Time for an alternative perspective: the eternal problem of supply and quality of anti snake venom in the developing world--"it's the economy, stupid".

The "crisis in anti snake venom supply" has been an enduring problem. Despite the frequency with which it appears in the literature, it remains unquantified and an enigma. If there is a serious shortage of anti snake venom (ASV), why has this not been resolved? Anti snake venoms are produced, and yet many suppliers are described as leaving the market. There appears to be a problem in the call for highly effective, high-quality, and cheap anti venoms that contributes to this result of suppliers leaving the market. Private companies are tasked with achieving adequate shareholder returns and by doing so ensure continued supply. Efforts should therefore target a means of lowering production cost by introducing whole immunoglobulin G (IgG) antivenoms with greater antibody yields, reducing the drive to eliminate adverse reactions, for which there are other more cost-effective treatments, as well as a means of introducing good manufacturing processes, with care based on demonstrable need. In order to ensure sustainability of supply, a private company supplier providing a whole IgG antivenom that effectively neutralizes venom is the most credible option. The need for ASV in areas of shortage mandates the need for clear decisions regarding the type of ASV and the recognition that the market requires acceptable returns for producers if supply is to be sustainable. This paper reviews the economic realities of ASV production and suggests a pragmatic, sustainable approach to the problem of supplying ASV to developing countries.