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Low production, inadequate distribution chains, and the need for species and region-specific products thwart global antivenom availability (14�C16). The result of low output and high Reelin Production costs are antivenoms that are unaffordable to those who need them most. There is a global deficiency of appropriate antivenom supply, and the poor rural areas most burdened by snakebite, such as Sub-Saharan Africa and parts of Asia suffer most from this limited availability, resulting in poor treatment outcomes (8,12,17). A commendable step was taken with the publication of the WHO Guidelines on production, control and regulation of snake antivenom immunoglobulins in 2008 (18). However, possibly due to the absence of follow up meetings or updates since, problems in the implementation of these guidelines in high-burden regions have arisen. In order to combat some issues of access, the WHO has included snake antivenom immunoglobulins in the WHO Model List for Essential Medicines, encouraging countries to do the same and thereby ensuring national antivenom stocks; this has yet to show an increase in global access to antivenoms (11,12,14). The reasons behind this have not yet been thoroughly researched, creating a need to investigate the barriers to antivenom accessibility. This study focuses on the extent to which the international industry and state institutions have been able to implement and put to use the WHO Guidelines. Further emphasis is placed on the factors behind the epidemiological knowledge gap regarding snakebites, and what countries are doing to improve data collection. The study also identifies factors impeding global antivenom accessibility, and analyzes how manufacturers cope with stringent quality control measures, and increasing demand. Recommendations based on the research findings are provided at the end. Objective The objective of the present study is to make recommendations concerning the improvement of antivenom access and control globally, by providing a clear overview of the factors limiting the successful implementation of WHO Guidelines within the international industry and state institutions. A second objective is to investigate the factors causing the epidemiological knowledge gap regarding snakebites. Methods Selection of participants Study participants were selected for three stakeholder categories: manufacturers, National Health Authorities (NHAs), and poison centers or experts. Participants included representatives from all WHO regions. All known (N?=?46) antivenom manufacturers were contacted based on the open-access WHO database of antivenom producers (19). NHAs from 23 high-burden countries were contacted, based on the attendance list of the WHO Bi-Regional Workshop on Production, Control, and Regulation of Antivenoms (2008, Jakarta), and 11 poison centers or experts from high-burden regions were contacted.