Last April was the 50th anniversary of the Clodomiro Picado Institute of the University of Costa Rica (UCR). Its history is full of milestones for Costa Rican science and, above all, directly benefits the most vulnerable population.
Named after Dr. Clodomiro Picado Twight (1887-1944), the institute recognizes his work as the Nation’s Distinguished Citizen, who applied scientific research and academia through a clinical and practical application to save lives and help the most needy and poor.
His work at the San Juan de Dios Hospital in the 1920s and ‘30s are an example of this. Because of that, the Tibás Metropolitan Clinic of the Costa Rican Social Security Fund (CCSS) has been named after him since 1965. At the entrance of the Clinic and in honor of Dr. Picado Twight, there is an iconic mural by Francisco Amighetti, that displays with attentive sensitivity the valuable work and contribution of this scientist to society.
In those first decades of the twentieth century, snakebites were widespread and in 1926 led to the approval of Law number 13 or Law of Protection of Ophidism. A second official accolade from authorities of the time recognized snakebites as a public health problem in Costa Rica and urged society, through the Ministry of Health, to provide a swift, systemized, and dignified solution to the consequences of this pathology.
In the 1960s, an anti-venom serum program was the best response that the Costa Rican State had fully materialized. Three determining institutions oversaw taking the next step: The Ministry of Health, the University of Costa Rica, and the invaluable collaboration of the Government of the United States of America.
This was accomplished, thanks to the commitment of Dr. Álvaro Aguilar Peralta, Minister of Health at the time, Dr. Herschel Flowers, expert and special representative of the United States Embassy and members of the Faculty of Microbiology that promoted the initiative, Dr. Pedro Vieto Asch and Dr. Roger Bolaños Herrera. Under the leadership of the latter, its first director, the organization of the Institute was consolidated on April 13, 1970. A solid example of bilateral cooperation in favor of science. A clear example of scientific diplomacy.
In 1972, an agreement signed between the Ministry of Health and the University of Costa Rica had a decisive impact on improving the health of the rural population of Costa Rica. The Institute was administered by the UCR as a research unit whose objective was researching and developing effective, safe, and sufficient products. In those first years, the serum production already exceeded 10,000 bottles a year and was capable of meeting national demands.
In those years, the Ministry of Health’s community centers for primary and preventive care, which some later became the EBAIS of CCSS, was the best way to universalize access to the Institute’s products. Of the 600 cases a year that occur nowadays, almost all are treated with anti-venom serum. With a low mortality rate of 0.2% of patients, more than 95% recover without repercussions such as amputations and other forms of disability for young and rural populations.
During my professional practice as a primary care, emergency, and hospitalization doctor in rural areas, such as Dos Ríos de Upala o Quepos, I was a faithful witness of the effectiveness of the Polyvalent and Anti-Coral serum. As a clinician, I can verify that these are two of the Institute’s most emblematic and safest products due to their excellent results when applied directly to patients who suffered snakebite. Without a health system with Universal Coverage like the one we enjoy in Costa Rica; the impact of these products would be very limited.
But I have also witnessed the valuable teachings and academic contribution made by the Institute. For example, educating health professionals and the general population to properly recognize and avoid the risks of encountering a snake, how to act when that happens and if the accident occurs, how to respond. Any public or private company must maintain corporate social responsibility policies.
In 1986, the first exports of serums to Central America were made and by 1996 production had reached sufficient level to supply the entire region. In that same year, within the COMISCA of the SICA group, the Ministries of Health of Central America declared the Clodomiro Picado Institute a regional reference center for this issue. In subsequent years, the Institute began the production and supply of anti-venom for Latin America and Sub-Saharan Africa.
The Clodomiro Picado Institute is self-sufficient, as the resources it generates from the sale of serums are used to finance operations and even finance future projects. The Institute is an example of a public enterprise capable of contributing to its financing, research, innovation, development, and exploitation of intellectual property, production, and distribution. It is also responsible for the sale and export of solutions of zero or little profitability for the private sector. In this process, it has often received support from the Ministry of Health and the Central Government.
As Vice Minister of Health, I witnessed the continuity of state policy that has been maintained throughout the Institute’s history- receiving support from the Ministry of Health. During the Chinchilla Miranda Administration, the Minster of Health at the time, Dr. Daisy Corrales Díaz, promoted the donation of the land where part of the Institute is located, which was kept under the Ministry of Health.
In the Solís Rivera Administration, the Minister who succeeded her, Dr. María Elena López Núñez, approved vice president, Mr. Helio Fallas Venegas, to officially deliver the land to the Rector of the UCR, Dr. Henning Jensen Pennington and the director of the Clodomiro Picado Institute, Dr. Alberto Alape Girón. Once realized, a “conflict of interest” ended after decades and strengthened the amount of assets needed to increase production, long-term growth and improve international projection.
In my speech as Minister of Health during the Institute’s 45 years celebration, I highlighted the surprising success story and contributions of its directors. I praised the undisputed founder, a pioneer in academia and research, Dr. Roger Bolaños Herrera (management 1970-1980) who passed down his vocation to the Bolaños Vives family. I also recognized the social aspect that Dr. Luis Cerdas Fallas (management 1980-1988) promoted, and the implementation of improvements in production and research by Dr. José María Gutiérrez Gutiérrez (management 1988-1996) and Dr. Gustavo Rojas Céspedes (management 1996-2004). And I could not fail to recognize the valuable contribution of the sole director of the Institute, Dr. Yamileth Angulo Ugalde (management 2004-2012), who promoted the importance of registering product patents and standardizing high-quality production. This innovation earned the Institute the PAHO/WHO Dr. Lee Jong-Wook Public Health Award.
On May 11, 2015, articles and historical archives related to anti-venom activity in Costa Rica were given to the Clodomiro Picado for them to take care of, protect and display at its Center. The Institute, together with the Laboratory of the San Juan de Dios Hospital of the CCSS, is the most important keeper of historical artifacts of Dr. Clodomiro Picado Twight. That day, the Ministry of Health also began transferring the land to the Institute so that they could dedicate themselves to such a noble cause.
The global impact
Snakebites are a neglected tropical disease. A health condition that annually affects the lives of almost 3 million people around the world, of whom nearly 120,000 die and 300,000 are left with some type of physical or psychological injury. Transforming the attitude of the international community on the approach to this pathology is a matter of life and death for many people around the globe.
As Minister of Health, on February 10, 2016 I formally requested to the World Health Organization (WHO), through DM 1752-2016, to declare that all ophidic accidents or snakebites are obligated to be reported. I did this on behalf of the Clodomiro Picado Institute, the British Health Action International (HAI) foundation, and the collaboration of the Global Snakebite Initiative.
On May 25, 2016, the latter organized and co-hosted, with the official sponsorship of Costa Rica, at the Science, State and Society side event. This global initiative meant to bring awareness to this issue occurred within the framework of the 69th World Health Assembly in Geneva, Switzerland. The account is documented in Minutes to Die by filmmakers James Reid and Pip Gilmour.
At the same time, the Ministry of Health of Costa Rica, with the help of the PAHO Mission in Costa Rica and under the technical leadership of the Clodomiro Picado Institute, was fulfilling all the necessary requirements, so that the initiative would be accepted by PAHO, which is a preliminary and necessary step for WHO to process the request of the Minister of Health of Costa Rica.
Finally, on June 9, 2017 the WHO resolution was achieved thanks to the commitments of the inter-institutional work of the Clodomiro Picado Institute, the technical leadership of Dr. José María Gutiérrez Gutiérrez, the Ministry of Foreign Affairs and Worship led by Ambassador Elayne Whyte Gómez and her team at the Costa Rican Mission to the United Nations, and the Ministry of Health. Recognition also goes to the indisputable leadership of Dr. David Williams of the University of Melbourne, a WHO specialist in the field, and to the support of the international community, who decided to make a change.
By reporting this health problem on a mandatory basis, the extent of challenges is evident worldwide and governments of the most affected countries are forced to act. The treatment is the serum in its fast and timely application. Costa Rica has specialized in producing it. The patents for these serums are in the hands of the UCR's Clodomiro Picado Institute and if production can be increased, the vital serum can be supplied to these poor countries on a large scale.
The Global Action Plan promoted by the Ministries of Health of Costa Rica and Colombia, was endorsed by 31 countries, and approved on March 24, 2018 at the 71st World Health Assembly. The Minister of Health at the time, Dr. Karen Mayorga Quirós, also pledged to make her support official. The plan was accompanied by the necessary financing to start changing the lives of those affected.
A snakebite or ophidic accident is a health problem of poor patients, farmers, who work in rural areas in agricultural work without adequate protection. Costa Rica can negotiate the use of its patents for humanitarian reasons with African or Asian countries, which are usually the most affected. Also, anti-venom serum can be developed for bites from scorpions or arachnids, which is common in the Americas. True Costa Rican intellectual property solutions can make a global positive impact.
A Benemérita Distinguished Institute
Noble teachings, academics, and research combined with a constant work of standardized and safe production of high-quality serums are the hallmark of the Institute. Making them available to the Costa Rican population, over many decades with the sole objective of saving lives, has been the main motivator. It is well deserved for the Clodomiro Picado Institute to be declared a Benemérita Distinguish Institution by the Legislative Assembly of Costa Rica.
The international recognition surrounding the Institute confirms that the Clodomiro Picado Institute represents the pinnacle of scientific achievement and social advancement in Costa Rica. Advancement is not limited to our borders because of our long history of success and international presence. However, today the Institute adds one more project to its public vocation of service.
In the current context of the COVID-19 Pandemic, human talent is crucial among the international effort to find an effective cure against the SARS-CoV-2 virus. Cooperation is underway between the CCSS, the Ministry of Foreign Relations and Worship, the Ministry of Science, Technology and Telecommunications. All of this is coordinated by the Ministry of Health and regulated by the National Council for Health Research (CONIS), which reactivated the Biomedical Research of quality in our country in 2015.
It is too early to assess the results and impact of this initiative, but the merits documented throughout these 50 years, of its noble commitment and its impact on the people of Costa Rica, are already undeniable. Fifty years of biting the snakebite. The Clodomiro Picado Institute must be recognized as a Benemérita Distinguished Institution.