Integrated Human Practices
For our integrated human practices, we followed a design approach based on the double diamond design process. This framework separates design into two parts: research and development. Within both there are two additional subphases: discovery and define; and develop and deliver respectively. The second part of this cycle is sometimes represented as having the full engineering cycle we are familiar with. We believe that this framework is well suited to exploration of the social conditions surrounding research topics.
First Iteration: Understanding the Scale of the Issue
The initial research phase started with meetings with members of the Institute of Biotechnology (IBT) from the UNAM. The most established research teams for the topic of recombinant antivenom, and many experienced in the topic of scorpionism in general, work there. They explained how they have been developing scFvs as potential recombinant antivenoms for around 20 years at this point. Their designs rely on iterative directed mutagenesis and evolutionary engineering. While historically they've focused on highly specific antivenoms, recently they have acknowledged that polyvalency is an important characteristic to design towards.
We settled on a collaboration. We could focus on bioengineering an optimized cell factory for high-level production of recombinant protein. The scFvs that IBT has developed over the years are generally similar, so optimizing for scFvs in general using synthetic biology would allow them to use it for scaled-up antivenom production. This way we wouldn't need to deal with testing the effectiveness of antivenoms or handling risky tests. Our project was about biomanufacturing.
Biologists: Changes Are Necessary
Shortly after speaking with the IBT, we spoke with biologists who specialize in venomous animals—spiders, scorpions, and snakes. We spoke about the feasibility of the project, and they were highly critical of it. According to them, Mexican antivenoms for scorpions generally work and production capacity is not really a problem. They said that synthetic biology would probably be better applied to snake antivenoms, since those are more unreliable and expensive. They shared with us the three-front approach to dealing with scorpion envenomation: education towards prevention, investing in the availability of medical attention, and research into antivenoms. They said that recombinant systems could be implemented, but that they should not be prioritized.
Industry and Network Experts
We contacted members of Redtox, a large independent network of researchers and industry experts who work in the field of animal envenomation. Redtox covers all venomous animals in the country, including scorpions. They were very open and enthusiastic about meeting us. They offered important advice on the general role of recombinant proteins and synthetic biology in the antivenom industry. They agreed that new molecules are a more attractive alternative for snake antivenom rather than scorpion, but said that recombinant technology has not been discarded. They have experimented with using E. coli to produce the venom that is then injected into horses, as part of a strategy to reduce the batch-to-batch variability of existing systems. They also shared their experiences with education into scorpion prevention. Redtox has invested significant resources into making material both aimed at the general public and medics. Some of the only available prevention materials in one of Mexico's many native languages are only available at their website.
They shared an interesting perspective on medical education, with a specific focus on scorpion envenomation. As mentioned, they have many educational resources. They believe their biggest limitations are communication channels. They cannot fight social media algorithms, and there people find alternative sources of information that contradict actual science. A culture of education towards prevention does not exist, so when someone gets stung, they use the internet as an alternative to a doctor. They also cited that people don't really know much about antivenoms. Some, especially older people, do not differentiate between the older serums and the new fabotherapeutics, believing that antivenoms are unreliable and dangerous. Another cited incident was of a man who believed they were vaccines. Since he had already been stung once, he thought he had acquired immunity to stings and did not require going to a doctor.
From a logistics perspective, they believe that Mexico is currently able to produce enough antivenoms to satisfy demand. The problems are infrastructure and supply chain limitations. They cite that medics have a tendency to not upload epidemiological data into the epidemiological surveillance database (SINAVE), so the 300,000 yearly cases are an underestimation, since that count is made from the cases that are reported. They also cited that in recent years the centralization of medicine purchases has made the process slow, compromising the capacity to supply medicine at a correct rate.
They had a better opinion on the use of recombinant technology in antivenoms, especially since they knew it had been implemented for spider antivenoms. While they maintained that currently scorpion antivenoms are affordable, safe, and effective, they also recognized that if a better system appears, it will slowly replace conventional antivenoms.
A note on terminology: In Spanish the problem of scorpion sting envenomation is usually called Alacranismo, a word derived from one of two common names for scorpions, Alacrán. Alacrán is derived from Arabic, like many words in Spanish. The other word "escorpión" is the direct translation of the English word scorpion and they share etymological Latin origins.
What We Learned from These Three Groups
At this point we were divided. We didn't know if redesigning the whole project was viable. At the same time, we didn't want to solve a problem that didn't require solving. By this point wet lab started to face hurdles, and we believed that changing our approach could hinder experimentation. We decided to compensate for this by using modeling. With these stakeholders, we understood that there were systemic limitations in antivenoms that go beyond production. Modeling could allow us to offer possible strategies to address these limitations. This modeling framework eventually became Stingwatch, one that is focused not only on bioengineering, but on systems medicine and epidemiology as tools to address the issue of scorpionism. With this in mind we expanded modeling to include a predictive model for scorpion envenomation.
Legal Advice
Early on we sought legal counseling to understand the framework of scorpionism in Mexico. You can read more about it in the context section. We were supported by a lawyer with expertise in IP and experience in bioengineering. She explained the normative framework of existing pharmaceuticals, and what a recombinant antivenom would need before being commercialized. This collaboration concluded by asking her to help us write a general context section on how health works in Mexico.
Reaching Out to the Government
We attempted to reach out to local health officials in the states of Morelos, Guerrero, and Guanajuato. We did not get an answer. However, we also reached out to the General Direction of Epidemiology (DGE). The initial objective was to ask for data to be used in our systems epidemiology model, but the collaboration turned out to be far more productive. They were very enthusiastic about the meeting. Recently they have implemented changes to the databases, allowing for more information about the context of scorpion stings. They also said this system is new, and they were looking for people with knowledge in mathematical modeling to use those new datasets. A collaboration was natural.
At this point we expanded the coverage of our models, not only to predict envenomation based on historical, environmental, and social data, but also to use deep learning for classification of at-risk groups and of general risk characteristics. We agreed to collaborate with the DGE and hope that our findings will be able to translate into policymaking. Our collaboration will continue beyond October 2025.
The DGE also shared their own experience on the issue of scorpionism. They confirmed that sting cases go undercounted. They also commented that part of developing the new epidemiological surveillance system is to design new prevention strategies that address the necessities of isolated communities.
Biology Educators
We participated in a few educational events that allowed us to learn about how to communicate about venomous animals. The general consensus is that if you find a potentially dangerous arachnid, be it spider or scorpion, the recommended strategy is to avoid contact. If the animal is located outside, then one should avoid it. If the animal is inside, using paper and a cup to move it outside while avoiding contact is recommended.
The general public has a great interest in rule-of-thumb identification of scorpions. While all scorpions are venomous, medically significant scorpions of the Centruroides genus are, as a generality, small, with smaller pincers, larger stings, and have a yellow-golden coloration. People with more experience than us on the topic pointed out that identification is important after a sting. If you find a scorpion in your home, your focus should be to remain calm and follow the protocol outlined above. They warn that people focus too much on identifying what type of scorpion it is and that can be risky.
Another important note from many people who work in education is to avoid the unnecessary use of insecticides against these creatures. While scorpions in Mexico are not protected species, they are not a species that people hold in high regard. However, they are not a plague, and their interactions with humans are usually because we moved into their habitats, so using insecticides should not be the first option. Scorpions also have an important role in the trophic chain and are predators of more problematic animals like roaches. While preservation of scorpions is not generally considered an important part of the topic of scorpionism, it has its merits, and we welcomed the feedback.
On-the-Ground Experience
One of the most important steps was to contact communities that suffer from scorpionism. This was to understand their experiences and see how we could help. There are many communities in Mexico that suffer from this problem, and contacting all in a single year is not possible. We focused on the municipality of Yautepec in Morelos. While you can read more about it in its own section, it painted a clearer picture of the issue for people who have lived it.
They confirmed many of the issues that are reported in existing articles and that other stakeholders commented on: poor infrastructure, lack of medicine, issues with transportation. The inability to attend a medical center in case of an accident was reported as a life-threatening factor for some of them. Many of them shared that while they do not understand how antivenoms work, in part it is because no one explained it to them. Emergency doctors usually don't take the time to explain what they give you.
The community has concerns about access to proper medical care in general, not just in the context of scorpionism. Many stakeholders had mentioned that the biggest limitations with antivenom treatment are due to the Mexican healthcare system. They are systemic limitations that need to be addressed at multiple levels. Yautepec was another instance of this.
While behavior described by other stakeholders was observed, the people locally rationalized it differently. Previously we were told that people rely on traditional medicine that conceals the clinical symptoms of envenomation because of a reliance on local healers or Google. However, the community offers the explanation that sometimes going to the hospital is a luxury they cannot afford. It takes time and resources.
Contacting the community gave us more boots-on-the-ground understanding of the issue—how it both contradicts and coincides with other points of view. This was a single municipality of at least 50 that are considered to have high incidence of scorpion stings, so the perspective was not universal. We tried to reach out to a few medical institutions to ask them about the issue but did not get an answer. Instead, we decided to reach out to medical students, who as part of their training sometimes need to offer medical services in these communities.
Contact with Medical Students
In the country's rural areas, the majority of physicians are medical students. In Mexico, medical students are expected to accomplish a one-year-long unpaid social service in order to graduate. By this point we had a picture of the limitations inside the health system that was full of contradictions. We decided to contact medical students and got answers from multiple universities. What we asked was both the general perspective of doing social service and healthcare, as well as any specific experience with scorpionism.
Their experiences were varied. Practically all students had to move in order to complete their service. The location one does their social service is supposed to be randomized, but there are ways for wealthier or better-connected students to avoid moving to completely unfamiliar places. Our interviewees expressed how they attempted to avoid remote locations. This was in part out of comfort. They were able to research that some towns far from urban centers have no internet, poor phone lines, and are generally isolated. However, they also showed concern about violence. Many of them were studying during the 2020 pandemic, when violence against medics, whom some communities saw as spreading the plague, rose.
When asked about the conditions of their service, the answers were also varied. They agreed that while those in dense urban areas had better access to equipment and didn't face as many shortages as those in rural areas, they also had longer shifts (some reported working for almost two days with no sleep) and were stretched thin. Interestingly, students located near the border with the US reported how on occasions they had to attend US nationals. While many students had experience helping tourists or foreign residents in the country, those near the border spoke about Americans coming into Mexico to get medications or medical treatment for cheaper. Since one needs registration to get public health in Mexico, they were unsure how they managed to get an appointment.
As for the topic of scorpion stings, only a sixth of students had to deal with cases, although those that did had dealt with multiple cases. They said that at least at the beginning of 2025, there was an antivenom shortage in many clinics, although medication shortages were also reported as being common. Their experience with supervisors was also varied. Some had the supervisor in the other room; a few had them in another town.
Students generally expressed frustration about resources allocated to health. Many complained about low monetary support, having to take part-time jobs or relying on family support to survive. Similarly, complaints about lacking proper facilities for even some basic services were not uncommon. In this sense frustration was common. Many commented on how the government has prioritized the reemergent welfare state while they work long shifts with little support, far from home. They also reported that reporting epidemiological data was not always completed. The reasons cited were instructions from supervisors or having to attend multiple patients in a short amount of time.
When asked about other limitations, answers were varied. Some students recalled having to interact with patients who did not speak Spanish as their primary language. For context, while 99% of Mexicans speak Spanish, the country recognizes 68 indigenous tongues, and since a reform around 20 years ago, it gives them the right to receive government services in their main language. Students had to rely on translators to communicate. They also said that many Mexicans are misinformed about health in general. They identified different reasons for this, from traditional medicine being common in the area to scientific misinformation, which is on the rise in the Spanish-speaking sphere. A common example was diet. Obesity is common in Mexico; usually it competes with America on obesity rates. Many patients not only expressed confused ideas about health, but they also had little interest in improving it, trusting quick Google searches over medics. However, this was not always the case. Many patients cited that for them going to the doctor, even in a public institution, was expensive. It meant traveling and taking a day off of work. They just don't have the conditions to travel even for medical reasons.
Finally, we asked about the prospect of 4Ps medicine. They had a mixed response. They said that a proper implementation of that model could genuinely help the Mexican public, but believed conditions are not favorable towards implementation. Personalized and participatory medicine has become common in certain parts of Mexico City, but only in private institutions. They were skeptical about reaching remote communities in their lifetime.
What Does This All Mean?
As you can see, the issue of scorpion sting envenomation is not a simple one. It has stakeholders at multiple levels and there seems to be a disconnect between them. While they agree on general issues like lacking infrastructure, medicine shortages, and not enough education, they disagree on the cause. What we learned is that the issue is a complex systemic problem, one that requires general improvement to the Mexican healthcare system to properly address. That is not to mean that incremental advancement is a bad idea. We hope our collaboration with DGE and Redtox can eventually materialize new strategies for management of scorpionism.
Below we leave a list and diagram (Figure 1) of the different levels of stakeholders in scorpionism in Mexico.
Government Agencies
In Mexico, government agencies at different levels are responsible for handling public health. At the federal level there is the Health Secretary, the main body in charge of health policy. The largest entities responsible for healthcare are the INSABI, the IMSS, and the ISSSTE. The second and third cover health for different types of workers depending on the sector they belong to. The first offers coverage to other Mexicans who would not have access to medical services otherwise. Each state also has its own secretary in charge of local healthcare. Since scorpionism is highly localized, these and municipal agencies are often in charge of making public policy dealing with scorpion stings. In addition to medical policy, the state also guides and supports research through the Secretary of Science (SECIHTI). It also handles regulations on antivenoms through the COFEPRIS, the local equivalent of the FDA. The different secretaries of health handle epidemiological surveillance through directions at different levels, the DGE being the federal agency. Data is extracted from a unified system known as SINAVE.
Healthcare Providers
While governments can guide policy, they require dedicated institutions to carry it out. As we mentioned, the biggest institutions for health in Mexico are the IMSS, ISSSTE, and INSABI. These institutions offer healthcare to the majority of the population. Especially in rural areas, they are often the only options for Mexicans to access treatment. Mexico also has private healthcare, although these hospitals are mainly concentrated in cities and are expensive. An important exception is Farmacias Similares, a privately owned chain of pharmacies that offer general medical checkups for around four dollars, as well as access to generic medication, usually for far less than other brands. For the Mexican public, healthcare usually means either long waiting times, shortages of medications, and suboptimal services in the overburdened public sector or high out-of-pocket costs in the private one. Farmacias Similares and local apothecaries serve as a middle option. They are comparatively cheap and accessible in low-income communities, although they have been criticized for possible conflicts of interest and overprescription. In rural areas, both with high and low incidence of scorpion stings, the majority of physicians are medical students. All Mexican undergrads are required to do social services in order to obtain their degree. However, medical students are tasked with taking one year of pro bono labor. These practices are poorly paid. Often they take place far from both their primary residence and their universities and can be risky (Mexican rural areas suffer from high degrees of criminality, affecting these students).
Research
The current landscape of antivenoms in Mexico would not be possible without research. The largest and best-established research groups in the topic of antivenoms belong to UNAM, the country's largest public university. Research is facilitated by funding from the already mentioned SECIHTI. The secretary has established a series of national research priorities (PRONACES) and scorpionism is among them. There are also other research teams in other universities, focused not only on developing antivenoms, but studying scorpions and scorpionism from different perspectives. The network Redtox (a shortened version of the Spanish phrase for toxicological network) also fits here. It is a large collection of experts, mainly biologists, who dedicate their lives to not only studying envenomation by venomous animals but also educating both the public and doctors on envenomation.
Industry
The industrial side of antivenoms is headed by Laboratorios Silanes, the largest supplier of antivenoms in the country, which also happens to supply the US and has registered FDA-approved antivenoms.
Environmental Agencies
Scorpions do not have a protected species legal status. Regardless of the known impact of environmental factors on scorpion envenomation, this makes environmental institutions important in dealing with scorpions. At the federal level, the secretary in charge of environmental protection and surveillance is SEMARNAT. As part of SEMARNAT, CONAGUA is the highest agency in charge of administering water bodies and keeps a database of climatological data used by the team. While not part of the secretary, the largest statistical databases for Mexico, including climatological data, are kept by INEGI.
Lawmakers
Mexico has a political system inspired by the US. It is a federalized, democratic, laic republic. It is more centralized than the US, but local legislatures are still capable of making laws.
Data Enablers
While they are part of other categories, agencies in charge of keeping large volumes of data should also have their own entry. For epidemiological data of any type, there are federal and state-level agencies in charge of recording and reporting disease numbers, including scorpionism. At the center of this is the SINAVE system, used by doctors to report case data to all of these agencies. Although according to the DGE, scorpion stings go partially unreported. Social data is reported by different agencies, but the largest databases are part of INEGI. For environmental data, there is the database of Normales Climatológicas from CONAGUA.
International Organizations
Mexico is part of multiple international agreements. This makes certain organizations like the WHO or the PAHO stakeholders in medical topics inside the country.
Communities
On the ground, scorpion sting envenomation is a problem for certain communities. These communities are incredibly diverse. In general, scorpion envenomation follows a trend set by the general health infrastructure available in the country. Many marginalized communities suffer from systemic issues, particularly in access to healthcare. Scorpionism is not the main problem, but is one of many.
