Bangladesh imports antivenom from India as the country has yet to produce an antidote of its own
The Directorate General of Health Services has undertaken a five-year project – worth Tk80m – to produce antivenom in Bangladesh by 2022.
According to a 2018 World Health Organisation (WHO) Report, around 7 lakh people in Bangladesh are bitten by snakes every year – and 6,000 of them are killed by the bites.
The WHO has undertaken a project, that should last until 2030, to reduce the number of deaths caused by snakebites. The project has prioritised producing and supplying antivenom; while the organisation is helping Bangladesh produce antivenom.
The antivenom used in Bangladesh is imported from India; where six companies produce the product.
Bangladesh imports Tk100m's-worth of antivenom to treat snakebite patients and just one Bangladeshi pharmaceutical company markets it – at almost Tk1,000 per vial.
"The annual demand for antivenom in Bangladesh is 10,000 vials worth Tk100m," Dr Md Sarowar Uddin Milon, deputy manager of the Emergency Preparedness and Response Programme of non-communicable disease control of the health directorate, told The Business Standard.
"Five hundred vials for divisional hospitals, 100 vials for every medical college and 50 vials for every sadar hospital are sent every year. Around eight-to-ten vials of antivenom are applied to snakebite patients depending on their condition," he added.
As a part of the project, as many as 120 species of snakes are being reared in an air-conditioned room at the ground floor of Chattogram Medical College's old academic building. Each box is labelled with information about the snakes inside each box. Mice, chickens and snakes are provided as food for the snakes.
Dr Sarowar furthered the price of antivenom will drop by half if the project to produce antivenom is successful.
"If the research is successful, antivenom will be provided to private institutes too, and there will be no shortage of antivenom. Then antivenom can easily be applied to snakebite patients. Additionally, it can be exported too," said Aniruddha Ghose, a researcher of the project and an associate professor of the medicine department in Chattogram Medical College.
It is a long-term project. We have made a roadmap and we are working according to that. After completing all the steps, antivenom will be made on a test basis and will be applied on different animals. If it works successfully it will be applied on human beings too, he said.
"The process of producing antivenom is ongoing based on the WHO's guidelines. WHO representatives have trained individuals concerned in producing antivenom and visited venom research centres. Apart from that, experts from Germany have trained local researchers on snake rearing and collecting venom, said Aniruddha Ghose.
A snakebite usually poisons the human body in three ways, as a: hemotoxin (blood), myotoxin (muscle), and neurotoxin (brain).
Dr Farid Ahsan, professor of the zoology department at Chattogram University, said most snakebite victims go to an ojha (local spiritual leader) for a cure.
Referring to his research, Dr Farid, professor at zoology department at Chattogram University, said, "Most of the victims die of black cobra bites. The majority of the victims approach an ojha for treatment, which is a dangerous practice. In the end, the ojha fails with his treatment and the patient dies."
In India, snakebite preventive is produced by collecting venom mainly from cobras, chandraboras and saw-scaled vipers. There is only one species of cobra in India but more exist in Bangladesh. Meanwhile, there are more chandrabora snakes in India than in Bangladesh. Saw-scaled vipers are found in India but rare in Bangladesh. Additionally, Indian and Bangladeshi cobras are different.
Dr Farid said 20 people died after being bitten by a certain species of snake in Rajshahi from 2013-2016. One of the main reasons for this was that the antivenom did not work properly.
As snake species vary by region, the intensity of their venom also differs. Due to this, the WHO has planned to produce antivenom from the venom of local snakes.
Dr Farid Ahsan was also a researcher for a previous venom production project in Bangladesh. He shared his experience and said, "After collecting the venom, we sent it to Taiwan but we did not receive a response. Later, the project ceased operating."
The antivenom project started in March 2018 and involves the: Zoology Department of Chattogram University, Medicine Department of Chattogram Medical College, Medicine Technology Society of Bangladesh, Bangladesh Association for Advanced Mentor Tropical Medicine, and Goethe University of Germany.
Venom is regularly created by some of the project's snakes. Additionally, other snakes are observed for their physical development and health to determine if venom can be collected from them.
Initially, the project aims to collect venom from ten species of snake. Nine of these species are being reared and the venom collected is being sent to labs in Rajshahi and Germany for categorisation.
The project is to be implemented in five phases. During the first, ongoing phase, snakes are being reared after being brought in from Chattogram, Khulna, Satkhira and other regions.
In the second phase, the venom will be collected and categorised. In the third phase, a model will be created with the collected venom. According to the category, antivenom will be included in the model.
In the fourth phase, the venom produced will be tested on animals and then snakebite patients – to determine their effectiveness. In the final phase, initiatives will be taken to commercially produce antivenom.