The Global Snake Bite Initiative: an antidote for snake bite.

Clinicians have for a long time witnessed the tragedy of injury, disability, and death from snake bite that is a daily occurrence in many parts of Africa, Asia, and Latin America. To many people living in these regions, including some of the world’s poorest communities, snake bite is an ever present occupational risk and environmental hazard, an additional penalty of poverty. Like malaria, dengue, tuberculosis, and parasitic diseases, the risk of snake bite is always present. Unlike many of these other public health risks, however, the burden of human suff ering caused by snake bite remains unrecognised, invisible, and unheard by the global public health community, forgotten by development agencies and governments alike. The problem is so underrated that it was only added to WHO’s list of neglected tropical diseases in April, 2009. Yet an estimated 5·4–5·5 million people are bitten by snakes each year, resulting in about 400 000 amputations, and between 20 000 and 125 000 deaths. We recognise that snake bite does not have the epidemic potential of infectious and vector-borne parasitic diseases, but we should emphasise that the yearly mortality caused by snake bite is much greater than that attributed to several presently recognised neglected tropical diseases, including dengue haemorrhagic fever, cholera, leishmaniasis, schistoso miasis, Japanese encephalitis, and Chagas’ disease (table). The reason might be that recognition of these important diseases as neglected problems has encouraged eff orts to combat them. In 1986–87, a massive epidemic of yellow fever occurred in Nigeria, killing an estimated 20 000 to 30 000 people. Since then, the hundreds of millions of US dollars rightly invested by the global community in immunisation of susceptible populations against yellow fever seem to have succeeded in the prevention of such epidemic catastrophes. This outcome is supported by accounts of 114 reported cases resulting in 58 deaths in seven African and four south American countries in 2006, and 2058 cases resulting in 106 deaths in 16 African countries, and 117 cases with 52 deaths in fi ve south American countries in 2005. Globally, 177 963 new cases of cholera and 4031 deaths in 2007 (36% reduction since 2006) are much fewer than even the most conservative data for snake bite. Dengue causes an estimated 500 000 new infections each year, including about 73 000 severe cases, 19 000 of which are fatal, whereas snake bite, a newly recognised neglected tropical disease, can kill up to six times more people. So what is the reason that snake bite, which causes enormous suff ering, and maims or kills hundreds of thousands of men, women, and children each year (fi gure), has not previously registered on the global health agenda? No other disease of similar importance is so closely associated with impoverished rural environments, and agricultural occupations. Do the communities at greatest risk of snake bite simply lack a collective political voice, and the three essential components of successful public health intervention— ie, consistent advocacy, comprehensive community engage ment, and compliance? Within communities, causes of illness and death are rarely forgotten. They are familiar to local medical fraternities, to those who study and record their eff ects, and, most of all, to the bereaved families of the victims and the communities in which they live and die. Diseases are forgotten, neglected, and abandoned by governments, public health organisations, and development agencies when their eff ects are not identifi ed and clearly articulated. Besides the need for concerted advocacy, timely, accurate information and appropriate policy settings are crucial to improve the perceptions of funding providers especially when public health budgets are entirely inadequate and priorities are too focused. The fi rst attempt to review the worldwide epidemiology of snake bite was reported in 1954. However, many governments and public health organisations did not formally recognise the actual burden of snake bite, which caused under-reporting and made improvement in the quality and authority of the estimation of the burden of global snake bite diffi cult. The few reported estimates of global snake bite urgently need to be substantiated with country by country data for the burden of disease. Substantial investments of time and eff ort are needed to establish acceptable methods to gather and analyse the data for snake bites, while avoiding the situation whereby funding partners demand the data before funding the data gathering. Compliance with appropriate regulatory standards in the production of therapeutic interventions is another fundamental public health requirement, allowing global partners to act on the basis of information that addresses Lancet 2010; 375: 89–91