Southern Papua New Guinea (PNG) has some of the highest localised snakebite incidence rates in the world. In particular, Papuan taipans cause more than 90% of snakebites admitted to Port Moresby General Hospital, including 60% of all Intensive Care Unit ventilator bed-days. Historically, Australian-made antivenoms have been used to treat snakebite envenoming in PNG, but over the past 30 years the costs of these antivenoms has skyrocketed, making them unaffordable and in short supply.
Safe, effective and affordable antivenoms save lives, yet Papua New Guinea faces constant, chronic shortages of these WHO-mandated Essential Medicines.
To address this problem, we have developed a new, lower cost antivenom for the treatment of Papuan taipan envenoming. This product, developed in a collaboration between CCTC, the UPNG School of Medicine & Health Sciences (University of PNG), the Australian Venom Research Unit at the University of Melbourne and the Instituto Clodomiro Picado at the Universidad de Costa Rica, has been subjected to preclinical assessment in accordance with World Health Organization (WHO) recommendations for the evaluation of candidate antivenoms, and has been shown to have overall potency against the lethal effects of this venom equivalent to the antivenom currently available in PNG (CSL taipan antivenom).
In a Phase I randomised controlled trial the new antivenom had equivalent efficacy against the neurotoxic activity of taipan venom, and superior potency against the medically important blood clotting effects. A larger Phase II clinical trial is almost complete and preliminary data analysis suggests that the antivenom will reduce the proportion of cases requiring intubation, significantly reducing the costs of treatment and the length of hospital stay.
At completion of the clinical trials, an application will be made to register the new antivenom with the PNG National Department of Health. As part of CCTCs sustainability plan, the costs of continued venom production, antivenom distribution, operation of our snakebite clinic, laboratory, ambulance services and health worker/community training activities will be incorporated into a final product price. Even with subsidization of these value-added services, we expect the price of the new antivenom to be approximately 25% of the cost of current antivenoms, ensuring that adequate supplies can be made available to all facilities and to all patients who need this life-saving medicine.
An application for registration of the new antivenom will be made to the National Department of Health later this year, with the hope that it will be able to enter general use sometime in 2017, bringing an end to the current cycle of chronic antivenom shortages that cost many lives every year.
When it comes to bites by taipan snakes – and the PNG taipan has perhaps the most toxic venom of any snake in the world – this is a major problem, because the longer that it takes the victim to reach a health facility where antivenom can be given, the more likely it is that antivenom will not be completely effective, or may not work at all. And in rural areas where advanced emergency interventions to support life are not available, lack of access to antivenom after a taipan bite is a death sentence.
Victims of taipan bite need to receive antivenom as soon as possible if they are to survive.