive an average of 50 victims every day. Some arrive here in very critical conditions and we just have to watch them die because we are helpless,” Abubakar Abdullahi Aliyu, Managing Director, Aliyu Mega Pharmacy, Gombe, said.

He said that more than 70 victims had died in the last three weeks following the lack of ASV to treat them, adding that many came from Adamawa, Taraba, Bauchi, Borno and Plateau States.

“An average of six deaths are recorded daily. If you go to the snake treatment centre at the Kaltungo General Hospital, you will pity the victims; the lucky ones among them get supportive treatment, while many are left to fate since the drugs are not available."

“Between August and October, we received 750 victims. We were given 700 vials of the anti-venom on August 31, but we exhausted them before October. Many people are just dying. It is a major crisis,” he stated.

Dr. Abubakar Ballah, the Snakebite Treatment Officer at the Kaltungo General Hospital, spoke in the same vein.

“It is a sorry situation; it is disgusting when one has to watch helplessly as patients gasp for breath and eventually give up. It is sad and unfortunate,’’ he said.

He said that the centre received 139 patients in one week, with 77 absconding when the hospital appeared helpless, following the non-availability of the drug.

“In the last few days, we have recorded 21 deaths. The figure should be more because many of those that absconded were in bad shape; many others did not even bother to come here because of the fore-knowledge of lack of ASV in the centre."

“The last drug was used on October 13. We try to give vitamin K to the victims to enhance blood clotting in the absence of anti-venom, because bites from the viper snakes cause bleeding which is difficult to control without anti-venom."

“It is a critical period, but we are helpless. We want government to invest on producing ASV to avoid crisis like the one in our hands. We must put our heads together to provide a lasting solution to this menace,’’ he said.

Dr. Titus Dajel, Medical Superintendent of Zamko Comprehensive Medical Centre, also expressed similar concerns, and urged government to act promptly to save the situation.

“We have had more than 200 cases in the last one month with many of them losing their lives, but we remain helpless without the ASV,’’ he said.

He regretted that traditional healers had taken advantage of the situation to extort monies from victims after promising to heal them.

“What the herbalists are doing is trial and error. Most victims bleed in the brain because the venom is vicious; traditional healers cannot tackle that because they only concentrate on healing the wound,” he explained.

But, with more people dying of snakebite by the day, analysts have continued to wonder why it had remained difficult for the country to have a sustainable supply of the ASV.

Findings revealed that the ASV come in two forms – EchiTAB Plus ICP polyvalent, produced at the Instituto Clodomiro Picado, University of Costa Rica, which treats bites from all venomous snakes in Nigeria, and EchiTAB G, produced by Micropharm Ltd, United Kingdom, solely for carpet vipers, the commonest snakes in Nigeria.

According to Dr. Nandul Durfa, Managing Director of EchiTAB Study Group, Representatives of the two ASV producing companies in Nigeria, a lot of processes are involved in producing and importing the ASV into country.

“Normally, we take the live snakes to Liverpool School of Tropical Medicine where they are killed and their venom extracted and sent to the manufacturing sites in Wales and Costa Rica. The drugs are produced there and brought to Nigeria.

“Aside the transport, the weather is different; we must ensure that the snakes are kept in a regulated temperature similar to what they are used to in Nigeria, so that they will not die.

“If we produced at home, we shall ward off the heavy amounts paid in foreign exchange to technicians in the UK, because salaries are lower here,” he said.

Durfa explained that local production of ASV would be “very easy” in Nigeria because the consultants had expressed their readiness to transfer the technology to the country.

“The consultants are willing to transfer the technology and also train local personnel to handle the processes. Nigeria must take full advantage of this kindness,” he stated.

He said that former President Olusegun Obasanjo approved the local manufacturing of the ASV in 2006, but regretted that nothing came out it.

“Obasanjo approved a production cost of N2 billion, and suggested that the money be sourced from the Millennium Development Goals (MDGs) fund; sadly, no money was made available for the project.”

Durfa explained that EchiTAB ASV, whose name is sourced from Echis ocellatus – the biological name for carpet viper – with TAB referring to Therapeutic Anti-Bodies, had two variants including EchiTAB G for carpet vipers responsible for 97 per cent cases of snake bites in Nigeria, and EchiTAB Plus for carpet viper, Puff Adder and Black Cobra venom.

He traced the ASV production to 1991, when Prof. Ransome Kuti, then health minister, sought the assistance of two UK Professors – David Warrel of Oxford University and David Theakston of Liverpool School of Tropical Medicine.

“There was an acute shortage of ASV then, and the minister contacted the duo.

“The production processes went through various levels of screening and 11 clinical purification trials before the drugs were certified and registered by NAFDAC.

“The clinical trials were carried out in Kaltungo General Hospital, Gombe State, Zamko Comprehensive Health Centre, Langtang and Jos University Teaching Hospital,” he revealed.

He advised government to pay special attention to local production of the drug because snake bites affect mostly the productive group, and regretted that many had continued to die from a menace that could be effectively tackled.

Durfa blamed the current ASV crisis on the “late placement of order for its production”.

“It is very sad that there is a sudden shortage that culminated in many deaths. The drought is due to technical hitches in the production chain which are being looked into, to prevent a recurrence.

“We have adopted measures to ensure continuous supply of the product. We are working to ensure that only quality anti-venom drugs are brought to the country. We want to guarantee continued supply so as to avoid the supply of fake ASV from multiple supply channels.’’

Durfa confirmed that the EchiTAB Study Group was already working with the Federal Ministry of Health to explore areas of collaboration toward manufacturing the drug locally, via a Public-Private-Partnership (PPP) arrangement.

He advised government to see snake bite as a menace that must be taken seriously because it was “worse than Ebola, Monkey Pox and even HIV/AIDS”.

“It affects rural dwellers who are major contributors to our GDP through farming, cattle rearing and mining. This is why we believe that even the Ministry of Agriculture and rural development should take interest in the management of snake bites,’’ he said.

But as stakeholders intensify efforts to check the recurring ASV crisis, Ballah, the snakebite specialist at Kaltungo General Hospital, has urged desperate victims to be wary of fake ASV currently in circulation.

“Fake ASV are flooding the markets; some criminals have taken advantage of the paucity to fake the EchiTAB drug which they sell at N43,000 per vial, even far above the cost of the original that is sold by the EchiTAB Study Group at the cost of between N13,500 to N30,000.

“What we must avoid is a situation where desperate people could produce fake drugs. We must work toward effective handling and supply of the drug to guarantee quality and ensure that only genuine drugs are supplied to the treatment centres.’’

Ballah urged government to treat the ASV as a national emergency, saying that the necessity for it should be equated with having an army, customs service, police force and other security agencies by every country.

He advised government to work with the EchiTAB Study Group to have a reliable supply channel.

“Government should subsidise the production cost to avoid a major crisis and save us the embarrassment of watching helplessly as patients die in utter agony,’’ he said.

Dajel, from Zamko, spoke in the same vein, urging the Federal Government to treat snakebite as “a national emergency”, and take urgent steps to make ASV steadily available.

“Continuous importation of ASV is dangerous, especially in view of the rising cost of the dollar. We must look into the possibility of domesticating the production of the drug to avoid constant crisis,” he said.

He explained that the cases of snake bite had become more common in Plateau because of the ongoing harvest by farmers.

“It is the peak period of snake bites; farmers go to the bush to harvest crops and get attacked by snakes forced out of their holes by the hot temperature.

“Some snakes go under heaps of rice gathered together preparatory for thrashing, in search of shelter from the scorching sun. Such snakes pounce on farmers when they open the heaps to start thrashing.

“Some snakes also move in groups in search of rats at yam farms where they clash with farmers harvesting the produce,” he said.

Dajel said that the centre had advised farmers to wear protective items like boots and gloves, and urged government agencies charged with public enlightenment to educate farmers on ways to protect themselves against snake attacks.

Meanwhile, Mr Tim Golu, member of the House of Representatives representing Pankshin/Kanam/Kanke in Plateau, has declared that his constituents were the worst victims of the snakebite menace.

“For my people in Plateau, the paucity of the ASV is catastrophic. We have lost many people in the past few weeks. Right now, we have several cases in Kanke, my village. The Zamko health centre is usually their only hope, but there are no drugs there. It is a huge disaster,’’ he said.

Golu regretted that fake drugs were being sold to desperate victims, causing more deaths and deformities, and appealed to the federal, states and local governments to intervene by committing funds for the purchase of ASV.

The legislator said that he had initiated a bill for the establishment of a National Centre for Research and Production of Snake Vaccines which would soon go through public hearing.

With government paying more attention to the agricultural and mining sectors so as to diversify the economy, analysts say that Nigeria cannot afford to ignore a major menace associated with the two industries – rising prevalence of snake bites.

They particularly note that the victims of the reptiles – farmers, cattle grazers, hunters, miners – are active members of the society on the fields to actualise the diversification goal, and urge government to intensify efforts to tackle the acute scarcity of ASV to minimise deaths from snakebites.