The year 2020 has not gone to plan in any shape or form; not for any sector of healthcare and certainly not for Neglected Tropical Diseases (NTDs). After recognition by the World Health Organization (WHO) and addition back into the collection of NTDs, snakebite envenoming was gaining recognition, funding and momentum. The WHO released the blueprint of the roadmap to reduce death and disability in May 2019; impressive targets were set, and the foundations were made ready. Four strategic objectives were highlighted; empowering and engaging with communities, ensuring safe and effective treatments, strengthening health systems and increasing partnerships, coordination and resources (Williams et al, 2019) .
Suddenly, all tools were laid down as the world reeled in the wake of the COVID-19 pandemic. There was a dramatic shift to supporting and maintaining essential services, whilst escalating a response to reduce the spread of disease and mitigate the consequences of the coronavirus. Understandably, outreach and community programs were halted. Clinicians were diverted from research to clinical commitments on the front line, whilst many of the public showed an extreme reluctance to present to a healthcare setting. Economies have been decimated, jobs lost and many have escaped bustling cities to return to rural areas, such as those affected by the NTDs. Whilst the UK faces an 'education epidemic' with many children out of formal education, in other countries, not being able to attend school means more than a lack of education; it means not having access to mass drug administration for diseases such as schistosomiasis and soil-transmitted helminths. Food supplies have been threatened and many families face the daily struggle of how to feed themselves. These are just a few examples of the way COVID-19 has impacted so many people in so many different ways, and the real threat it poses to achieving universal health coverage.
For the countries where NTDs still predominate, many have healthcare systems that were already balancing on a precipice. COVID-19 may well be a challenge too great for them to face unsupported. The impoverished, remote and agricultural communities stand to suffer the most in the face of such adversity, including those affected by NTDs, such as snakebite. Snakebite alone is responsible for, on average, as many as 11,500 deaths every month across the world (WHO, 2019). This is approximately the number of deaths that the UK recorded secondary to COVID-19 in May 2020 (Stewart, 2020) . The UK's response to these unnecessary excess deaths has been immense -so too, should be the response to deaths secondary to snakebite envenoming. An occupational disease of the rural poor, snakebite is largely a preventable and treatable disease. Patients affected by snakebite already face many barriers to costeffective, timely treatment. COVID-19 is a further obstacle to accessing healthcare, for any health complaint, as there is fear and stigma surrounding the disease.
Significant challenges remain to improving outcomes for NTDs. Leadership and direction from the WHO is needed now more than ever. However, with the withdrawal of funding from the United States of America, the WHO faces having to do more, but with less. Nevertheless, COVID-19 presents us with an opportunity to re-design our approach to NTDs -we must take a more collaborative approach by strengthening existing partnerships and forging new ones. A united and holistic approach to neglected communities, rather than neglected diseases is paramount. Water, sanitation and hygiene (WASH) has been one of the key strands of the public health message to prevent the spread of COVID-19, and the impact of this will also be of benefit to NTDs. Specifically for snakebite, the importance of good wound care is critical. Snakebite advocates must collaborate with not only WASH projects, but also with other programmes supporting the other NTDs and other significant health issues in these affected communities.
This pandemic has certainly highlighted how the health of humans, animals and the environment are intrinsically intertwined. Therefore, the importance of a 'One Health' approach has never been more apparent. Cross-sectoral col-PERSPECTIVE ©The Authors | Journal of Venom Research | 2020 | Vol 10 | 30-31| OPEN ACCESS As COVID-19 drives more people into poverty and as we slip further away from universal coverage, we, as a community of committed and motivated individuals, must work together to reinvent, reshape and refocus. As the number of cases of COVID-19 continues to drop, we now have a golden opportunity to drive forward with novel and innovative ideas, and work towards reducing the burden of disease from all the NTDs, including snakebite.
On 17 th June 2020, the WHO commenced a series of webinars dedicated to the NTDs in the context of COVID-19 and how we continue progress in line with historic targets. We need to update and revise the snakebite roadmap, in keeping with recent events. The target of halving death and disability remains achievable, but the process of achieving this must be reconsidered; the way that we interact with rural, isolated and vulnerable communities may be impaired by a fear of catching the virus. Funding dedicated for snakebite research into developing safe and cost-effective antivenoms, in addition to novel therapeutics, should be honoured; indeed further investment must still be sought out. A greater emphasis should be placed on the third objective outlined in the roadmap; systems strengthening and capacity building in countries affected by snakebite is critical to recovery from COVID-19.