The plan to give WHO’s snake venom strategy more bite

Five years ago, those working to prevent the hundreds of thousands of deaths and permanent injuries annually from snakebite had a win. The World Health Organization agreed on a strategy to increase access to high-quality antivenoms and increase awareness in high-risk areas in order to try and halve deaths and disability from snakes by 2030. WHO put the total price tag for the work at around $137 million. Fast-forward to 2024, and not all of that money has materialized. “We got kicked in the teeth pretty much in 2020 when COVID came along,” WHO snakebite expert David Williams told Devex in an interview last month. Logistically and financially, public health work on other issues got more difficult during the pandemic. Still, the Australian — who’s spearheading WHO’s snakebite strategy — is counting some wins. Spurred by the WHO South-East Asia Region’s snakebite action plan, India, with one of the highest rates of snakebite in the world, recently launched its own national action plan. Similar initiatives have emerged in Kenya, Uganda, Eswatini, Namibia, Nepal, and Bangladesh. Meanwhile, a WHO webpage is helping to reveal which snakes are found where and the potential antivenoms available. One of Williams’ jobs is to help assess antivenoms’ risk-benefit ratio. He says the aim is to be “realistic and pragmatic.” A product may have a 20% risk of an adverse reaction, for instance, but an effective dose may offer an 80% chance of cure. Rather than drive manufacturers away with an onerous pre-qualification regime, the aim is to encourage them to make improvements. One of WHO’s main lessons in recent years has been uncertainty around what constitutes an effective dose in the first place. “Most antivenoms are not designed, historically at least, with much consideration to the biological reality of the problem,” Williams said. “The amount of venom each species of snake can inject was never considered, and this is why we see products that are designed to treat bites from 10 different species all with the same dose — which has absolutely no chance of working.” WHO is now working on a pooled procurement approach in eight West African countries, using products which have been assessed and recommended by WHO. The first products under the scheme could be on the ground by roughly August 2025, Williams said. When it comes to distribution, pilot projects are examining whether it is more effective to store antivenoms centrally in capital cities or to decentralize stockpiles in areas where snakes and humans are most likely to come into contact. “Understanding the human and snake ecology really is the pivot point to being able to solve snakebite problems in the longer term,” Williams said. “All the other stuff we are doing relies on this information.” New research mapping how climate change will affect where snakes are likely to be found, and their proximity to humans, is due to be published in the coming months. The main “chicken-and-egg” problem remains comprehensive data. The 2019 strategy — which Williams says will be updated next year — cites 81,000 to 138,000 deaths a year from snakebite, with a further 400,000 people suffering permanent disability such as blindness or amputation. But Williams says data on deaths from snakebite is patchy, while the disability numbers do not get captured at all. That in turn makes it harder to attract funding and buy-in from governments. “If you have the epidemiological data then you can look at the public budget and properly resource the budget to respond to the problem,” Williams said. And yet, “it’s always going to be hard to convince governments to just lash out lots of money to provide health care coverage for these sorts of things if they have no data.” Many victims still prefer to seek assistance from traditional healers, but Williams’ hope is that as more trusted, WHO-verified antivenoms become available, more people will seek treatment at health care centers, thus helping to complete the epidemiological picture as well. Williams saw this firsthand in Papua New Guinea when antivenom became regularly available at a hospital. The number of people being treated tripled, he said, “once people saw all of a sudden that snakebite victims were coming home from hospital alive.” “And with that of course, then the interest of the government is piqued and they can see the sense in making further investment.”