‘Nightmare crisis’ — SA’s National Health Laboratories run out of snake, scorpion and spider antivenom

4 Mar 2025

The National Health Laboratory Service has admitted that due to construction work at its facility, all manufacturing of snake, scorpion and spider antivenom has ceased.

The South African National Health Laboratory Service has stopped manufacturing snake, scorpion and spider antivenom and has not yet indicated when it will start again, leaving millions of people in sub-Saharan Africa at extreme risk.

“As of next month people will start dying,” says Arno Naude of Snake Bite Assist.

“Hospitals everywhere tell me they are running out.”

The National Health Laboratory Service has admitted that due to construction work, all manufacturing of snake, scorpion and spider antivenom has ceased and their stockpiles are now empty, except for boomslang antivenom.

“Today, exactly a year ago (4 March 2023), we were assured by the National Health Laboratory (NHLS) that they have ‘more than enough’ antivenom,” Naude said. “We thought they were back on track. But the truth is their stockpile was next to nothing.”

Upgrades

But this week, the NHLS’s Mzi Gcukumana said that in late 2024, the service reported that the South African Vaccine Producers (SAVP) facility had undergone extensive infrastructure and equipment upgrades.

“These upgrades were planned and necessary due to the deterioration of ageing infrastructure, which had hampered compliance with Good Manufacturing Practices (GMP) within the SAVP sterile manufacturing unit.

“This deterioration became more apparent during significant load shedding, resulting in frequent operational disruptions. A steady power supply is important for manufacturing controlled-air-and-temperature conditions,” Gcukumana said.

“Due to the extent of the work required, antivenom manufacturing processes had to be temporarily discontinued during the renovations. While in the middle of renovations, the project experienced delays due to postponed delivery of specialised equipment and the requirement to maintain required quality standards, both of which were aggravated by the rigorous regulatory environment for sterile manufacture.

“During this period, the stockpiles of spider, scorpion, and polyvalent antivenoms were depleted. As a result, only the supply of boomslang antivenom remains available for distribution. The NHLS is now concentrating on the commissioning of the facility. This process entails cleaning, validation and quality control protocols to meet the regulatory requirements for sterile pharmaceutical production.

“The NHLS is doing everything possible to speed up the final stages of the process to resume snakebite antivenom production and will keep providing updates on progress,” Gcukumana said.

Read more: Nationwide snake antivenom stockpile shortage an ‘absolute catastrophe’ – reptile expert

There are two types of antivenom in South Africa. Polyvalent antivenom is made from the poison of 10 types of snakes found in southern Africa — puff adder, Gaboon adder, rinkhals, green mamba, Jameson’s mamba, black mamba, Cape cobra, forest cobra, snouted cobra and the Mozambique spitting cobra.

Boomslang antivenom can be used to treat only boomslang bites.

Naude said the failure of the NHLS to provide sufficient antivenom should cause outrage in South Africa as thousands of lives of both humans and animals are placed at extreme risk.

“We are going into the second peak of the snake season. During the Easter holidays, we always see a huge increase in snakebites,” he said.

Several sub-Saharan countries, including Uganda, had been buying antivenom from South Africa and now had to import it from elsewhere.

“South Africa is importing a product from India. It is a little cheaper, but you have to use more. But this is only available for emergency use if you have medical aid. You can’t find this in a state hospital. And even if you did, the product was never intended to be used in South Africa, so it doesn’t state on the leaflet that it can be used for … South African snakes. So the doctors are refusing to administer it, Naude said.

‘Poor and rural people will be hit hard’

“Poor and rural people will be hit hard by this. Most state hospitals in rural areas tell me they have maybe enough left for two or three bites and after that, their antivenom will be finished.”

He said there was a product in use in Swaziland that was cheaper and worked better than the imported product, but in South Africa, it could be used only by vets.

“They had good results there with this product. Out of 800 patients bitten, they did not have one death. But this product has not yet been approved by the World Health Organization,” he said, “and it can’t be used on humans in South Africa.”

Naude welcomed the upgrading of the equipment at the NHLS and said it also had become clear that in the recent past, the antivenom supplied by South Africa was not up to standard.

“The quality was not what it should have been and we saw a lot of allergic reactions. Skilled people have left the NHLS and their equipment is very old.”

However, he said they had been assured that there was enough stock to see the upgrading project through. “But then again, we are lied to all of the time,” he said.

‘Huge crisis’

“We have a huge crisis on hand,” Naude said. “Other countries in sub-Saharan Africa are buying antivenom from the Middle East and India. But they can just as well buy distilled water. It is completely useless. Also, it isn’t stocked by government hospitals so you also must go buy it yourself.

Read more: Grave warnings from snakebite experts as minister of health is asked to intervene in antivenom crisis

“No vets have antivenom any more,” Naude said. “This country should also be held responsible for the deaths that occur in sub-Saharan Africa because of what the NHLS has done.”

Apart from running out of polyvalent antivenom, the NHLS also no longer has antivenom for scorpion stings and spiders.

“Two weeks ago, a young child died in Botswana after a scorpion sting. Their family sold everything they had to buy vials of antivenom, but this was made for a scorpion in North Africa so it didn’t help,” he said.

“We are facing the prospect of hundreds if not thousands of deaths.”

He said if a person who has medical aid was bitten by a snake today, they could still scramble and find something to use. “But [it] might be too late. I have seen people die within 9 minutes.”

“The other problem is that people might survive, but without antivenom they will likely lose an arm or need a kidney transplant. The suicide rate among snakebite victims within two years after the bite is sky high, he said, “especially those who suffered a significant injury”.

“The government must stop messing around. Snakebites have been declared a neglected tropical disease. It is actually the most neglected,” he said.

He said the risk, especially in the Northern Western Cape, the Northern Cape, Limpopo, Botswana and Namibia of fatal thicktail scorpion stings were sky-high.

“Children and the elderly are especially at high risk. And there is nothing you can import for this scorpion sting, he said.

Naude said it didn’t help for the NHLS to declare that it still had boomslang venom.

“First, what does it help to have boomslang antivenom? These bites are so rare. You almost have to apply in writing to get a bite,” he said.

He said the antivenom could offer some solace, though, because he had witnessed a person dying from a boomslang bite “and it was excruciating”.

Steve Meighan from Deep South Reptile Rescue said it could not be overstated how much trouble the country was in. “And even if they start working today it will still take months before they are producing antivenom,” he said.

“I have been involved with snakes since 1991 and this is the first time that this [has] happened. He said in two recent cases, snakebite victims had to be treated with products from a vet.

Michele Clarke from the Democratic Alliance said the party would question the NHLS in the parliamentary committee on health on Wednesday (5 March) about the antivenom crisis.

“We will demand clarity on how much antivenom has been produced and distributed since 2023. The NHLS must also account for reported shortages in hospitals and what is being done to address them. The crisis is reportedly due to load shedding and renovations at the South African Vaccine Producers (SAVP). Reports indicate that South Africa, once an exporter of antivenom, is now forced to import substandard alternatives. This places thousands of lives at risk, especially in rural communities.

“South Africa records approximately 4,000 snakebites annually, with around 900 hospitalisations and 100 patients requiring antivenom. Without urgent access to treatment, severe complications or death can occur,” she said.

“A single snakebite can kill within hours—without access to antivenom, lives and limbs are being lost unnecessarily.” DM

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South Africa

Upgrades

‘Poor and rural people will be hit hard’

‘Huge crisis’