June 19, 2019
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WHO to reduce snakebite mortality rate, health crisis, by half with new plan

By Clea House

Madrid, May 23 (efe-epa).- Snakebites, the cause of a largely neglected health crisis that kills 138,000 sufferers a year and leaves 400,000 others grappling with serious disabilities, could experience a transformation with the introduction of revolutionary new treatments backed by the World Health Organization as well as a prevention strategy, a leading expert told Efe.

The WHO has launched a global campaign to raise awareness of the scale of the problem and spurred the development of new antivenom remedies it aims to roll out across the most affected regions in Africa, South East Asia and Latin America that could reduce death rates by up to 50 percent.

"Over the last three years, the WHO's department of medicines and health technology has been assessing antivenom products," said David Williams, an expert leading the WHO's snakebite prevention and treatment program. "They have carried out a very comprehensive assessment of a number of products and are finalizing their evaluations at the moment," he added.

The development of antivenoms is no straightforward nor universal process, but requires a tailored approach for different snakebites, he said.

Australian snakes have short fangs and generally only enter the skin tissue with a shallow bite, so the standard treatment combines compression and mobilization.

In Africa, where blood vipers have fangs that can be two centimeters long, venom is injected deep into the muscle tissue and can cause huge swelling which could be exacerbated by the compression technique, he said.

The first phase of the program launches Thursday with a pilot in five countries in East Africa, five in Western Africa, and two countries in Southeast Asia, Williams said.

And while the distribution of effective treatment is essential, prevention is also a large part of the program considering some 7,400 people are bitten by snakes every day.

Williams said one key to reducing the crisis was acknowledging the scale of the problem.

“Indian government statistics from 10 years ago suggested that 13,000 people a year were dying of snakebites, but then a very elegant study called the million death study was done,” Williams continued. “The staggering thing was they came up with a figure of snake bites in India of 46,000 a year.”

One reason snakebite disease and prevention may have been neglected by governments is that the data available was surprisingly off the mark, he concluded.

"A study in Kenya has shown that snake bites are the major cause of conflict between humans and wildlife leading to compensation claims,” Williams said. “Almost 45 percent of all the cases are related to snake bites, whereas elephants account for 22 percent and lions are in single digits,” Williams told Efe in an exclusive interview.

The fact that only lion attacks seem to grab the headlines validated Williams’ appraisal that snakebites were a hidden epidemic and that there were many challenges to be overcome in the drive to reduce mortality rates and improve treatments.

Another challenge was that in many countries, snakebites are not considered a health problem.

“In Cambodia, for example, 90 percent of people who have been bitten snakes don't visit a health center," he said, adding, "they go to a traditional healer because they suspect witchcraft, or sorcery or some supernatural source.”

The same occurs in Papua New Guinea, where many people believe that a snakebite means an enemy has sent a curse, so many people treat bites by visiting healers rather than doctors, he said.

If victims fail to seek professional help, data collection is also affected, he said.

This was a serious weakness, given that snake bites often lead to premature deaths or devastating disabilities which, at worst, can leave the victim in a vegetative state.

In sub-Saharan Africa, children are at a very high risk of getting bitten by spitting cobras whilst they sleep, and although rarely fatal they can lose limbs and be left with severe tissue damage.

“It has been proven in Nepal that the use of bed-nets prevents nocturnal snake bites,” Williams told Efe.

Wearing adequate footwear could also provide protection and Williams estimated that in some areas more than 50 percent of snake bites could be prevented that way.

The WHO now aims to reduce the crisis with a four-pronged approach consisting of stockpiling antivenom medicine in affected areas, developing community outreach programs, strengthening health systems and promoting partnerships and networks between manufacturers, governments and the organization to ensure only effective products enter the market.

The approach was similar to the oral cholera vaccine program, he said, adding that the hope was to get word to spread that health centers were stocked up with effective antivenom cures such that people would start visiting doctors to get their wounds seen to, driving up demand and eventually, once an economy of scale kicks in, lowering the cost of treatments.

Anywhere between 70-80 percent of people are bitten in their lower limbs whilst working or going out to use a bush toilet at night.

“Women walking to the river to get water down grassy pathways, men who are plowing fields in bare feet in areas where carpet vipers are particularly common, people who hunt in forests during the day who tread on snakes that have hidden in the leaf litter," were examples, Williams said.

Improving sanitation and access to water were both things that would curb the burden of snakebites, the expert said.

The numbers could be reduced overnight if workers were given proper footwear, according to Williams.

Following the initial pilot phase between 2019 and 2020 working with 12 countries, the program will be scaled up to include up to 40 countries and will aim to issue 500,000 treatment between 2021 and 2024, he said.

By 2025 a full roll-out across all the affected countries will launch with the aim of administering 3 million treatments and reducing mortality rates by up to 50 percent by 2030.

When asked what snakebite was the most dangerous, Williams said: "the one that bites you." EFE

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