High Level Meeting and Workshop on Snakebite in Nepal on 2-3 August in Kathmandu, is the first international conference on snakebite in the country. Taking part are 20 of the world’s foremost authorities on snakebite including David Warrell of Oxford, David Williams, head of the Global Snakebite Initiative (see interview, page 7), Ulrich Kuch of Goethe University in Frankfurt, and Priyanka Kadam from India, and 50 Nepali scientists are taking part.
Nepal is aiming to be one of 11 member countries on WHO’s roadmap for snakebites, and is trying to muster serious commitment from the government for research and treatment.
“We hope to sensitise policymakers and the public about the hidden burden of this neglected tropical disease,” said Sanjib K Sharma, a doctor at the BP Koirala Institute for Health Science in Dharan, one of the conference organisers. “We also want to start working on developing anti-venoms in Nepal instead of depending on imports.”
Of the four types of anti-venom imported for the 21 types of poisonous snakes in Nepal, one doesn’t work and three others are not reliable. In fact, 80% of people here who are administered anti-venom suffer from reactions, 12% of which are fatal. Activists in India are now lobbying to stop the export of anti-venom because of unmet domestic need.
Anti-venom is produced by injecting donor animals such as horses and sheep with venom, and then extracting the antigen from the blood. But the procedure is expensive – a vial of anti-venom costs up to $2,200. Since snakebite requires between 20-25 vials to neutralise the venom, the pharmacy bill alone would total $30,000 per patient. Global production is limited, and most snake bites can only be cured with anti-venom from that particular species.
WHO’s target is to halve the numbers of deaths and disability from snakebite by 2030, and the Wellcome Trust and UK Department for International Development (Dfid) have announced £80 million and £9 million respectively for the development of a universal anti-venom. However, clinical trials will take decades.
Nepal’s challenge is at ground level. Awareness about preventing snakebite is still low, people prefer to visit traditional healers if bitten, and many patients get to anti-venom centres too late. Even so, snakebite fatalities fell from 10.5% to 0.5% after motorcycle volunteers were deployed in a pilot project in 2013. (see box)
Diana Barr of the Australian Venom Research Institute at the University of Melbourne says Nepal and Bangladesh are best equipped to take the WHO strategy forward. “You’ve got some of the key things, like local expertise, your health ministry is pushing for change, and there is support from outside organisations,” she told Nepali Times. “Nepal can easily implement the WHO strategy and get dramatic results in a couple of years.”
Experts attending the Kathmandu conference this weekend believe the WHO target of halving snakebite deaths is doable. All it needs is effective treatment, trained nurses and doctors who deliver that treatment, educating the community to take simple precautions, and come to hospitals sooner if bitten.
Said Sharma of BPKIHS: “The universal vaccine is the holy grail for snakebite treatment, but until then we have to work on anti-venom epidemiology within the country and educate people about snakebites.”