India needs to look for effective lifesaving Anti-Snake Venoms from Latin America

By Sandeep Wasnik, 

India is the home of nearly 275 snake species, of which 60 are considered venomous and medically relevant, and with various levels of toxicity. Out of these 60 venomous species, only four venomous snake species are responsible for causing the greatest number of medically significant human snake bite cases in India. These four venomous snakes are collectively referred to “Big Four” — Common Krait (Bungarus caeruleus), Russell’s viper (Daboia Russelii), Indian saw-scaled viper (Echis Carinatus), and Indian Cobra (Naja Naja).

In India, every year between 45,000 to 50,000 people die because of snake bites and others are left with amputations and permanent disabilities. This accounts for half of all the snake-related deaths in the world, where WHO estimates that 81,000–138,000 people die each year from snakebites worldwide. About 94 per cent of snakebite deaths occurred in rural areas, and 77 per cent occurred out of hospital or due to the unavailability of specialised hospitals. In the world, snakebite every month caused 10,417 total deaths, whereas compared to death due to EBOLA in 26 months is 11,325. This clearly indicates that death caused by snakebite is more than 2000 per cent as compared to death by EBOLA (436 deaths per month), this seems serious subject for the countries, the national and International Health Organisations.

Snakebite in India has remained a much-neglected subject in spite of the significant mortality and morbidity it causes. If diagnosis and treatment is given in a timely fashion the victim can go back to a productive life. The World Health Organisation (WHO) has called to half global snakebite deaths by 2030 and this will require substantial progress in India. The WHO also says complications linked to attacks make the phenomenon one of the most neglected of tropical diseases (NTD).

India’s Anti-Snake Venoms and its effectiveness.

In 1895, the first anti-venom was developed by Albert Calmette against the Indian Cobra. There is only one type of “Anti-Snake Venoms'' (ASV) used for any snakebite treatment in India, this ASV is polyvalent snake antivenom, a mixture made from venom extracted from the ‘Big Four’ snakes. But this ASV can be ineffective for those victims bitten by snakes outside of the Big Four. For production of Anti-venom, only horses are used and the venom utilized is a combination of those collected from the ‘Big Four’ species. Although this treatment has saved many lives, it is weakly effective as snake venoms and their toxins vary significantly across all subspecies and only 10 to 15 per cent of the antibodies in the sera bind to the venom.

The snakebite treatment in India is a kind of `Hit’ and `Trial’ as well as very expensive, if one vial of antivenom did not work, then 20 vials can be injected into the snakebite victim. The geography of India is extremely diverse and toxicity of snakes also depends on their geography, to understand in a simple way, each species and sub-species of snakes of different regions displays variation in the protein composition of venom.

India has to learn about life saving model of anti-venom from Latin America

Snakebite is a huge problem in Central and South America, there's the jungles, the Amazon and the rain forests, but in this part of the world, affordable Anti-Snake Venoms (ASV) are produced by numerous public institutions along with strong commitments by Government Health Ministries. Snakebite deaths and disabilities have been kept in check in Latin America. The production of anti-venom in Latin America can be considered a model for India and other parts of the world. In Latin America, there are 137,000 to 150,000 snakebite reports and 3400 to 5000 deaths per year. Several poly-specific and few mono-specific anti-venoms are manufactured in the region, with two laboratories (one public and one private) in Argentina, Colombia, and Mexico, four public laboratories in Brazil, and one public laboratory in Bolivia, Peru, Venezuela, and Costa Rica.

In Latin America, the network of public anti-venom manufacturing laboratories has established an informal dynamics of inter-group consultations on specific aspects, which has become a useful mechanism for troubleshooting in antivenom production. Technology transfer projects and cooperation contribute to the upgrading of anti-venom manufacture in public laboratories.

Venoms and Antivenoms of Brazil

According to the herpetologist of Instituto Butantan, Marcelo Ribeiro Duarte, Brazil has about 412 species of snakes, being 15 per cent poisonous. In this country, the following snake bites anti-venoms are produced: for rattlesnakes (Genus Crotalus), pit-vipers (Bothrops, Bothrocophias, and Lachesis), and Coral snakes (Micrurus and Leptomicrurus)".

In the Americas, the first public institution in charge of manufacturing anti-venoms was Instituto Butantan(English: Butantan Institute), created in 1901 in São Paulo, Brazil, under the leadership of Vital Brazil Mineiro da Campanha, after that in 1907 the Fundação Ezequiel Dias “FUNED” (English: Ezequiel Dias Foundation) was created in Minas Gerais and then in 1919,Vital Brazil moved to Niteroi, State of Rio de Janeiro to establish antivenom production at InstitutoVital Brazil. The production of anti-venoms at a national level coordinated between the Ministry of Health and the four manufacturing laboratories, Instituto Butantan, FUNED, Instituto Vital Brazil, and the Centro de Pesquisa e Produção em Imunobiológicos “CPPI” (English: Center for Research and Production of Immunobiologicals).

Brazilian Snake Island: Nearly 33 kilometers away from the coast of São Pauloin the Atlantic Ocean, yet no one lives there, in fact the Brazilian Navy forbids any visitors at all and with good reason, it's probably the most dangerous place on the earth but as deadly as they are the golden lance head Viper czar, golden lancehead one of the most venomous snakes in the world, actually save lives because their venom is being used to produce new blockbuster medications.

The island is also known as Snake Island, the island is small in size, only 43 hectares (106 acres), and has a temperate climate. Island is the home of estimated 3000 specimens of snake and in which 2000 golden lancehead, around one snake every300 meters, has the highest concentration of venomous snakes in the world.

Venoms and Antivenoms of Costa Rica

The Instituto Clodomiro Picado “ICP” (English: Clodomiro Picado Institute), established in 1970, attached to the Faculty of Microbiology of the Universidad de Costa Rica, responsible for the production of snake anti-ophidic serums and scientific research on serpents and their venoms and is one of the world’s leading manufacturers of snake anti­venoms, and the only one in Central America. Costa Rica is home to 23 species of venomous snake, including the Central American “Bushmaster—one of the world’s largest vipers, growing up to 11 feet—and the “Bocaracá”, whose indigenous name means “Devil” that brings death when it bites. The production of anti-venom is produced by injecting the snake venom in horse and then drawing the horses’ blood, separating the venom-resistant antibodies, and mixing them into a fluid. Instituto Clodomiro Picado also produces anti-venoms in much the same way but with more advanced processes allowing for a purer product.

Today, Instituto Clodomiro Picado is not only producing the Anti-venoms for the country but for also for the LatAm regions as well as for the African and Asian countries at affordable prices. For example, Sri Lanka, a US based NGO (Animal Venom Research International “AVRI”), is supporting the development by Instituto Clodomiro Picado (of the University of Costa Rica) of a pilot batch of anti-venom against the venoms of the most dangerous Sri Lankan snakes.

The venoms were collected from Sri Lankan snakes to develop the Anti Snake Venom in Costa Rica. Once this anti-venom has been developed and pre-clinically tested, a clinical trial will be undertaken in Sri Lanka. If the new anti-venom is demonstrated to be clinically effective and safe, a technology transfer agreement among AVRI, Instituto Clodomiro Picado and the Sri Lankan authorities is expected to establish sustainable local anti-venom production.

How Brazil and Costa Rica could help to develop Anti-Snake Venoms for India?

Similar arrangements involving experienced anti-venom manufacturers and technology developers could be promoted in India. Successful international collaborations in the biopharmaceutical field, involving the so-called innovative developing country, would encourage and provide useful guides for such projects. Exporting the diverse snake venoms (according to geography) of India to Brazil and Costa for anti-venom development and clinical trial will be undertaken in India.

The involvement of World Health Organisation, other International health organizations, Ministry of health, Ministry of External Affairs in efforts to produce safe, effective anti-venoms locally or regionally is of paramount importance also promote awareness and help coordinate regional and global efforts in this area through regional training workshops and other activities to promote guidelines on anti-venom manufacture and control. Also, programs can involve between India-Brazil-Costa Rica for workshops and seminars, as well as a variety of activities aimed at enhancing the anti-venom production, quality control and capacity of manufacturers.

(The author is Director of Trade and Investment of Grupo 108 and Independent Latin America and Caribbean Countries Market Expert. Email: intolatam@gmail.com. Views expressed are personal and do not reflect the official position or policy of the Financial Express Online.)