The Clodomiro Picado Institute (ICP), affiliated to the School of Microbiology at the University of Costa Rica (UCR), was established in April 1970. Its foundation was the culmination of a chain of national efforts that began with the pioneering work of the distinguished scientist Clodomiro Picado Twight in the early decades of the 20th century. These initiatives reached an important turning point in the 1960s, when an inter-institutional and international process called the "Antiophidic Serum Program" was developed. The objective of this program was to produce antiophidic serum in Costa Rica for the treatment of snakebite envenomations. These efforts led to the production of the first national batches of antiophidic sera in 1967, which were evaluated within the public health system and demonstrated to be effective.

Building on this initial success, the Clodomiro Picado Institute was founded in April 1970, initially a unit of the Ministry of Public Health. The laboratories located in Dulce Nombre de Coronado were built, and the first steps were taken to consolidate the project's human resources. In 1972, a pivotal change occurred when an agreement was signed between the Ministry and the University of Costa Rica (UCR). This agreement made the ICP a unit of the latter, attached to the School of Microbiology.

Membership at the UCR has been fundamental, as it allowed the ICP to expand its scope of action to include, in addition to the production of antivenoms, substantive university research, social action, and teaching. Thus, the ICP adopted a philosophy of comprehensive development, centered on the mission of contributing to the solution of the problem of snake envenomations through collective action that included generating knowledge through research and extending these scientific and technological inputs to society and university teaching. From the beginning, an institutional culture centered on teamwork and the integration of the contributions of all those involved was developed.

A solid endogenous science and technology program

Since its inception, the ICP placed great emphasis on consolidating an ambitious research agenda on topics related to snakes, venoms, and antivenoms. This agenda has included the biology of snakes and other venomous animals, understanding the chemical nature of venoms and their mechanisms of action, the search for new substances that inhibit venom toxins, the epidemiology and clinical characteristics of envenomations, the preclinical evaluation of serum efficacy, the study of toxins from other organisms such as bacteria, scorpions, bees, and fish, and technological development aimed at improving antivenoms and generating new medications.

Throughout its evolution, the ICP has established strong cooperative ties with other research groups in the country and on all continents, which has allowed it to join global knowledge-generating networks and contribute to the understanding of snakes, venoms, and antivenoms not only in Costa Rica but also in other latitudes. This process has been accompanied by the consolidation of a group of high-level researchers, who have forged a scientific and technological platform of excellence. Likewise, these individuals have contributed to undergraduate and graduate university teaching, through courses and by guiding students in the development of their theses. This large contingent of students who have worked at the ICP has been a key player in the generation of new knowledge through research.

Snakebite Serum: From Costa Rica to the World

The production of snakebite serum at the ICP initially focused on providing this medicine to the national public health system, a goal that was met during its first decade of existence. As production capacity was consolidated, and thanks to a philosophy of continuous innovation and creativity, with the participation of all those responsible for serum production and with inputs from research and technological development, the volume of serum produced increased. This allowed for the distribution of this medicine to all countries in the Central American region. This process later led to the supply of snakebite serum in Ecuador and, more recently, in Peru and other countries in Latin America and the Caribbean.

Beginning in the 2000s, and due to the supply crisis of antivenoms in other regions of the world, the ICP committed to developing serums for the treatment of snakebite envenomations in sub-Saharan Africa, Papua New Guinea, Sri Lanka, and, more recently, the Middle East and North Africa. The serum for sub-Saharan Africa in particular has had a significant impact on public health in several countries in that region. Snakebite envenomation is a "neglected tropical disease," neglected by large pharmaceutical companies and global research agendas, a disease that affects the most vulnerable sectors of the population in rural regions of countries in the Global South. Therefore, the ICP's contributions are part of the philosophy of solidarity and the pursuit of the common good that underpins the ethos of the UCR. Throughout its history, the ICP has grown from producing 10,000 vials of serum per year in the 1970s to 120,000 today. Thousands of lives have been saved thanks to this medicine.

This extensive experience in the technological development and production of antivenoms has allowed the ICP to venture into other types of blood-derived products, such as human albumin and immunoglobulins, and a serum against the SARS-CoV-2 virus that causes the COVID-19 pandemic. This has also allowed for the initiation of technology transfer processes, through which the ICP shares its knowledge so that other laboratories can produce medicines derived from blood proteins.

Sharing Knowledge with Society

In addition to contributing to the solution to the problem of snakebite poisoning through the production and distribution of antivenom, the ICP has consolidated a social action or outreach program through which the knowledge generated by research is transmitted to broad sectors of society. This is based on activities in communities with a high incidence of snakebites, including indigenous communities, as well as partnerships with institutions, which allow for the dissemination of basic concepts on bite prevention and how to respond in the event of a bite. The ICP has also focused on continuing education programs for health sector professionals and students and, in conjunction with these sectors, has developed manuals and algorithms on the treatment of snakebites.

These processes have included close cooperation with the Costa Rican Social Security Fund (CCSS) and the Ministry of Health. The growth of the ICP has gone hand in hand with the consolidation of the Costa Rican public health system, so that anti-venom serum is available at all three levels of care within the CCSS, and health professionals have extensive knowledge of the diagnosis and management of these medical emergencies. Furthermore, these continuing education activities have also been developed internationally in various countries in Central America, South America, and the Caribbean.

Contributions to regional and global public policy

In addition to its contributions at the national level, the experience gained by the ICP has allowed it to become an active player in the development of public policy on the issue of snakebite at the regional and global levels. The ICP promoted the creation of a Latin American network of public anti-venom laboratories, which has been consolidated in recent years with the creation of the Latin American Network of Public Antivenom Laboratories (RELAPA), under the coordination of the Pan American Health Organization (PAHO). Furthermore, the ICP, in close collaboration with the Ministries of Health and Foreign Affairs and with the Permanent Mission of Costa Rica to the United Nations agencies in Geneva, together with various non-governmental organizations and representatives of 22 countries, managed to position the issue of snake poisoning on the agenda of the World Health Organization (WHO) and to have a resolution on this topic approved at the 2018 World Health Assembly, in which countries are urged to develop prevention and control programs for this health problem.

Conclusion: A National Project with Global Reach

The development of the ICP has allowed Costa Rica to generate an endogenous scientific and technological base in a key public health issue, which has had an impact not only in the country but also in many other regions. This project was developed within the UCR, has had the strong support of this institution, and has been marked by the philosophy of academic excellence and pursuit of the common good that characterizes this university. Furthermore, the ICP is part of the solid development of public health in the country and should therefore be viewed as an element of a highly valuable public institutional framework, which must be defended and strengthened. The achievements made should prompt us to reflect on the importance of investing in endogenous scientific and technological development in Costa Rica, aimed at understanding relevant phenomena and solving problems, through interdisciplinary efforts that combine basic and applied science and technological development, in close collaboration with broad institutional and social sectors in the country and other regions.