South Africa’s Antivenom Shortage: A Crisis Years in the Making
South Africa is once again facing a serious shortage of antivenom. But describing the current situation simply as a temporary stock-out misses much of the story.
South Africa is once again facing a serious shortage of antivenom. But describing the current situation simply as a temporary stock-out misses much of the story.
South African Vaccine Producers (SAVP) is South Africa’s only domestic antivenom manufacturer, and NHLS describes it as the only manufacturer of antivenom in the sub-Saharan African region. That makes disruptions at a single facility potentially consequential region-wide.
Factors leading to the shortage trace back several years, drawing on National Health Laboratory Service (NHLS) records, official communications, news reporting, scientific literature, and the experiences of medical, veterinary and snakebite professionals. Taken together, they describe a recurring supply problem that predates the widely reported shortages of 2023 and has continued despite major investment in South Africa’s antivenom-production infrastructure.
Warning signs before the crisis became national news
The problems did not begin in 2023.
NHLS's 2020/21 annual reporting documented a 13.75% decline in SAVP antivenom sales, delays involving imported raw materials, procurement and maintenance problems, and a substantial antivenom back-order. Major upgrades to the production area were already being planned.
By March 2022, the African Snakebite Institute was reporting that SAVP had no stock available for hospitals, doctors and veterinarians seeking antivenom. The following month, SAVP attributed production difficulties in part to mandatory Good Manufacturing Practice validation work.
By early 2023 the problem had become difficult to ignore. News24 reported production backlogs producing waits of at least six months, while veterinarians and other users were struggling to obtain stock. Professionals interviewed in subsequent reporting described orders that had gone unfilled for months.
The shortage became a major national story in April 2023, when hospitals, veterinarians, snake handlers and medical specialists publicly raised concerns about access to antivenom. Among the problems being discussed were aging machinery, unreliable backup electricity, refrigeration and infrastructure problems, staffing and management constraints, and the difficulty of keeping sufficient stock in circulation.
A Cape cobra bite reported that month illustrated a crucial distinction: antivenom can exist somewhere in the national system while still being effectively unavailable to the person who needs it. People involved in the case struggled to locate appropriate stock for the patient.
That makes antivenom supply a problem not only of manufacturing quantity, but of where the product is stored, who can access it, and how rapidly it can reach a patient.
A temporary recovery
The situation improved during 2023.
By November, NHLS reported that more than 6,100 vials had been distributed to 302 medical institutions during the year, and the Western Cape was reported to have adequate stock. The immediate shortage appeared, at least temporarily, to have been resolved.
But the production system itself was about to undergo a major disruption.
Renovating the only domestic production facility
During 2024 and 2025, SAVP underwent extensive renovations intended to address many of the problems that had contributed to the earlier instability.
NHLS documents describe a production system that had been hampered over the preceding five years by aging infrastructure and equipment, leadership instability, interruptions to electricity and water, and resulting disruptions to manufacturing.
The renovations were therefore necessary. But they introduced another vulnerability: antivenom production had to stop while the work was carried out.
NHLS's 2024/25 annual reporting states that all antivenom production processes were discontinued during the renovation period. Stockpiles had been accumulated in advance to cover the shutdown, but delays in completing and commissioning the facility — including work required for Good Manufacturing Practice compliance — meant that those reserves were depleted before normal production could resume.
By March 2025, manufacturing of snake, scorpion and spider antivenoms had ceased and remaining reserves were being exhausted.
This was particularly consequential because antivenom cannot be replenished instantly. Manufacturing biological antivenoms is a lengthy, specialized process involving production, purification, testing, quality control and regulatory requirements. Once reserves disappear, simply restarting the production line does not immediately restore stock to hospitals.
Production restarts — but rebuilding supply takes time
NHLS announced on 23 September 2025 that production had resumed at the renovated SAVP facility.
The first released batch contained 536 units of polyvalent snake antivenom, with additional batches of polyvalent, scorpion, spider and boomslang antivenoms projected to follow.
The restart was an important milestone, but restarting manufacture does not immediately restore a depleted national supply. Antivenom production is slow and technically demanding, and finished batches must pass extensive quality-control and regulatory requirements before they can be released.
By June 2026, shortages were again being reported.
An NHLS stakeholder communication dated 1 June projected that 1,300 units of polyvalent antivenom would be released on 15 July 2026. It also gave projected release dates for scorpion and spider antivenoms.
In a 20 July communication, however, NHLS listed polyvalent antivenom as out of stock and revised expected availability to 31 October 2026. Spider antivenom was also listed as out of stock with the same anticipated availability date. Boomslang, Echis and scorpion antivenoms were listed as available.
The expected recovery period was subsequently extended again.
In a stakeholder communication dated 11 September 2026, NHLS continued to list both polyvalent and spider antivenom as out of stock, with estimated availability for both products revised to 30 December 2026. Echis, boomslang and scorpion antivenoms continued to be listed as available.
NHLS emphasized in that communication that antivenom manufacture is an intricate and highly specialized process requiring precision, rigorous testing and strict quality assurance. The continuing shortage illustrates one of the fundamental difficulties of antivenom supply: once inventories have been depleted, production cannot simply be increased overnight.
The challenge of rebuilding supply
The changing 2026 availability estimates illustrate how difficult recovery can be after a prolonged interruption in antivenom production.
- 1 June 2026: NHLS projected the release of 1,300 units of polyvalent antivenom on 15 July.
- 20 July 2026: polyvalent antivenom was listed as out of stock, with expected availability revised to 31 October.
- 11 September 2026: polyvalent antivenom remained out of stock, with estimated availability revised to 30 December.
Spider antivenom followed a similar trajectory and was also listed as out of stock through an estimated 30 December 2026 availability date.
It is important to distinguish between manufacturing, release and actual access. A batch may be in production but not yet have completed quality testing; finished product may have been released but not yet distributed; and national stocks may exist while remaining difficult to obtain rapidly in a particular region.
This is one reason antivenom supply cannot be understood simply by asking how many vials have been produced.
More than a manufacturing problem
The South African experience illustrates a broader challenge faced by antivenom systems around the world.
South Africa depends heavily on a single domestic producer for products that may be urgently required when severe envenomation occurs. Maintaining reliable access therefore involves considerably more than keeping a production line operating.
A resilient supply system also depends on adequate reserve stocks, production forecasting, continuity planning, distribution networks, regulatory processes and mechanisms for responding when domestic production is temporarily unable to meet demand.
The relevant questions are therefore broader than, “When will the next batch be available?”
How large should antivenom reserves be? How should stock be distributed geographically? How quickly can it be moved when an emergency occurs? How can supply be maintained during periods of interrupted production? And what alternative sources or emergency mechanisms are available when domestic production is insufficient?
A 2026 South African Pharmaceutical Journal policy paper cited in the evidence dossier identifies several structural barriers, including constrained manufacturing capacity, fragmented regulation and weak stakeholder coordination. Proposed measures include improved surveillance, designated regional referral centers, streamlined emergency access mechanisms and a national snakebite task force.
The larger lesson
South Africa's experience provides a useful case study in just how difficult it can be to maintain a reliable antivenom supply.
Production difficulties were documented as early as 2020 and 2021. Serious shortages were publicly evident by 2022 and became a national issue in 2023. Supply subsequently improved, but extensive renovations intended to address aging infrastructure required production to be halted. When commissioning of the renovated facility took longer than anticipated, reserve stocks were depleted before full production could resume.
Manufacturing restarted in September 2025, but rebuilding inventories has proved difficult. As of 11 September 2026, polyvalent snake antivenom — the principal product used for a range of medically important South African snake envenomations — remained out of stock, with availability estimated for the end of December. Spider antivenom was in the same position, while Echis, boomslang and scorpion antivenoms were listed as available.
The renovations may ultimately leave SAVP with a more reliable and modern production facility. At the same time, the experience demonstrates why antivenom security depends on more than manufacturing capacity alone. Production, quality assurance, reserve stocks, distribution and contingency planning all have to work together.
For snakebite patients, the practical question is ultimately straightforward: when antivenom is medically necessary, can the appropriate product reach the patient in time?
South Africa's current shortage shows how challenging it can be to make sure the answer is consistently yes.