Snakebite continues to be a significant public health issue worldwide. In the current issue of Wilderness and Environmental Medicine (2009;20:43-56), Ian Simpson and Robert Norris have published an article entitled, “The Global Snakebite Crisis – A Public Health Issue Misunderstood, Not Neglected.” In this very well thought out concept paper, the authors introduce a marketing model to examine global snakebite and to identify if the current approach to treatment (specifically, with antivenom) is relevant and effective. They use a model to examine if the correct products are available, whether sufficient information exists concerning estimated market size, whether the assumptions frequently made about the costs of the product are correct and fully understood, if the product is promoted properly, and whether the method by which the product reaches the end user is optimum.
By their reasoning, the authors present the case that perhaps the current approach to antivenom issues is not adequate, and compounded by a lack of implementation of key solutions, such as training doctors in developing countries with relevant protocols.
Multiple flaws in snake antivenom (ASV) production and distribution are revealed, including selection of venoms against which to create ASVs, unscrupulous behavior by certain manufacturers, assumptions about the epidemiology of snakebites, definition of envenomation syndromes, estimations of mortality, sustainability of the current economic model, and others. The authors do not merely sit back and take shots at what they perceive to be flaws. They offer a practical model for how it might be possible to achieve solutions for most of these issues.
This paper has already stimulated a great deal of discussion, and will undoubtedly be viewed by some readers as provocative. The topic of snake bite, and therefore ASV production, distribution, and use, is on the agenda of the World Health Organization. Anyone interested in venomous snakebite and the medical-economic-social-political issues related to antivenom and other medical interventions for envenomation, would be interested in reading this paper carefully, and considering how best to determine if there is a need to validate the contentions and suggestions.
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