Snakebite envenoming: A neglected global health crisis

Snakebite envenoming is a significant but often overlooked public health issue, particularly in tropical and subtropical regions.

Each year, millions of people in Africa, Asia, and Latin America suffer from venomous snakebites, many of which lead to severe health complications or death.

According to the World Health Organization (WHO), “up to 2 million people are envenomed by snakes in Asia annually, while Africa records between 435,000 and 580,000 snake bites that require treatment.

” The burden of snakebite envenoming is heaviest on rural communities where healthcare systems are underdeveloped, and resources are scarce.

Snakebites can trigger severe medical emergencies such as paralysis, bleeding disorders, kidney failure, and tissue damage that can result in permanent disability or even death.

Children, due to their smaller body mass, often experience more severe effects than adults. However, despite the gravity of this issue, effective treatments exist.

WHO states that "most deaths and serious consequences of snake bites are entirely preventable with the use of safe and effective antivenoms." High-quality antivenoms are the most efficient treatment available and are listed as essential medicines by WHO. Yet, the accessibility and affordability of these antivenoms remain a significant challenge.

The production of antivenoms faces several hurdles. A major obstacle lies in the preparation of appropriate immunogens, or snake venoms, required for manufacturing.

"Very few countries can produce snake venoms of adequate quality," WHO notes, adding that many manufacturers rely on commercial sources that may not accurately represent the venom variations seen in different regions. This discrepancy can reduce the efficacy of the antivenoms produced.

Regulatory challenges compound the problem. In countries where snakebites are prevalent, a lack of regulatory capacity makes it difficult to ensure the quality and appropriateness of antivenoms.

WHO highlights that "poor data on snakebites and deficient distribution policies have led to decreased production, higher prices, and a lack of confidence in available antivenoms." This combination has led to an antivenom crisis, especially in regions like Africa and parts of Asia.

One of the most critical issues in combating snakebite envenoming is the lack of reliable data. Many snakebite incidents go unreported, particularly in rural areas where traditional remedies are often preferred over hospital treatment.

In some countries, the official figures on snakebite incidents vastly underestimate the real burden. For instance, WHO cites a study from India estimating that 45,900 deaths from snakebite occurred in 2005 over 30 times higher than the government’s official figure.

This underreporting contributes to the failure to accurately assess the need for antivenoms, further reducing production and availability.

Recognizing the severity of the situation, WHO has taken steps to address the crisis. In 2017, snakebite envenoming was formally listed as a highest priority neglected tropical disease.

The WHO Snakebite Envenoming Working Group was established to develop a road map to reduce mortality and disability caused by snakebites by 50% by 2030.

This strategy focuses on community engagement, ensuring access to safe and effective treatment, strengthening health systems, and increasing partnerships and resources.

In 2019, WHO published a comprehensive strategy in the journal PLoS Neglected Tropical Diseases, which outlined specific interventions to improve antivenom availability and enhance regulatory controls.

WHO is also working on building capacity in affected regions and improving data collection. "We urge regulators, producers, and health authorities to collaborate on improving the availability of reliable data on snake bites and enhancing the regulatory control of antivenoms," WHO emphasized.

With continued focus on these efforts, WHO aims to reverse the current trajectory of antivenom shortages and improve outcomes for snakebite victims in vulnerable regions.