“Dad! A viper bit me!” Ibrahim heard his son’s cry and wove through the sugarcane field toward him. He found the boy on the ground, clutching his rapidly swelling leg. Lifting him into his arms, Ibrahim rushed to the nearest clinic. He arrived breathless after half an hour… it was closed. Desperate, they paid a passing motorcyclist for a ride to the hospital. When they arrived, there was no antivenom in stock. The boy’s nose, eyes and gums began to bleed and he began to vomit. Again, they paid a taxi driver for a three hour journey to the next hospital. There, too, there was no antivenom.
Across every continent, a silent scourge reaps rural poor communities. The WHO estimates that between 80-140,000 people die from snakebite envenoming (SBE) each year, with many more suffering permanent disabilities. Snakebite is a disease of poverty, affecting mostly agricultural and indigenous communities in tropical low and middle income countries (LMICs). In urban centers, political and health authorities underestimate or ignore this underreported issue.
Capitalist and neocolonial systems consistently fail to provide solutions to Neglected Tropical Diseases such as snakebite envenoming. The WHO has included antivenoms in their list of essential medicines since 1977. Despite this, antivenom procurement is seldom prioritized In Nigeria, where snakebite patients can occupy up to 70% of hospital beds during snakebite season, the government stocks less than 2% of the antivenom for the nation’s needs.
Since governments seldom procure and patients have very little financial capacity to purchase antivenom, the profits for this medicine are almost nonexistent. Manufacturers are dropping out of the market, while the few remaining companies hold immense monopoly power.
Antivenoms are scarce, exorbitantly priced (often upwards of $100 per vial) and heavily ineffective. The only antivenom currently approved by the WHO for use in Africa requires 60-80 vials for cobra bites. Meanwhile, diluted, counterfeit and unsafe products flood the market. Antivenoms are only effective for the regions and species they are tailored to neutralize, yet smugglers pack African warehouses and pharmacy shelves with cheaper Indian antivenomsmade for South Asian snakes. This unreliable antivenom quality causes clinicians to doubt whether antivenom is effective at all.
Despite its controversies, high-quality antivenom is effective, reducing snakebite deaths by 70-90%. Even considering their high price, antivenoms are more cost-effective than antiretrovirals or many vaccines administered in the same regions.
Besides antivenom, a handful of complementary care procedures (intubation or neostigmine for paralyzed neurotoxic snakebite patients) can save lives. However, clinical SBE management is unstandardized in most endemic countries, and not taught in most medical schools. Healthcare facilities in snakebite-prone regions face a lack of staff and equipment. Clinicians are reported to misdiagnose snakebite for lack of a single glass test tube to conduct clotting tests.
In communities, too, snakebite education is neglected. Myths and misconceptions abound surrounding snakebite first aid. This has to do with the complex epidemiology and perception of SBE. Most snakes are non-venomous, while venomous snakes can bite without injecting venom. Herbal remedies which reduce pain or swelling but fail to neutralize neurotoxic or hemotoxic toxins may be perceived as effective, when in fact there was never any venom to begin with. Similarly, incision, suction, and tourniquets have been found to worsen prognoses and increase the likelihood of infections, amputations and death. Yet, community education has been persistently underfunded.
Injustice lies at the core of the snakebite crisis. SBE shows us the current medical apartheid, the blatant decision to ignore diseases of the poor. Simple public efforts can change the broken status quo, however. Snakebite must be integrated into clinical training and broader global health initiatives. Antivenom should be locally produced or reliably procured and strategically distributed to high-risk regions. Basic snake identification and evidence-based first aid should be incorporated into primary school curricula, like “stop, drop, and roll” for fire safety. For millions of families like Ibrahim’s, a single bite can change the course of a lifetime. We can stop it from ending one.
Snakebites has been an inequity problem in global health for many years. Read our previous article on snakebites here.