The World Health Organization says it plans to reduce the number of deadly and disabling snakebites by half by 2030, something that experts say is ambitious but could be done.
In Canada, snakebites are relatively rare, with only about 100 people bitten per year and no deaths, according to one journal article.
In much of the world, though, they are a big problem. Snakebites kill an estimated 81,000 to 138,000 people per year worldwide, mostly in rural and impoverished areas, according to the WHO. Another 400,000 people are left permanently injured, with amputated limbs, blindness or other severe disabilities due to the venom’s effects.
But despite the death toll, snakebites were only recently recognized as a “Neglected Tropical Disease” by the WHO, putting international focus on the issue.
Historically, snakebites have never gotten the attention they deserve as a health risk, said Dr. Leslie Boyer, founding director of the University of Arizona’s Venom Immunochemistry, Pharmacology and Emergency Response (VIPER) Institute.
“That’s partly because it’s rare and tropical, and partly because it’s not infectious,” she said.
Unlike a virus, you can’t eliminate snakebites entirely — killing all the world’s poisonous snakes would be devastating to the environment, she said. The goal has to be different: making snakebites less deadly.
That’s why the WHO is focusing on ensuring better treatment and strengthening health systems around snakebites, starting with the most high-risk countries, in a multi-stage $US136 million plan announced Thursday.
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Venom affects people in a number of ways, according to Stephen Mackessy, a biology professor at the University of Northern Colorado who studies venomous snakes. Most snakes can be divided into roughly two groups: vipers, which would include rattlesnakes, and another group, elapids, that includes snakes like cobras and coral snakes.
Viper venom mimics human proteins that perform functions like clotting blood, regulating blood pressure or digesting certain molecules, he said. When someone gets a dose of viper venom, they get a huge dose of these proteins all at once, which can cause the body’s control systems to fail.
Elapid snakes’ venom works a little differently, blocking the transmission of signals between your nervous system and muscles, he said.
Every snake species’ venom is unique, which makes creating antidotes tricky. Something that works on a rattlesnake in the northwestern U.S. won’t work on an Indian cobra, said Philip
Price, a snakebite specialist with the U.K. charity Wellcome. They even vary by region, he said, meaning a substance that counteracts the venom of an Indian cobra might not work on a Sri Lankan one.
Antivenom is made the same way as it was 120 years ago. Scientists get venom from a snake. They then inject tiny amounts of the venom into a large animal — commonly a horse or a sheep. Over time, the animal develops antibodies in its blood. The animal is then bled, and the blood is purified to keep just the useful part — the antivenom.
Good-quality antivenom is in short supply. The WHO estimates that in sub-Saharan Africa, the number of effective treatments only represented about 2.5 per cent of what was needed in 2012.
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Much of what’s on the market is poorly made, Boyer said, as black marketeers often see a profit and step in. People in developing countries might have no way to tell a good product from a bad one, she said. The WHO says that poor-quality antivenoms, which are cheaper to make, have driven more expensive but higher-quality competitors out of the market in many countries.
Mexico was successful in stopping that problem, though, she said, by simultaneously releasing good antivenom onto the market and educating doctors on how to treat snakebites.
The U.K. charity Wellcome recently announced that it was investing in improving antivenom production around the world, including exploring alternatives to the century-old animal manufacturing process, Price said. The WHO intends to create stockpiles of antivenom in high-risk countries.
And of course, once the venom is made, it needs to get to those who need it. “Time is tissue” when it comes to snakebites, said Mackessy, meaning that people need to be treated quickly after they’re bitten, or they may suffer serious health consequences.
That’s a tall order for someone in a rural part of a poor country, Price said. They have to get themselves to a doctor, have that doctor be trained in snakebite treatment, have an appropriate antivenom available, have that medicine be affordable and have the care they need after being treated.
“It’s very difficult to see patients within that critical time window before you really start to have some of the bad and long-lasting effects of snakebite,” he said.
All this means combating snakebites is a huge undertaking. But advocates remain hopeful.
“If you can get the right antivenom to the right people, to the right place — and we know that they work — you can almost eliminate death entirely from snakebite,” Price said.
“Like anything, you set an ambitious goal so you have something to aim for and then you do your best to come as close to it as you can,” Boyer said. “What’s new, what’s different and what gives us hope is that we have people from many countries at one time, people from funding sources, people from the WHO, agreeing that it’s time to make a concerted effort.
“I think for the first time, really, people in the field of toxinology are hopeful that we may be able to make some serious progress.”