Strengthening antivenom access in South Africa: Regulatory priorities and policy actions

Abstract

The critical antivenom shortage in South Africa is a consequence of fragmented regulations, constrained manufacturing capacity and weak stakeholder coordination. The snakebite envenoming (SBE) burden is preventable if access and equity are prioritised. Priority barriers were identified using the nominal group technique (NGT) through two expert consultations with members of the South African National Snakebite Advisory Group (NSAG). Experts emphasised urgent reforms to regulation, improved surveillance, supply chain governance and clinical guidance. Recommended actions include listing SBE as a notifiable medical condition, streamlining Section 21 import authorisation processes, strengthening national stockholding strategies, and restructuring South African Vaccine Producers (SAVP) through a public-private partnership. Through strong stakeholder engagement and leveraging technical expertise, the chronic antivenom shortage could be reversible. Without immediate regulatory and strategic reform, preventable deaths and disability from snakebite will continue.