Guarantee the market: pooled procurement, subsidy, prequalification and regional manufacturing

The proposal

Treat antivenom as a market that must be actively guaranteed rather than left to unsubsidised demand. Combine: (1) pooled, guaranteed-volume procurement that gives manufacturers a predictable order book; (2) subsidy so the patient price is affordable; (3) a WHO prequalification/quality scheme that drives ineffective products out and gives buyers confidence; and (4) investment in regional manufacturing so products are made near, and matched to, the snakes that bite local people.

Why it would work

The core failure is economic, not technical: manufacturers have known how to make good antivenom for over a century. Sanofi's effective FAV-Afrique was withdrawn purely because unsubsidised sales collapsed below viability. Guaranteed procurement plus subsidy fixes the broken demand signal; prequalification fixes the "cheap but ineffective product displaces the good one" failure; regional manufacturing shortens supply chains and improves venom matching. The same guaranteed-market logic underpins vaccine procurement (e.g., Gavi).

Evidence

FAV-Afrique's collapse (production ended 2014; a dose cost >US$100; sales fell to a small fraction of burden) is the textbook demonstration that effective medicine disappears without a functioning market (MSF; The Lancet 2015). The WHO 2019 road map (halve deaths/disability by 2030) and Wellcome's £80m programme explicitly target production, regulation and access, noting the world makes less than half the antivenom needed and that up to ~90% of African product may be ineffective.

Implementation path

Establish a pooled procurement facility and subsidy fund (donor + endemic-country governments); stand up or expand WHO antivenom prequalification; underwrite technology transfer to regional producers (e.g., public institutes such as Instituto Clodomiro Picado, Butantan, or African facilities); tie purchasing to quality standards.

Trade-offs and limitations

Requires sustained, coordinated financing and political will across many low-income countries and donors — historically the missing ingredient. Subsidy without quality control can entrench bad products; regional manufacturing needs regulatory capacity that some countries lack. This solution fixes availability and affordability but depends on the efficacy sub-issue for products worth buying.