Nigeria: Why Scarcity Of Snakebite Vaccines?

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An early process in the search for anti-venom. Source: bbc.com

Massive deaths from snakebites have become a recurrent decimal in Nigeria. The casualty figures usually get more staggering during the heat when these cold-blooded reptiles are forced out of their hiding places in search of fresh air.
That period, usually between January and April, is incidentally the time farmers go to the fields to clear their farms, preparatory to the farming season.
It is also the time herdsmen in the north move into thicker forests in their search for greener fields in view of the harsh realities of the dry season.
Records from various snakebite treatment centres across the country have also indicated that the figures go up during the harvest season, especially for crops like rice and yam.
According to a medic at Zamko Comprehensive Medical Centre, Langtang, a snakebite treatment point in Plateau State, rats go to yam farms to eat yam, snakes go to the farm to wait for the rats. When farmers reach their farms for the harvest, they get bitten.
During one of such peak snakebite periods last year, 250 victims died within three weeks in Plateau and Gombe States.
The figure represented the number of confirmed deaths in two snake treatment centres – General Hospital, Kaltungo, Gombe State, and Zamko Comprehensive Medical Centre. More victims were confirmed to have died at herbal treatment centres within the period.
States worst hit by the menace include Gombe, Bauchi, Taraba, Adamawa, Plateau, Borno, Nasarawa and Benue.
Dr Nandul Durfa, managing director, Echitab Study Ltd Guarantee, the outfit handling the collection and distribution of Echitab Anti-Snake Venom (ASV), from their production centres in United Kingdom and Costa Rica, says that the situation has been particularly bad this year because of a paucity of the ASV.
“As at January, we had less than 200 vials left for the whole country. The report we get from the snakebite treatment centres is mind boggling, but there isn’t much we can do,’’ a hapless Durfa told newsmen in Jos recently.
He said that his outfit was expecting the next supply of 2,000 vials from Micropharm Ltd in Wales, UK, and another consignment from ICP University in Costa Rica, on April 22.
“Clearly, the nation is in trouble at this peak period of snakebite. The quantity in the store has proved too little to meet the demand. The situation is frightening.
“Already, the snakebite treatment centre at the General Hospital, Kaltungo, receives an average of 16 cases a day. That centre received more than 3,086 cases last year. The situation is even worse at the Zamko medical centre,’’ he said.    
He regretted that not much attention was being paid to victims of snakebites, and blamed that on a claim that the victims of snakebite were mostly the poor people.
“Everyone should be interested in assisting victims of snakebites because those affected are mostly the productive group – the farmers, miners, hunters, youths and herdsmen – responsible for our food, milk, meat and other critical areas of the economy,’’ he posited.
But, with more Nigerians dying as a result of snakebite, analysts have continued to wonder why the shortage of the ASV has persisted over the years. They particularly wonder why Nigeria had yet to start producing the facility locally so as to make it readily available and affordable.
Durfa says that ASV is always in short supply because of the process involved in producing and ferrying it to Nigeria.
According to him, ASV comes 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.
 Durfa says that tedious processes, lasting more than three months, are involved in producing and importing the ASV.
 “Normally, we take 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 ASV in 2006, but regretted that nothing came of 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 further 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 three 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 venoms.
 He traced the ASV’s production to 1991, when Prof. Olikoye 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 recalled.
 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 suggested that the Federal Government could establish a factory to manufacture the drug using a Public-Private Partnership (PPP) arrangement.
“The best arrangement is the PPP because government policies are usually unstable. One government can start a project that its successor may discard. That will take us back to square one.
“But if private hands are involved, continuity will be guaranteed,” he argued.
Durfa declared that snake bite was a menace that must be taken seriously because it was worse than Ebola, monkey pox and even HIV/AIDS.
“It happens mostly to the rural dwellers who stabilise the economy by farming. We cannot abandon them to face the consequences of heeding government’s call to return to the farm because that will not be good for the economy,” he said.
To be cont’d.
Sheyin writes for the News Agency of Nigeria.

Ephraims Sheyin