WHO's Snakebite Envenoming Strategy for prevention and control
Authors: Ren Minghui, Mwelecele Ntuli Malecela, Emer Cooke, Bernadette Abela-Ridder
Journal: The Lancet Global Health (2019)

To some, the prospect of getting bitten by a venomous snake might seem extremely remote, but most of the world's population—5·8 billion people—is at risk of encountering a venomous snake. Every day, 7400 people are bitten by snakes, and 81 000–138 000 die as a result every year.1Gutierrez JM Calvete JJ Habib AG Harrison RA Williams DJ Warrell DA Snakebite envenoming.Nat Rev Dis Primers. 2017; 3: 17079Crossref PubMed Scopus (54) Google Scholar Currently, around 400 000 people who have been bitten have permanent physical or psychological disabilities including blindness, amputation, and post-traumatic stress disorder.1Gutierrez JM Calvete JJ Habib AG Harrison RA Williams DJ Warrell DA Snakebite envenoming.Nat Rev Dis Primers. 2017; 3: 17079Crossref PubMed Scopus (54) Google Scholar In acknowledgment of this important risk to health, WHO listed snakebite envenoming as a neglected tropical disease, which was followed by a 2018 World Health Assembly resolution,2WHOAddressing the burden of snakebite envenoming WHA71.5. World Health Organization, Geneva2018Google Scholar and began developing a global strategy to halve the number of snakebite-induced deaths and disabilities by 2030. WHO will launch the ambitious new strategy at this year's World Health Assembly.3WHOSnakebite envenoming—a strategy for prevention and control.https://www.who.int/snakebites/resources/who-cds-ntd-nzd-2019.03/en/Date accessed: May 23, 2019Google Scholar A key aspect of this strategy will be to engage and empower communities in preventing venomous snakebites and increasing training to provide better treatment. There are more than 250 species of venomous snake around the world that are considered to be medically important by WHO, and the people most at risk are those living in rural areas, including agricultural workers and herders.1Gutierrez JM Calvete JJ Habib AG Harrison RA Williams DJ Warrell DA Snakebite envenoming.Nat Rev Dis Primers. 2017; 3: 17079Crossref PubMed Scopus (54) Google Scholar, 4WHOWHO Expert Committee on Biological Standardization, sixty-seventh report (WHO technical report series; no. 1004). World Health Organization, Geneva2017Google Scholar, 5Warrell DA Snake bite.Lancet. 2010; 375: 77-88Summary Full Text Full Text PDF PubMed Scopus (519) Google Scholar As many as 45% of snakebite victims are women and children. People are bitten working in fields, as they fetch drinking water, while sleeping in houses at night, when going to school, or even just walking to an outdoor toilet. Community education is therefore crucial, because many snakebites are not reported or people seek care too late. Success will also depend on accelerating the development of antivenoms and, crucially, building a sustainable market for safe, effective treatments. For decades, the production and quality of antivenoms has not always met international standards, nor has there been a reliable system of supply and demand.6Gutierrez JM Burnouf T Harrison RA et al.A multicomponent strategy to improve the availability of antivenom for treating snakebite envenoming.Bull World Health Organ. 2014; 92: 526-532Crossref PubMed Scopus (44) Google Scholar In much of sub-Saharan Africa and Asia, antivenom production has stagnated or, in some cases, collapsed altogether.7Williams DJ Snake bite: a global failure to act costs thousands of lives each year.BMJ. 2015; 351: h5378Crossref PubMed Scopus (27) Google Scholar Through this new strategy, WHO aims to drive the creation of a revolving stockpile of antivenoms that can be sent wherever they are needed. We need the international scientific community to support research that solves practical problems, yields innovative new solutions, and leads to effective treatment, faster recovery, fewer deaths, and less long-term disability. Snakebite envenoming is an acute emergency that requires health systems that can function at a level of responsiveness that ensures time-critical service delivery. Thus, integrating an approach to prevention, treatment, and management of snakebite envenoming, in which the community is fully engaged, into national health policy and health systems will be crucial. Tackling the underlying social, cultural, and economic barriers to health care that many victims of snakebite experience will lead to earlier treatment and more effective outcomes. The strategy will be tested over a year (2019–20) in ten to 12 countries with a high burden of snakebite envenoming. WHO and partners will support countries in designing and implementing locally relevant plans. The next phase, in 2021–24, will see this scaled up to 35–40 countries. During the full roll-out in 2025–30, all countries will be expected to integrate the strategy into their national public health agendas. WHO plans to review and adapt the strategy between now and 2030 to ensure that it is tailored to the countries that need it most. Reducing the number of snakebite-related deaths and disabilities by 50% by 2030 is achievable, as they are mostly preventable. But WHO cannot do this alone. When we launch the strategy on May 23, we will call on governments, health professionals, researchers, international health agencies, antivenom manufacturers, philanthropists, and other stakeholders for their support in its implementation. We declare no competing interests. We thank Thomas Junghanss, David Williams, Ashok Moloo, and Priya Joi for their assistance in the preparation of this manuscript. Snake bite: prevention and management in rural Indian settingsAlthough it could be said to be too late, given that snakebite poisonings are century-old, time-sensitive, life-threatening accidents, we welcome WHO's first strategy for the prevention and control of snakebite envenoming.1 Full-Text PDF Open AccessSnakebite—emerging from the shadows of neglectEvery year, snakebites kill between 81 000 and 138 000 people and cause long-lasting disabilities in another 400 000 people. This disease burden is likely to be an underestimate given snakebite is rarely notifiable, and many bites and deaths go unrecorded. The burden of snakebite death and disability is equal to that of prostate or cervical cancer, and is greater than any other neglected tropical disease. Yet investment into snakebite has been just £30 million between 2008 and 2017, with limited research, stagnating development of treatments, and declining access to antivenoms in many countries. Full-Text PDF