Vietnam hospitals lack antidotes, antivenom

For nearly a week, a boy has been in a coma at Bach Mai Hospital, Hanoi’s largest public facility, following a snake bite due to lack of an antidote.

“Patients bitten by venomous snakes like him would have to be put on a ventilator from two weeks to a month. If there’s an antidote available, it would only take two to three days before they could be discharged,” Nguyen Trung Nguyen, director of Bach Mai Poison Control Center, said Wednesday.

The center is also treating two patients suffering from arsenic poisoning. They have received two simple antidotes, but have side effects and severe allergies. There is currently no antidote available that can remove the arsenic from the patients’ bodies, he said.

“There are better drugs, but the hospital cannot buy them immediately to treat patients. Moreover, even the most basic antidotes for those with paracetamol or methanol poisoning are also lacking,” he added.

Bach Mai Poison Control Center is one out of two foremost units when it comes to treating poisoning in Vietnam, with around 2,000 patients being treated each year. Most of them have very severe symptoms and high chances of death.

Nguyen said antidotes are vital in such treatments. They can reverse the poisoning process and return patients to a normal state, substantially reducing their chance of death.

“However, there is a lack of such drugs, requiring doctors to use all available treatment method to help patients, even with low efficiency. We really need antidotes,” he said.

The same situation is also happening at Cho Ray Hospital in Ho Chi Minh City, the foremost poison treatment unit in southern Vietnam. The hospital is currently lacking antivenom and antidotes for heavy metal poisoning, like mercury.

Le Quoc Hung, head of the hospital’s Tropical Disease Department, said these drugs have to be imported, and has long been in shortage due to supply issues.

“Other common antidotes can still be used for basic treatment. Sometimes there are shortages, but the hospital can still secure them in a short amount of time,” Hung said.

Dao Xuan Co, director of Bach Mai Hospital, said antidotes are often scarce, and companies do not want to import them due to low profit.

For example, dozens of people in Vietnam had botulinum poisoning due to consuming contaminated vegan pate in 2020. Vietnam had no antidote available at the time, so they had to be bought from Thailand.

“Such rare poisoning cases happen once every few years, meaning hospitals do not store antidotes. Such drugs also have expiration dates,” Co said.

When it comes to snake antivenom, an expert said the production for such antivenoms is quite costly. There are several snake species in Vietnam whose bites among humans are reported only a few times per year, while producing just a few vials of antivenom would require a large assembly chain. As there are such few poisoning cases, procedures to approve these drugs are also complex as there are simply not enough people using them to evaluate the drugs’ effectiveness and side effects.

Bach Mai Hospital has already proposed the Ministry of Health to store scarce drugs, as they must be ready whenever a case shows up.

“Such a storage could be located at one of the hospitals with poison control centers, like Bach Mai or Cho Ray… and drugs could be distributed to medical facilities throughout the country when the need arises,” Co said.

A representative of the Drug Administration of Vietnam said antidotes are important drugs, but are usually scarce, with low demand and only used in special cases. They are also not readily available globally.

“The health ministry would propose to the government to have specific mechanisms when it comes to the sale and storage of certain rare drugs to satisfy treatment demand,” said the administration.

Vietnam has been suffering from shortages of drugs and medical equipment since April.

In Hanoi and HCMC, certain hospitals lack even basic equipment like needles and certain drugs. The causes have been attributed to delays in the drug approval process, impacts of the Covid-19 pandemic and bidding procedures for drugs and medical equipment.