The Jure vs The Facto

The clashing reality of the Mexican healthcare system

In order to fully comprehend the reality of scorpionism in Mexico, it is necessary to understand two clashing realities. That of the legal framework behind the Mexican healthcare system and the pharmacological legislation surrounding antivenom, animal or microbial produced; and the reality of material shortcomings of healthcare in Mexico. The present section of the project was written by iGEM-UAM in collaboration with a legal advisor and multiple medical collaborators to explain the reality of the Mexican healthcare system from paper to ground.

Part 1. Legal framework for healthcare, existing antivenoms, and biotechnological research.

A universal right

The Mexican constitution of 1917, established in the context of the Mexican revolution, contains in its 29 first articles a series of individuals guarantees, a bill of rights of sorts. The legal foundation for the entire Mexican public health strategy, including the management of endemic diseases like scorpionism, resides in Article 4 of the Political Constitution of the United States of Mexico. This article establishes the right of every person to health protection, among other things like gender equality and food security. The individual guarantees are not only a statement but a binding obligation of the Mexican state to make them a reality. This law stablishes that all people shall have Access to healthcare, and for the provision of a welfare centered healthcare system that stablishes a progressive, quantitative, and qualitative healthcare extension that is free and integral (Constitución Política de los Estados Unidos Mexicanos › Título Primero› Capítulo I - De los Derechos Humanos y sus Garantías› Artículos 1o. al 29, 2023).

Fulfilling healthcare

Mexico has an establish hierarchy of laws, the purpose of this hierarchy is to solve contradictions and conflicts between laws, always deferring to the highest level. The constitution sits at the top, followed by any international treaty that Mexico has signed and ratified, then federal, then state law (Ferreira, 2021). Mexico has signed multiple health related agreements, although similar to the constitution, these agreements do not create a clear mechanism for the implementation of healthcare systems, rather goals and obligations for the government (Guerra et al., 2021).

The Ley General de Salud, or general health law (LGS), is the principal statute detailing how the constitutional health guarantee is to be fulfilled. This law establishes the National Health System and defines access to health services. It also governs the sanitary regulation of products and services, including medical equipment and supplies, and empowers agencies like COFEPRIS (Federal Commission for the Protection from Sanitary Risks) to issue health permits and enforce regulations. The law is of public order and social interest, ensuring that health is a priority for the nation. Scorpion envenomation is addressed within the LGS framework by classifying the vector itself as a threat to public welfare. Title VIII, Chapter II of the LGS addresses the prevention and control of communicable diseases and accidents, defining animals that pose a danger to salubridad general (general public health). Specifically, this danger includes any animal that serves as a "vehicle of diseases transmissible to the human being” (Ley General de Salud, 2023). This framework establishes the medical terminology used in dealing with venomous animals. These are regarded as accidents, some specific terminology like ophidic accident (accidente ofidico) for snake envenomation serve as clear examples (Maguiña-Vargas et al., 2020).

Scorpionism Norms

Most of the specific regulatory legislations in the topic of health, focused on scorpionism are in the form of normas oficiales mexicanas or Mexican official norms (NOMs). These are mandatory technical regulations for products, services, and processes in Mexico, designed to ensure quality, safety, environmental protection and to inform consumers. NOMs are at the base of the hierarchy of legislation, often acting as regulatory legislation in service of other laws (Economía, n.d.).

The operational core of the response to alacranismo is the NORMA Oficial Mexicana NOM-033-SSA2-2011, titled Para la vigilancia, prevención y control de la intoxicación por picadura de alacrán (For the vigilance, prevention and control of poisoning by scorpion sting). Since this is a binding, mandatory technical standard, meaning all public, social, and private health entities nationwide must comply with its specifications regarding detection, notification, treatment, and environmental control. The NOM mandates standardized epidemiological surveillance. Cases of envenomation must be reported using specific coding, such as T63.2 for Venom of scorpion, and X22, X22.0, or X22.1 for traumatic contact (at home or in residential institutions). This standardized coding ensures that predictive epidemiological data are collected uniformly across the country, allowing federal authorities to accurately track endemic hot spots and monitor the effectiveness of public health campaigns. Information is collected in a centralized epidemiological database known as the national system of epidemiological surveillance. Local health authorities and the general direction of epidemiology can access the system to publish relevant information of disease trends. The NOM dictates strict clinical guidelines. Following a sting, the protocol mandates immediate medical attention, noting that the first 30 minutes are the most crucial for effective treatment. Critically, the standard legally prohibits ineffective or dangerous traditional practices, specifically ruling out suction of the wound, application of ice, self-medication, or the use of home remedies, as these can mask symptoms or delay appropriate care. It also establishes the proper treatment as one that utilizes fabotherapeutics, also known as antivenoms (NOM-033-SSA2-2011 – Normalización, n.d.).

While NOM-033 is federal, its execution is enforced by state health secretariats, particularly in highly endemic regions such as Jalisco, Nayarit, Durango, Guanajuato, Guerrero, and Morelos. The operational requirement for rapid response places significant pressure on primary care facilities in these states to maintain consistent stock levels of antivenom and personnel trained in immediate clinical application. Local health advisories, such as those issued by the Secretariat of Health of Jalisco, reiterate the federal mandates, emphasizing the critical importance of maintaining composure and seeking prompt, professional medical care to ensure the efficacy of the mandated clinical protocol (Jalisco, n.d.). This reflects the reality that while federal guidelines exist for scorpionism in Mexico, actualization of healthcare often falls on state level governments and agencies (Chippaux et al., 2020; Trinidad-Porfirio et al., 2023).

Environmental laws

The primary statute governing environmental policy is the Ley General de Equilibrio Ecológico y Protección al Ambiente (LGEEPA), which promotes sustainable development and mandates public participation in ecological management (Ambiente, n.d.-a). The key to controlling the scorpion population lies in its status under the specific environmental protection norms. NOM-059-SEMARNAT-2010 lists native species of flora and fauna under risk categories. Medically relevant species (Centruroides spp), responsible for the most severe envenomations, are generally not included in this list. The exclusion of these scorpions from NOM-059 (Ambiente, n.d.-b), coupled with the LGS designation of them as a general public health danger. grants significant legal latitude to public health authorities. This structure eliminates the need for complex environmental impact assessments or exceptions that would be required if the vector were classified as protected fauna. Consequently, health authorities can implement aggressive physical and chemical control measures necessary to fulfill the constitutional health mandate without being constrained by general ecological preservation laws (Ley General de Salud, 2023).

The practical execution of chemical control is governed by specialized public health norms focused on pest management. NOM-256-SSA1-2012 details the Sanitary conditions that establishments and personnel dedicated to urban pest control services must meet using pesticides. This regulation ensures that the environmental actions mandated by NOM-033: the use of insecticides and habitat modification for the elimination of scorpions, are carried out safely, ethically, and by licensed professionals. NOM-256 regulates the specific industry tasked with physically reducing the vector population, ensuring compliance with general sanitary regulations and protecting the public and applicators from unnecessary exposure to dangerous chemicals (NOM-256-SSA1-2012 – Normalización, n.d.).

Regulations for existing antivenoms

The production, quality control, and distribution of currently used antivenoms, which are typically biological products containing F(ab')2 immunoglobulin fragments derived from equine plasma, are strictly regulated by the Federal Commission for the Protection Against Sanitary Risks (COFEPRIS), the national equivalent of the FDA (Transparencia COFEPRIS, n.d.). COFEPRIS holds the exclusive authority for granting the sanitary registration required for the production and commercialization of antivenoms in Mexico. This process demands rigorous proof of quality, safety, and efficacy, consistent with the requirements set forth in the LGS and the Regulation of Health Supplies (Reglamento de Insumos para la Salud). Once approved, manufacturers are subject to continuous post-market surveillance (REGLAMENTO de Insumos Para La Salud, n.d.). Regulatory vigilance extends critically to the distribution network, particularly because scorpion antivenom is a life-saving biological product, often supplied entirely to the public health sector. COFEPRIS actively uses tools such as Sanitary Alerts to maintain control over the supply chain. For example, a recent alert concerning the antivenom Alacramyn detailed the identification of falsified product lots (e.g., lot B-3L-33, expiration OCT 25).

Regulatory pathway for new antivenoms

The cornerstone of biopharmaceutical regulation is the LGS, specifically Article 222 Bis.

This article establishes a clear regulatory bifurcation for biological products:

  1. Innovative Biotechnological Medicines: These are entirely novel products requiring a comprehensive package demonstrating quality, safety, and efficacy (QSE) to the Secretariat of Health.
  2. Biosimilar Biotechnological Medicines (Biocomparables): These are biological drugs that seek approval by demonstrating high similarity and comparability to an already-approved innovative reference product.

For a recombinant antivenom, the necessary regulatory pathway depends on whether it is genuinely novel or designed to replace an existing conventional antivenom. If it is a copy, the manufacturer must satisfy the Secretary of Health that the product is biocomparable. For scFvs and de novo molecules, the first typification would be used. For recombinant fabotherapeutics, the second typification would be adequate (Ley General de Salud, 2023).

The research and development of any new antivenom, whether conventional or recombinant, must adhere to strict ethical and safety standards defined in the LGS Regulation on Health Research. For all human subject research, the law requires that the dignity and rights of the subjects prevail. Furthermore, COFEPRIS, in evaluating biocomparability, requires adherence to international standards, including the ICH E9 Harmonised Tripartite Guideline Statistical Principles for Clinical Trials. This adherence signals that the Mexican regulatory infrastructure is formally aligned with global best practices for the complex statistical and design requirements of advanced biopharmaceutical trials. This legal framework establishes clear institutional accountability. If a research subject suffers harm directly related to the investigation, the healthcare institution is legally responsible for providing immediate medical attention, irrespective of any legally applicable indemnification (Ley General de Salud, 2023).

Biotechnological legislation

At the core of Mexico’s legal control for the production of genetically modified and recombinant organisms is the Ley de Bioseguridad de Organismos Genéticamente Modificados (LBOGM), enacted in the mid-2000s and subject to subsequent amendments that incorporate evolving scientific evidence and international safety commitments. This law comprehensively governs the research, development, confined use, experimental release, and commercialization stages of GMOs. It emphasizes the precautionary principle, mandating that any activity involving GMOs undergo rigorous molecular, ecological, and economic risk evaluations before approval. Furthermore, the LBOGM establishes a structured approval process, typically divided into experimental, pilot, and commercial phases, thereby ensuring that the progressive scaling of recombinant production adheres to stringent biosafety metrics. Key to the effective implementation of the LBOGM is the creation of specialized regulatory bodies such as the Intersecretarial Commission for Biosafety of Genetically Modified Organisms (CIBIOGEM). CIBIOGEM is charged with overseeing compliance with biosafety standards and coordinating responses between various governmental ministries responsible for agriculture, health, and the environment (Ley de Bioseguridad de Organismos Genéticamente Modificados, n.d.).

Laboratory Safety Standards Recombinant production in Mexico is not solely governed by production-level laws; stringent laboratory biosafety practices are equally mandated to protect research personnel, the environment, and public health. The regulatory framework for laboratory biosafety stems from both the overarching LBOGM and specific health and safety regulations detailed in the General Health Law and customary NOMs. For instance, NOM-062-ZOO-1999 specifies technical requirements for the production, care, and use of laboratory animals, forming an ethical and safety foundation for preclinical research involving recombinant products (Agroalimentaria, n.d.). Additionally, NOM-012-SSA3-2012 outlines the criteria for conducting health research projects involving human subjects, ensuring that clinical studies related to biotherapeutics comply with international ethical standards (NOM-012-SSA3-2012 – Normalización, n.d.). NOM-257-SSA1-2014 specifically addresses the registration and regulation processes for biotechnological medicines, including those produced via recombinant methods, emphasizing adherence to Good Manufacturing Practices (GMP) and comprehensive pharmacovigilance (NOM-257-SSA1-2014 – Normalización, n.d.). To ensure that recombinant products are manufactured consistently and safely, additional norms such as NOM-164-SSA1-2015 and NOM-220-SSA1-2016 have been established. NOM-164-SSA1-2015 provides guidelines for good manufacturing practices in the pharmaceutical and biotechnological sectors, ensuring that production processes are monitored and controlled to maintain product integrity (NOM-164-SSA1-2015 – Normalización, n.d.). Meanwhile, NOM-220-SSA1-2016 sets forth criteria for pharmacovigilance, including the installation and operation requirements for systems that track the safety and efficacy of biotechnological products throughout their lifecycle (NOM-220-SSA1-2016 – Normalización, n.d.). In addition to the specific NOMs, the “Reglamento de la Ley General de Salud en Materia de Investigación para la Salud” and the “Reglamento de Insumos para la Salud” provide a regulatory framework for the safe execution of biotechnological research, including recombinant production, in laboratories. These regulations require that laboratories obtain accreditation and implement rigorous internal quality control and biosafety measures. The guidelines ensure that researchers follow standardized operating procedures, which include risk assessment protocols, waste management, and emergency response strategies tailored to the handling of recombinant materials (Bienestar, n.d.; REGLAMENTO de Insumos Para La Salud, n.d.). NOMs also regulate safe handling of certain substances: NOM-006-STPS-2014 stipulates safe practices related to the storage and handling of hazardous materials in work environments, while NOM-009-STPS-2011 governs work at heights and other high-risk activities which may be relevant in certain production contexts. These standards are enforced by the Ministry of Labor and Social Welfare, thereby ensuring that occupational safety in biotechnology facilities is maintained at the highest levels (NOM-006-STPS-2014 – Normalización, n.d.; NOM-009-STPS-2011 – Normalización, n.d.).

Protection of Biotechnological Inventions In addition to biosafety and workplace standards, the governance of biotechnological production in Mexico is influenced by intellectual property laws that protect innovations resulting from recombinant production. The Ley de la Propiedad Industrial safeguards exclusive rights over biotechnological inventions, prescribing what aspects of recombinant processes are patentable and defining limitations for biological processes associated with reproduction (Ley de la Propiedad Industrial, n.d.).

Despite the comprehensive legal architecture governing both production-level and laboratory safety in traditional recombinant production, emerging fields such as synthetic biology and human gene editing present regulatory gaps. Scholars have noted that while the LBOGM and associated regulations provide a strong foundation for traditional genetic engineering, they tend to exhibit ambiguity concerning novel applications that fall outside the conventional parameters of DNA modification. This is compounded by political movements in recent years that, in an effort to gain self-sovereignty and avoid the use of GM corn, have impeded development of biotechnological systems and used broad stroke legislation to prevent implementation of genetically modified organisms (Antal, 2019; Garcia Ruiz et al., 2018; Kinchy, 2010; Kobayashi, 2025).

Research support for antivenoms

The Ley General de Ciencia, Tecnología e Innovación (LGCTI) mandates the federal government to promote and finance scientific research addressing strategic national challenges. Under LGCTI, the National Projects of Research and Incidence (PRONAII) establish specific thematic areas for prioritized investigation. Within the health sector, PRONAII explicitly identifies "Venenos y antivenenos" as a key area of strategic focus (Ley de Ciencia y Tecnología, n.d.; ‘Programas Nacionales Estratégicos’, n.d.). This direct legislative endorsement ensures that public funding and institutional resources (such as those at research universities like UNAM) are legally channeled toward projects that advance knowledge in toxinology and product development. This legal provision facilitates both basic research on venom composition and applied research necessary for the improved production of existing and novel antivenoms (Riaño-Umbarila et al., 2021, 2025).

Part II. De jure & De facto paradox

On paper Mexico aims to cover universal healthcare. While the country still allows private healthcare. There are multiple institutions responsible for providing care. However, Mexico has a long standing limitation on being able to fulfill or accomplish its legal obligations. This gap can be explained by the difference between de jure (legal rights on paper) and de facto (real-world implementation and cultural norms). The gap is present in many issues in Mexican law. Gender inequality metrics for example usually puts Mexico at a relatively high position, while the reality for Mexican women is that they need to endure violence, gender inequality, and social impediments (Mexico, n.d.; ‘“The Era of Women”’, n.d.). The gap is also present in the Mexican healthcare system. The transition from the pre-reform era to the current configuration has created a paradox where the legal right to care exists alongside widespread, systemic failures in service delivery. The journey toward this point began with the establishment of Seguro Popular in 2003, a reform designed to dismantle the country's fragmented system and provide health insurance to millions who had previously been uninsured (Cram, 2008; Garcia-Diaz, 2022; Unger-Saldaña et al., 2023). By 2016, Seguro Popular had reached 56 million people, or 43.5% of the population, representing a significant expansion of coverage. This progress was short-lived. In January 2020, Seguro Popular was dismantled and replaced by the Instituto de Salud para el Bienestar (INSABI), which was intended to centralize care for the uninsured but quickly became mired in operational chaos and funding shortfalls, this was part of a broad series of reforms aimed at dismantling neoliberal institutions in the country (Garcia-Diaz, 2022; Guerra et al., 2021; Unger-Saldaña et al., 2023). The situation deteriorated to such an extent that by 2022, the number of Mexicans lacking any access whatsoever to health services had ballooned from 17 million in 2018 to 50 million (Arceo-Gomez et al., 2022; Gilardino et al., 2022; Unger-Saldaña et al., 2023).

This collapse in access highlights the fundamental disconnect between Mexico's stated goal of universal healthcare and the practical implementation of its policies. The transition from Seguro Popular to INSABI was poorly managed, leading to a decline in public health insurance coverage from 87.2% in 2018 to just 72.9% in 2020. The new system lacked clear operational rules, a defined benefits package, and sufficient funding, resulting in chronic medicine shortages, reduced service access, and a sharp drop in utilization; only 28% of the population accessed services through INSABI in 2020, compared to 43% via Seguro Popular in 2018 (Garcia-Diaz, 2022; Reich, 2020; Unger-Saldaña et al., 2023). These shortcomings were compounded by a reallocation of funds away from the Ministry of Health for the uninsured, which saw its budget decline by 6% in real terms between 2016 and 202—. The subsequent creation of IMSS-Bienestar in 2023, which absorbed INSABI's functions, has not fully resolved these underlying problems. As of August 2022, nearly one in four Mexicans still did not have access to social protection in health because states like Jalisco had opted out of the federal system, creating a patchwork of care across the country (Carletto, 2025; Garcia-Diaz, 2022; Unger-Saldaña et al., 2023).

The consequences of this policy instability are stark. For many, particularly those in rural or impoverished areas, the "universal" promise of healthcare remains an unfulfilled ideal. The system's inability to guarantee a consistent supply of medicines or functional facilities forces families to rely on private clinics, pharmacy-based doctors, or even home remedies, leading to high out-of-pocket spending that can be catastrophic. In 2021, out-of-pocket payments accounted for a staggering 41.4% of total health expenditure, a burden that disproportionately falls on the most vulnerable. Furthermore, the lack of a coherent national strategy means that while some programs show localized success, they cannot compensate for the systemic weaknesses (Carletto, 2025; Unger-Saldaña et al., 2023).

The challenge of providing adequate healthcare in Mexico's rural and semirural communities is rooted in a profound deficit of physical infrastructure and essential resources. Despite decades of reform aimed at improving access, these regions remain the most underserved, facing a combination of geographic isolation, dilapidated facilities, and a chronic lack of medical supplies. The statistics paint a grim picture: in 2024, 13.9 million people living in rural zones lacked access to health services, a figure that underscores the scale of the problem. This is not merely a matter of distance; it is a crisis of availability and functionality. Many primary care units in remote areas offer only basic care or rely on family support and traditional medicine due to the cost and limited availability of formal service. Infrastructure in these areas is poor or nonexistent. Additionally, they often rely on medical students in absence of dedicated physicians for the community (Garcia-Diaz, 2022; Unger-Saldaña et al., 2023).

Beyond infrastructure, the shortage of medicines and equipment is a critical barrier to effective care. Even when a facility exists, it may be empty-handed. The distribution of pharmaceuticals has been a persistent weakness. Centralized procurement through the state distributor Birmex has faced delays and supply issues. This has forced patients to travel long distances or pay exorbitant prices for necessary medications, exacerbating financial burdens and hindering treatment for chronic conditions. To address the logistical nightmare of getting these supplies to remote clinics, the government is launching the "Rutas de la Salud" system in August 2025, deploying over 190 trucks for last-mile delivery (José, 2025; República, n.d.-a). These initiatives represent a crucial pivot from neglect to investment. The government has also announced plans to open 19 new hospitals and 6 medical units in 2025, with projects underway for 2026–2027 in various states. These investments are supported by a dedicated MX$4 billion (US$200 million) allocation for 2025–2026 to ensure all health centers and hospitals are fully equipped with technology and staffed appropriately (República, n.d.-b). While these measures are promising, their success will depend on sustained execution and coordination. The history of medicine shortages and logistical failures suggests that building the infrastructure is only half the battle; ensuring its continuous and reliable operation is the greater challenge. Until then, the reality for millions in rural Mexico remains one of a broken promise, where the physical possibility of care is often negated by the absence of the tools required to deliver it.

The limitations of human resources

A defining feature of the Mexican healthcare system is the severe maldistribution of its human resources, a crisis that pits a surplus of graduates against a dire shortage of practitioners in the areas that need them most. On paper, Mexico appears to have a sufficient number of physicians. In 2023, the country had nearly 666,000 licensed physicians, equating to a ratio of 2.5 physicians per 1,000 inhabitants, which is below the OECD average of 3.5. However, this aggregate figure masks a critical imbalance. Approximately one-third of all licensed physicians do not practice clinically, meaning the pool of active clinicians is significantly smaller. More importantly, the vast majority of these active doctors are concentrated in urban centers, drawn by better compensation, superior quality of life, and more advanced facilities (Zavala et al., 2025). Multiple states have registered less than the WHO recommended number of health professionals as a function of population. To combat this shortage, the government has resorted to hiring foreign doctors. This strategy has sparked significant controversy, as it occurs against a backdrop of approximately 30% of licensed Mexican physicians being unemployed or unable to find clinical work. This creates a bitter irony where Mexico imports doctors to fill gaps that domestic-trained physicians cannot or will not fill, likely due to insufficient incentives and poor working conditions. Adding another layer of complexity is the quality of medical education itself. Only 15 of Mexico's over 165 medical schools are accredited by the National Commission for the Accreditation of Health Professions Education (COMAEM), raising serious concerns about the variability in training standards and preparedness of new graduates entering the workforce (Gómez-Dantés et al., 2024).

Medical students in Mexico also face significant challenges. Medicine is one of the longest in time it takes to accomplish, making it a significant challenge for someone to enter and finish the degree. Mexico has both private and public education, including at the university level. However, only a few universities offer medicine as a degree, this includes UNAM, IPN, UAM, and ITESM. Medicine is famously one of the degrees with the highest demand, to enter into public university one must pass a standardized entrance examen (the exam is different depending on the university), with medicine consistently being the degree that requires the highest score to enter. This makes it so that students from marginalized communities, who have poorer academic performance, are barred from public universities. On the other hand, private universities that have medical programs often require prohibitory high tuition. In practice, most students in degrees like medicine proceed from wealthier areas of the country (Barajas-Ochoa et al., 2020; García Luna Martínez et al., 2021; Van Zanten et al., 2012).

For medical students undertaking their mandatory social service internships in Mexico's remote rural communities, the experience is often a harrowing introduction to the profession, far removed from the controlled environment of a teaching hospital. These internships, a core component of medical training, are meant to instill a sense of public service and professional responsibility. However, in practice, they have become a microcosm of the nation's healthcare crisis, exposing students to environments of extreme resource scarcity, safety risks, and profound institutional failure. Violence against students isn’t unheard of. Beyond the threat of violence, interns are confronted daily with a lack of basic resources. Reports reveal that interns are sent to health centers with no running water, no electricity, and no supplies. Additionally, local communities often lack physicians, meaning these students are left as primary doctors despite lack of experience. Medication distribution is often arbitrary and mismatched to patient need. The financial compensation offered for this arduous and dangerous work is minimal and varies wildly based on location. The psychological toll is immense. Students report feeling completely unprepared for the reality they encounter and unsupported by the system. Supervision is virtually non-existent, with mentors visiting their remote posts only once or twice a month, if at all. These conditions have a psychological toll that often leads to abandonment of the medical profession (Hamui Sutton, 2022; Ramírez de la Roche et al., 2012; Robles-Rivera et al., 2024; Velazco-Guillen et al., 2025).

Part III. What does this mean for antivenoms

It should be clear by now that there is a clear difference between the legal obligations of the Mexican healthcare system, and the reality on the ground. Scorpionism is defined by higher incidence on rural and semirural areas. While large urban centers in certain states can have larger overall incidence of stings, per capita the burden falls on more isolated communities (Chippaux et al., 2020; Trinidad-Porfirio et al., 2023). The lack of care for scorpion envenomation is a systemic problem that can’t be solved through biotechnology or synthetic biology alone. This section reflects issues that were mentioned during our meetings with stake holders. Medical students often mentioned how they had to send patients to other locations since they were not supplied with adequate medicine. Members of industry complained how antivenom production should be enough to satisfy demand, but bureaucratic processes delay purchases and the government has problems with the logistics associated with distributing medicine. Federal authorities mentioned how the lack of infrastructure and surveillance means that scorpion sting envenomation is currently being unreported, although we don’t know by how much. Additionally, people at different scales of the problem usually have complaints about the other levels, there are clear disconnects between stakeholders at different scales. It is clear that fixing the issue of scorpionism requires systemic changes at multiple scales and the participation of private and public entities, ones that would better the health outcomes of Mexicans in general not only in regard to envenomation.

Bibliography

  • Agroalimentaria, S. N. de S., Inocuidad y Calidad. (n.d.). NOM 062 ZOO 1999. gob.mx. Retrieved 4 October 2025, from http://www.gob.mx/senasica/documentos/nom-062-zoo-1999
  • Ambiente, P. F. de P. al. (n.d.-a). LEY GENERAL DEL EQUILIBRIO ECOLÓGICO Y LA PROTECCIÓN AL AMBIENTE. gob.mx. Retrieved 4 October 2025, from http://www.gob.mx/profepa/documentos/ley-general-del-equilibrio-ecologico-y-la-proteccion-al-ambiente-63043
  • Ambiente, P. F. de P. al. (n.d.-b). NORMA OFICIAL MEXICANA NOM-059-SEMARNAT-2010. gob.mx. Retrieved 4 October 2025, from http://www.gob.mx/profepa/documentos/norma-oficial-mexicana-nom-059-semarnat-2010
  • Antal, E. (2019). The United States and Mexico in the Face of Scientific Uncertainty: Regulating Genetically Modified Organisms. Critical Issues in the New US-Mexico Relations: Stumbling Blocks and Constructive Paths.
  • Arceo-Gomez, E. O., Campos-Vazquez, R. M., Esquivel, G., Alcaraz, E., Martinez, L. A., & Lopez, N. G. (2022). The income gradient in COVID-19 mortality and hospitalisation: An observational study with social security administrative records in Mexico. The Lancet Regional Health – Americas, 6.
  • Barajas-Ochoa, A., Andrade-Romo, J. S., & Ramos-Santillán, V. O. (2020). Challenges for medical education in Mexico in the time of COVID-19. Gac Med Mex, 156(3), 253–256.
  • Bienestar, I. de S. para el. (n.d.). REGLAMENTOS DE LA LEY GENERAL DE SALUD. gob.mx.
  • Carletto, A. F. (2025). The transformation of the mexican health system toward Primary Health Care: The window of opportunity. Saúde Em Debate, 49, e10056.
  • Chippaux, J.-P., Celis, A., Boyer, L., & Alagón, A. (2020). Factors involved in the resilience of incidence and decrease of mortality from scorpion stings in Mexico. Toxicon, 188, 65–75.
  • Constitución Política de los Estados Unidos Mexicanos › Título Primero› Capítulo I - De los Derechos Humanos y sus Garantías› Artículos 1o. Al 29. (2023, May 25). Justia.
  • Cram, N. (2008). The State of the Healthcare System in Mexico. Journal of Clinical Engineering, 33(1), 38–42.
  • Economía, S. de. (n.d.). Standards. gob.mx.
  • Ferreira, O. R. (2021). Supremacía constitucional, jerarquía normativa y derechos humanos en México: Evolución jurisprudencial histórica y narrativas actuales. Revista de Investigações Constitucionais, 8, 679–705.
  • García Luna Martínez, J. E. E., Silva Ulibarri, L. A., García Macías, J. L., López Tapia, J. D., Sandoval Mussi, A. Y., & Garza Sáenz, O. G. (2021). Los desafíos de la educación médica en México. ARS Med.(Santiago, En Línea), 77–83.
  • Garcia Ruiz, M. T., Knapp, A. N., & Garcia-Ruiz, H. (2018). Profile of genetically modified plants authorized in Mexico. GM Crops & Food, 9(3), 152–168.
  • Garcia-Diaz, R. (2022). Effective access to health care in Mexico. BMC Health Services Research, 22(1), 1027.
  • Gilardino, R. E., Valanzasca, P., & Rifkin, S. B. (2022). Has Latin America achieved universal health coverage yet? Lessons from four countries. Archives of Public Health, 80(1), 38.
  • Gómez-Dantés, O., Serván-Mori, E., Cerecero, D., Flamand, L., & Mohar, A. (2024). Mexico’s Health System, 2023. Salud Publica De Mexico, 67(1 (ene-feb)), 91–105.
  • Guerra, G., Orozco, E., Jiménez, P., Ruckert, A., Labonté, R., & Snyder, N. S. de. (2021). Global health diplomacy in Mexico: Insights from key actors in the field. Globalization and Health, 17(1), 137.
  • Hamui Sutton, M. (2022). Mirando al futuro: ¿aspiran los estudiantes universitarios de instituciones mexicanas públicas y privadas consolidadas a la movilidad social? Sociológica (México), 37(106), 79–112.
  • Jalisco. (n.d.). Boletín no. 130 Con medidas de prevención es posible evitar picaduras de alacrán y otros animales ponzoñosos | Secretaría de Salud de Jalisco.
  • José, E. S. (2025, April 16). Las irregularidades en las compras de Birmex desatan la primera crisis de desabasto de medicamentos. El País México.
  • Kinchy, A. J. (2010). Anti-genetic engineering activism and scientized politics in the case of “contaminated” Mexican maize. Agriculture and Human Values, 27(4), 505–517.
  • Kobayashi, T. (2025). Role of the indigenous exceptions in international economic law for effective protection of indigenous peoples’ rights and interests: A case study of Mexico – GE corn dispute under the USMCA. Polar Science, 44, 101163.
  • Ley de Bioseguridad de Organismos Genéticamente Modificados. (n.d.).
  • Ley de Ciencia y Tecnología. (n.d.).
  • Ley de la Propiedad Industrial. (n.d.).
  • Ley General de Salud. (2023, May 25). Justia.
  • Maguiña-Vargas, C., Chincha-Lino, O., Vilcapoma-Balbín, P., Morante, D., Maguiña-Vargas, C., Chincha-Lino, O., Vilcapoma-Balbín, P., & Morante, D. (2020). Actualización en clínica y terapia de mordedura de serpiente (ofidismo). Revista Medica Herediana, 31(1), 48–55.
  • Mexico. (n.d.). UN Women – Americas and the Caribbean.
  • NOM-006-STPS-2014 – Normalización. (n.d.).
  • NOM-009-STPS-2011 – Normalización. (n.d.).
  • NOM-012-SSA3-2012 – Normalización. (n.d.).
  • NOM-033-SSA2-2011 – Normalización. (n.d.).
  • NOM-164-SSA1-2015 – Normalización. (n.d.).
  • NOM-220-SSA1-2016 – Normalización. (n.d.).
  • NOM-256-SSA1-2012 – Normalización. (n.d.).
  • NOM-257-SSA1-2014 – Normalización. (n.d.).
  • Programas Nacionales Estratégicos. (n.d.). SECIHTI.
  • Ramírez de la Roche, O. F., Hamui Sutton, A., Reynaga Obregón, J., Varela Ruiz, M., Ponce de León, M. E., Díaz Villanueva, A., & Valverde Luna, I. (2012). Condiciones de trabajo de los médicos pasantes mexicanos durante el servicio social. Perfiles educativos, 34(138), 92–107.
  • REGLAMENTO de Insumos para la Salud. (n.d.).
  • Reich, M. R. (2020). Restructuring Health Reform, Mexican Style. Health Systems & Reform, 6(1), e1763114.
  • República, P. de la. (n.d.-a). Arrancan Rutas de la Salud: Se abastecerán 15 millones de medicamentos e insumos a más de 8 mil unidades médicas del IMSS Bienestar. gob.mx.
  • República, P. de la. (n.d.-b). Paquete Económico 2026 garantiza Programas de Bienestar, aumento en salud, educación, vivienda, seguridad, inversión y rescate a Pemex. gob.mx.
  • Riaño-Umbarila, L., Romero-Moreno, J. A., Ledezma-Candanoza, L. M., Olamendi-Portugal, T., Possani, L. D., & Becerril, B. (2021). Full Neutralization of Centruroides sculpturatus Scorpion Venom by Combining Two Human Antibody Fragments. Toxins, 13(10).
  • Riaño-Umbarila, L., Romero-Moreno, J. A., Possani, L. D., & Becerril, B. (2025). State of the art on the development of a recombinant antivenom against Mexican scorpion stings. Toxicon, 257, 108306.
  • Robles-Rivera, K., Limón-Rojas, A. E., Wakida-Kuzunoki, G. H., Morales-Carmona, R. O., Silva-López, Y. P., & Ramírez-Grycuk, M. T. (2024). Prevalencia de percepción de conductas de violencia durante el servicio social en médicos pasantes de México. Investigación en Educación Médica, 13(51), 9–20.
  • “The Era of Women”: Challenges and priorities in the women’s human rights agenda in Mexico. (n.d.). WOLA.
  • Transparencia COFEPRIS. (n.d.).
  • Trinidad-Porfirio, B. E., Morales-Pérez, A., Nava-Aguilera, E., Flores-Moreno, M., Morales-Nava, L., García-Leyva, J., Silva-Domínguez, R., Cortés-Guzmán, A. J., Fernández-Salas, I., & Andersson, N. (2023). Occurrence of scorpion sting and associated factors in a highly marginalized municipality in Guerrero, Mexico: A cross-sectional study. PLOS Neglected Tropical Diseases, 17(5), e0011271.
  • Unger-Saldaña, K., Lajous, M., & Reich, M. R. (2023). Improving health system performance in Mexico. The Lancet, 402(10403), 674–676.
  • Van Zanten, M., McKinley, D., Durante Montiel, I., & Pijano, C. V. (2012). Medical education accreditation in Mexico and the Philippines: Impact on student outcomes. Medical Education, 46(6), 586–592.
  • Velazco-Guillen, D., Quiroz-Gomez, S., Celorio-Méndez, K. del S., & Guzmán-Priego, C. G. (2025). Nivel de satisfacción de médicos prestadores de servicio social de una universidad pública del sureste mexicano. Educación Médica, 26(1), 100977.
  • Zavala, B. M., Block, M. A. G., & Domínguez, M. S. S. (2025). Effects of the 2019 Mexican health system reform on the Decision-Making Space of federal entities for breast cancer care (preprint). medRxiv.