By Chloe Vasquez | 06 March 2025
I travelled to Hyderabad not for the legendary biryani, but to unravel the mystery behind antivenom pricing in India. I planned to visit two key antivenom (often referred to as “Anti-snake venom,” or ASV in India) producers in the region. Biological E. Limited and VINS Bioprodicts produce the highest quantity of snake antivenom vials per year. These pharma giants are both located outside of Hyderabad city center, close to the airport.
Globally, antivenom markets are broken and unreliable, plagued by sky-high prices, severe shortages and the constant drop-out of producers from the market. India is a special case. Antivenoms here are cheap and widely available.
So, how is India producing so much antivenom at such a low cost?
Biological E. Limited currently produces 4 antivenom products:
- Indian Polyvalent, which targets (Spectacled Cobra), (Common Krait), (Russell’s Viper) and (Saw-Scaled Viper) snakes’ venoms
- Pan-Africa (10), which targets 10 of Africa’s most venoms: Bitis gabonica (Gaboon viper), Bitis arietans (puff adder), Echis leucogaster (white-bellied carpet viper or Roman’s saw-scaled viper), Echis ocellatus (West African carpet viper), Naja haje (Egyptian cobra), Naja melanoleuca (Forest cobra), Naja nigricollis (Black-necked spitting cobra), Dendroaspis polylepis (Black Mamba), Dendroaspis viridis (Western Green Mamba), and Dendroaspis jamesoni (Jameson’s Mamba).
- Central Africa (6), which targets Bitis arietans (puff adder), Echis leucogaster (white-bellied carpet viper or Roman’s saw-scaled viper) Naja haje (Egyptian cobra), Naja nigricollis (Black-necked spitting cobra), Cerastes cerastes (Saharan horned viper), Macrovipera deserti (Moorish viper).
- Echis Monovalent, targets the venom of Echis ocellatus, the West African carpet viper. Bites from this snake kill more people than all other African snakes combined.
The Indian government has price controls on antivenom, such that no company can domestically sell the vials for more than 420 rupees (about $5 USD) each. Keep in mind that antivenom in the US can cost around $3,000 to $40,000 per vial. In other countries, a vial will set you back a few hundred USD. I was curious how Indian antivenom manufacturers can meet (and sometimes even undercut) this $5 price cap.
Companies like Bio E. can produce at this price for two reasons:
1.) Economies of Scale in Production Quantity
India has a huge population that is exposed to snakebites, so there’s a large market for antivenom. Why? The country is densely populated, but most areas are exposed to wildlife. A lot of agricultural work is conducted in a rustic manner, using hands rather than machines and working without shoes. Many communities remain mired in poverty, with poor housing that may allow snakes to slither under doors or through cracks in the walls. All these factors make India the world’s “snakebite capital,” with a million cases of envenoming estimated per year. Since so many people get bitten by venomous snakes across India, there is a high demand for antivenom, such that manufacturers can produce at scale.
2.) Economies of Scale in the Quantity of Products
Besides the high demand, there is a lot of bureaucracy involved in pharmaceutical operations: permits, legal proceedings, sales and marketing of the antivenom, etc. For a company that produces other pharmaceutical products besides antivenom, they are already engaging each state health ministry to participate in tenders (tenders are the process by which governments buy pharmaceuticals, explained in more detail below). So, they can lean on these same salesmen, lawyers and experts to push antivenom through the drug acquisition system.
Besides the domestic market, I wanted to know how Biological E. can sustainably export antivenoms. On the African continent, other companies such as Sanofi Pasteur have dropped out of the market due to poor profitability. Yet, Bio E. has been producing for Africa and is even developing new products for the continent. One component could be lower costs compared to global north-based companies. India is well known for its competitively priced pharmaceutical industry.
There is one other main reason that Biological E. can afford to sustain antivenom manufacture. Dr. Palakurthi explained that Bio E. already exports a range of other pharmaceutical products. When a pharma company hopes to export a product, they navigate the regulations of the importing country, gain a series of export and import permits, and understand the local drug distribution system (Who is the purchaser? National health ministries? State health ministries? Private hospitals or pharmacies?). This is time-consuming and expensive, requiring local counterparts in each country. Since Bio E. already sells other products to many African countries, however, they can add antivenoms to their international portfolio for a small marginal cost, rather that having to overcome all of these obstacles from scratch.
Dr. Palakurthi explained some of the intricacies of antivenom production. The company takes great care to filter out potential contaminants. The process is costly, and with price caps, antivenom production is not a profitable endeavor.
Insights from India’s Largest Antivenom Producer
On Monday morning, I headed to VINS Bioproducts to meet Dr. Darshan Patel. In contrast to Bio E. and most other Indian manufacturers, VINS Bioproducts focuses on antisera and immunoglobulins. VINS is India’s largest antivenom manufacturer in terms of vial production; they produce about 2 million vials of Indian Polyvalent ASV annually, and another 500,000 vials for export. They make 3 products for Africa: Echiven (Echis monovalent), Biosnake (African trivalent), and Afriven (a polyvalent made to reverse envenoming from 10 species across the continent). These products are exported around the continent, to Kenya, Libya, Chad, Egypt, Sudan, Ethiopia, Nigeria, Tanzania, and Algeria (among others, as of March 2025). However, Dr. Patel reported that demand from the continent is unreliable. The funding frenzy that came after snakebite was recognized as a Neglected Tropical Disease in 2017 created a sudden interest in producing ASV for Africa. As different companies vie for African purchasers, clients may shift their preferences over time. Antivenom regulation is still developing in many countries, which may also suddenly change demand. So, it’s hard to know how much antivenom to produce for Africa each year.
Even domestically, states may supply ASV from different companies depending on the quoted prices. In addition, the quantity of snakebites each year is hard to estimate. Data is sparse, and most health facilities don’t currently report snakebites. Even if they did, the number of bites per year will fluctuate depending on factors such as rainfall, temperature, and even chance. Unreliable demand is a big problem for manufacturers, given that antivenom supply is not so flexible.
Challenges to Production:
After getting the forecast, VINS estimated that they need 9 months to one year to even begin producing that ASV (and this is for established products; new products take 3-4 years to get off the ground, since they must also undergo testing, licensing and regulatory processes).
According to the forecast, manufacturers may have to acquire horses, which then require 6 months to slowly gain immunity to the venom. If a company produces more than one antivenom product, the WHO does not recommend switching a horse from one venom scheme to another (e.g. Indian venom to African venom).
There are many production factors that are outside of companies’ control but affect production. During the rainy season, horse farms are more likely to experience waves of infections (think “flu season,” but for horses). Sick horses cannot be used for antivenom production, according to WHO guidelines. Instead of targeting venom toxins, their immune systems will be chugging out antibodies against whatever infection they are fighting. These outbreaks can be controlled using quarantines, but it requires vigilance and veterinary services, which add more costs.
VINS claims that its biggest current hurdle is quality venom. Dr. Patel cited the poor quality of venom from the Irular Co-Op, the only licensed venom producer in India. Low quality venom has to be further filtered to ensure that contaminants don’t cause infections in the equines. During this filtration process, there is some loss of venom. So, ASV producers may have to buy even more venom to make the same quantity of antivenom. At the same time, poor quality venom makes a less effective product (since some toxins will be degraded, and no amount of filtration can bring them back). Besides the quality, Irular Co-op often fails to fill their orders on time (I covered some of the reasons why in my blog on the Co-Op).
Dr. Patel mentioned that most ASV manufacturers would produce snake venom themselves, but licenses to house snakes are very difficult to come by. This is partially because snakes are protected under the Indian Wildlife Act. Second, there is a black market for venoms because some people have tried to use venoms as narcotics.
Right now, VINS is encouraging the Centre for Cellular and Molecular Biology (CCMB) to get a license to host a serpentarium and supply higher quality venom.
How Tenders Work in India:
Nationally, the Indian demand for antivenoms hovers around 4 million vials, and this is likely to increase over the coming years as the National Action Plan for Snakebite (NAPSE) increases awareness of proper first aid and improves access to healthcare. Improved data systems will also give state governments a better sense of local ASV needs. 90-95% of VINS’s antivenom sales go to the public sector through a “tender” system. How does this work?
- State health ministries “float a tender,” which is basically a reverse auction. The health ministry stated how much ASV they want to buy, and companies compete to give the lowest price, called “filing for the tender”.
- The company that quotes the lowest price wins the tender. They are now “T1” and get to fill however much of the order they can supply.
- Now, let’s say T1 cannot fulfill the full order. They can only produce 60% of the required antivenom vials. Now, T2, the company who quoted the second highest price, will have the opportunity to match T1’s price. If they say ‘yes,’ they get to fill the gap.
- If companies do not fulfill orders on time, they have to pay a penalty and they will be “blocklisted,” or not allowed to participate in tenders over the next 3-5 years
In this way, companies must compete to sell their products (in this case, antivenom vials). Companies are not allowed to collectively decide to raise the price of their antivenoms. This would be oligarchic behavior and is illegal. Also, remember that there is a per-vial price cap of 420 rupees (about $5 USD).
Some critics argue that this system can create a sort of “race to the bottom,” such that companies must cut corners in production to meet such low prices. Indeed, Indian antivenom has a poor reputation internationally for its quality. Researchers have cited dwindling protein concentrations in many of the largest manufacturers.
Outsourcing Serum Production to Simplify Business
In most of the world, antivenom producers keep their own horse farm and produce ASV from venom to vial. In India, however, the production chain is more fragmented. Bharat Serums has sold off its ASV horse farm, and entirely outsourced serum-production to Raut Serums (a company which houses the horses and immunizes them, bleeds them, and sells the separated plasma). ViNS, Premium Serums, Biological E., and others are shifting more and more serum production to Raut. Why?
This cuts out the need to constantly test venom quality and addresses the complexity of maintaining an equine farm.
“It’s a very hectic job,” Dr. Patel said. “Deciding how many ponies to immunize against which venoms, outbreaks, venom quality issues, stalled venom deliveries, the need for permits and lawyers, etc.”
All these issues can be pushed onto Raut Serums, who can handle these at scale.
Takeaways
- Antivenom is expensive to produce
- It is a biological product with many moving parts
- Antivenom demand fluctuates and is difficult to forecast
- Antivenom supply is inflexible
- There are price caps on antivenoms in India, keeping prices very low.
What does all this mean?
Antivenom is not an attractive market. Existing players may leave at any time, and current manufacturers are not interested in investing more than they currently do. Old players may slowly increase their manufacturing quantities.
Dialogue is going on between ASV manufacturers, the WHO and Indian government. India hopes to produce regional venoms and antivenoms, improve antivenom quality, and get approved by the WHO “Pre-Qualification Programme” (PQP), a certificate which would give them a stamp of WHO approval. This way, states can make a more informed decision about which product is most effective.
While global snakebite funds seem to be taking a hit, things are moving quickly in India. The 2024 release of the National Action Plan for the Prevention and Control of Snakebite Envenoming (NAPSE) triggered a cascade of action, and many states are now working on state action plans. Venom production centers are popping up across the country, wading through the bureaucracy to gain licenses and permissions. Policy is giving more legitimacy and resources to civil society actors, and, despite many remaining challenges, the future currently looks bright.
Want to learn more? Check out these links:
Venom, Antivenom Production and the Venomous snakes of India
Biological E. Antivenom Products
MoU Signed between Vins Bioproducts, India, and Atlantic Lifesciences, Ghana!
In India, a Need for New Antidotes to Curb Deadly Snakebites
Chloé is a recent undergraduate student learning about snakebite management around the world. When her mother survived a Bothrops asper bite in 2020, she decided to dedicate her career to ensuring all people have access to quality snakebite information and treatment. At the moment, Chloe is interning at the Madras Crocodile Bank in South India, learning about snakebite management.