The anti snake venom to be used in Sub continent and adjacent countries including Pakistan, India, Sri Lanka, Bangladesh, Bhutan etc. is effective against the following common venomous snakes, of whom different sub species are mostly found in each of the mentioned countries with slight difference of color, body structure and with variation in the composition of venom even among the geographically different groups of same specie
|a. Cobras:||Naja naja (S)|
|Naja oxiana (KPK)|
|b. Krait spp||Bungarus caeralus (ordinary Ktait) (S)|
|Bungarus sindanus (Pean in Thar) (S)|
|a. Russell’s viper||Daboia russelii sp. (S)|
|b. Saw scaled viper||Echis Carinatus|
|c. Other Vipers||Persian horned viper (Baloachistan)|
|McMahan’s Viper (Baloachistan)|
|Levantine Viper (Baloachistan)|
|Himalayan Pit Viper (Northern Areas)|
* (S) Presently Existing in Sindh
So far there is only one public sector organization involved in manufacturing of this life saving product i.e. National Institute of Health (NIH), Islamabad. Its production capacity is limited (only 20000 to 25000 vials/ year) as compared to National demand because of decade’s old manufacturing unit (1960s) which could not be updated with the ever increasing demands.
The NIH at present is producing only 13.33% of the total national demand which is around 150,000 vials annually. There is an ever increasing demand and supply vacuum in Pakistan, and the province of Sindh with highest number of snake bite cases suffers most of this shortage. The same is true for other regional Countries even in India where 10 such manufacturing institutes were working but now four of them have changed their production priorities to produce other costly biological products and due to strong movement for restoration of animal rights by Sonia Gandhi.
The product produced by NIH is against four common venomous species of Pakistani Snakes and is being priced at Rs.700/- per vial of 10 ml. It is effective against a. Cobra, Saw Scaled Viper (Echis Carinatus Schureki) Russell Viper and Krait and each vial of it is having potential of neutralizing 4.5 mg of venom of each four types. The NIH is a public sector organization working on no profit no loss basis. The lower cost of it’s product attributes to various factors like low paid salaries, limited capacity building, rudimentary research and development activities, short staff, poor animal farming, scanty budget for lab operations and poor quality control, and above all no autonomy to tune strategies for conversing market forces or to meet institutional development demands.
The cost of finished product of high purity and effectiveness will definitely be high especially if produced by private sector alone. However, it can be sold at reasonable profit to hospitals/dispensaries/Medical Institutions and chemists as an essential life saving commodity. The liquid form preparation (shelf life 2 years) although costs less but is advantageous only where cold chain system is being ensured, if not than needs to introduce a more costly lyophilized form having shelf life of more than five years. This financial hypothesis is further supported by the fact that ASV in other manufacturing countries, like Japan, Burma, Thailand, Australia, costs nearly double or triple than in Pakistan.
It is since last many years; ASV is being imported or smuggled from India and sometimes from Iran to cope the shortage. Such Indian or Persian sera partially help because are manufactured from biochemically different venoms of non local species. However some of these outside production are advantageous in terms of their polyvalent and lyophilized nature which is easy to transport and store than the liquid form. The total difference of biochemical characteristics of Egyptian, Korean, Saudi and Thailand snake venoms makes them of no clinical use for snake bite victims in Sindh.
It is therefore the Sindh ASV needs to be a representative antidote against all the six venomous species of medical importance. Although cross synergism allows neutralizing effect for the closely similar species like ASV produced from Naja Naja venom may effectively treat the Naja Oxiana cases and that made from the venom of common krait Bangarus Caeralus may neutralize the venom of Sindh Krait Bangarus Sindnus but scientifically it needs to incorporate the venoms of all six species in the ASV production spectrum. Likewise keeping in view the long duration power shut down and other cold chain deteriorating conditions the Sindh project has to produce Lyophilized (powder form) ASV for peripheral health service outlets as well as liquid form ASV for bigger hospitals having standby power supply system and more trained staff for sustaining the cold chain.