02767nas a2200385   4500000000100000008004100001260001200042653001800054653001500072653003400087653003200121653002400153653002500177100001200202700001200214700001000226700001300236700001200249700001400261700001500275700001200290700001200302700001500314700001400329700001500343700001400358700001200372700001500384245008000399856007000479300001100549490000700560520180000567022001402367       2021                            d  c11/202110aAffordability10aAntivenoms10aHealth services accessibility10aNeglected Tropical Diseases10aRegulatory capacity10aSnakebite envenoming1 aPotet J1 aBeran D1 aRay N1 aAlcoba G1 aHabib A1 aIliyasu G1 aWaldmann B1 aRalph R1 aFaiz MA1 aMonteiro W1 aSachett J1 adi Fabio J1 aCortés M1 aBrown N1 aWilliams D00aAccess to antivenoms in the developing world: A multidisciplinary analysis.  uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8578041/pdf/main.pdf  a1000860 v123 a<p>Access to safe, effective, quality-assured antivenom products that are tailored to endemic venomous snake species is a crucial component of recent coordinated efforts to reduce the global burden of snakebite envenoming. Multiple access barriers may affect the journey of antivenoms from manufacturers to the bedsides of patients. Our review describes the antivenom ecosystem at different levels and identifies solutions to overcome these challenges. At the global level, there is insufficient manufacturing output to meet clinical needs, notably for antivenoms intended for use in regions with a scarcity of producers. At national level, variable funding and deficient regulation of certain antivenom markets can lead to the procurement of substandard antivenom. This is particularly true when producers fail to seek registration of their products in the countries where they should be used, or where weak assessment frameworks allow registration without local clinical evaluation. Out-of-pocket expenses by snakebite victims are often the main source of financing antivenoms, which results in the underuse or under-dosing of antivenoms, and a preference for low-cost products regardless of efficacy. In resource-constrained rural areas, where the majority of victims are bitten, supply of antivenom in peripheral health facilities is often unreliable. Misconceptions about treatment of snakebite envenoming are common, further reducing demand for antivenom and exacerbating delays in reaching facilities equipped for antivenom use. Multifaceted interventions are needed to improve antivenom access in resource-limited settings. Particular attention should be paid to the comprehensive list of actions proposed within the WHO Strategy for Prevention and Control of Snakebite Envenoming.</p>
  a2590-1710