The development of snake
antivenoms more than a century ago should have heralded effective treatment of the scourge of
snakebite envenoming in impoverished, mostly rural populations around the world. That
snakebite still exists today, as a widely untreated illness that maims, kills and terrifies men, women and children in vulnerable communities, is a cruel anachronism.
Antivenom can be an effective, safe and affordable treatment for
snakebites, but apathy, inaction and the politicisation of public health have marginalised both the problem (making
snakebite arguably the most neglected of all
neglected tropical diseases) and its
solution. For lack of any coordinated approach, provision of
antivenoms has been pushed off the public health agenda, leading to an incongruous decline in demand for these crucial antidotes, excused and fed by new priorities, an absence of epidemiological data, and a poor regulatory framework. These factors facilitated the infiltration of poor quality products that degrade user confidence and undermine legitimate producers. The result is that
tens of thousands are denied an essential life-saving medicine, allowing a toll of human suffering that is a summation of many individual catastrophes. No strategy has been developed to address this problem and to overcome the intransigence and inaction responsible for the global tragedy of
snakebite. Attempts to engage with the broader public health community through the World Health Organisation (WHO), GAVI, and other agencies have failed. Consequently, the toxinology community has taken on a leadership role in a new approach, the Global
Snakebite Initiative, which seeks to mobilise the resources, skills and experience of scientists and clinicians for whom
venoms, toxins,
antivenoms, snakes and
snakebites are already fields of interest. Proteomics is one such discipline, which has embraced the potential of using
venoms in bio-discovery and systems biology. The fields of venomics and antivenomics have recently evolved from this discipline, offering fresh hope for the victims of
snakebites by providing an exciting insight into the complexities, nature, fundamental properties and significance of
venom constituents. Such a rational approach brings with it the potential to design new immunising mixtures from which to raise potent
antivenoms with wider therapeutic ranges. This addresses a major practical limitation in
antivenom use recognised since the beginning of the 20th century: the restriction of therapeutic effectiveness to the specific
venom immunogen used in production. Antivenomic techniques enable the interactions between
venoms and
antivenoms to be examined in detail, and if combined with functional assays of specific activity and followed up by clinical trials of effectiveness and safety, can be powerful tools with which to evaluate the suitability of current and new
antivenoms for meeting urgent regional needs. We propose two mechanisms through which the Global
Snakebite Initiative might seek to end the
antivenom drought in Africa and Asia: first by establishing a multidisciplinary, multicentre, international collaboration to evaluate currently available
antivenoms against the
venoms of medically important snakes from specific nations in Africa and Asia using a combination of proteomic, antivenomic and WHO-endorsed preclinical assessment protocols, to provide a validated evidence base for either recommending or rejecting individual products; and secondly by bringing the power of proteomics to bear on the design of new immunising mixtures to raise Pan-African and Pan-Asian polyvalent
antivenoms of improved potency and quality. These products will be subject to rigorous clinical assessment. We propose radically to change the basis upon which
antivenoms are produced and supplied for the developing world. Donor funding and strategic public health alliances will be sought to make it possible not only to sustain the financial viability of
antivenom production partnerships, but also to ensure that patients are relieved of the costs of
antivenom so that poverty is no longer a barrier to the treatment of this important, but grossly neglected public health emergency.