REPORT OF The Lancet Special Commission ON THE RELATIVE STRENGTHS OF DIPHTHERIA ANTITOXIC SERUMS.

Envenomation challenges international public health, and antivenom serum is a strategic tool in the management of this condition. However, although antivenom serum has been in use since the late 19th century, the accessibility, quality and safety of this essential health product are still causes for concern in the most affected areas. The reasons for such a situation are multiple and include the poverty of snakebite victims, the high production costs of serum, the logistical difficulties pertaining to the mostly rural location of envenomation events, however one root cause has been the recurring difficulty to standardize antivenom serum as a health commodity. This paper, grounded in “Science and Technology Studies” (STS) focuses on this standardization issue, and argues that it can be explained in two complementary ways: on one hand, the difficulty to standardize serum relates to the nature of venom itself, and on the other hand, it relates to the social and institutional characteristics of envenomation as a neglected disease. The argument is supported by the analysis of reports published by the World Health Organization expert committee on biological standardization from 1947 to 2022 and dealing with the standardization of venom and antivenom. The paper describes the successive standardization strategies implemented by international public health actors. This analysis shows that standardization procedures are shaped by a series of interactions between objects (venom and antivenom), scientific bodies of knowledge that characterize them (eg. toxinology or venomics), organizational and financial public health regimes that frame their circulation. The difficulties raised by the standardization of antivenom reveal the problematic articulation between these domains. Acknowledging this problematic articulation, the discussion emphasizes its consequences for the understanding of relations between medical technologies, global markets and so-called “natural resources”. One conclusion drawn from these findings is to call for a “One Health” approach that would take into greater account the diversity and complexity of non-human life.

The COVID-19 pandemic, caused by SARS-CoV-2, has led to a rapid search for therapeutic and preventive measures because of the potentially severe course of infection. The antiviral drug, remdesivir, and the anti-inflammatory agent, dexamethasone, have shown beneficial effects. As the current COVID-19 vaccines are not yet fully available to everyone, or they may not be readily and universally accepted, various treatment options are being evaluated and will still be needed under these conditions. One of these treatment options, passive immunization, has shown promise in some studies. Further research is needed to determine the utility of immunotherapy with convalescent plasma or artificially produced monoclonal antibodies for the treatment of symptomatic patients, and potentially for use as post-exposure prophylaxis, at least until more effective drugs are available or safe and effective vaccines are distributed and administered to everyone.