Strengthening global snakebite data for WHO's goal for 2030
Authors: Hrishikesh Munshi, Rahul K Gajbhiye
Journal: The Lancet (2024)

Snakebite envenoming is a substantial but neglected public health issue, particularly in low-income and middle-income countries (LMICs). Annually, there are approximately 4·5–5·4 million snakebites, 1·8–2·7 million cases of envenomation, 81 000–130 000 deaths from snakebites, and a considerably higher number of permanent disabilities from snakebites worldwide.1WHO Snakebite envenoming..https://www.who.int/news-room/fact-sheets/detail/snakebite-envenomingDate: May 17, 2021Date accessed: June 20, 2023Google Scholar Roughly 95% of these incidents occur in LMICs.1WHO Snakebite envenoming..https://www.who.int/news-room/fact-sheets/detail/snakebite-envenomingDate: May 17, 2021Date accessed: June 20, 2023Google Scholar, 2Chippaux J-P Snakebite envenomation turns again into a neglected tropical disease!.J Venom Anim Toxins Incl Trop Dis. 2017; 23: 38Crossref PubMed Scopus (341) Google Scholar Snakebite envenoming was initially overlooked by the WHO review of neglected tropical disease burden in 2007.2Chippaux J-P Snakebite envenomation turns again into a neglected tropical disease!.J Venom Anim Toxins Incl Trop Dis. 2017; 23: 38Crossref PubMed Scopus (341) Google Scholar It was later included in the list of neglected tropical diseases in 2009, removed in 2013, and reinstated as a category A neglected tropical disease in June, 2017. During the World Health Assembly in May, 2018, WHO urged member states to assess the burden of snakebite envenoming and strengthen surveillance, prevention, treatment, and rehabilitation programmes, while promoting international collaborations to enhance national capacities for snakebite prevention and control. To halve snakebite deaths by 2030, WHO launched the Snakebite Information and Data Platform with the aim of creating a comprehensive database of information on venomous snakes and anti-venom while providing an opportunity for member countries to share their epidemiological data on snakebite envenoming. However, the platform does not currently display any data for highly affected Asian and South American countries, suggesting that these countries might not have shared their snakebite envenoming data. The absence of data on global disability-adjusted life-years (DALYs) associated with snakebite envenoming in the World Health Statistics 2023 report and the Global Report on Neglected Tropical Diseases 2023 highlights a substantial gap in the data. The available data figures are based on only a few hospital-based sources and probably underestimate the true impact of snakebite envenoming (appendix p 1). Despite these data limitations, snakebite envenoming has emerged as the most fatal disease of the 20 neglected tropical diseases listed by WHO. Studies conducted in west Africa (16 countries; 319 874 DALYs; 95% CI 248 357–402 654),3Habib AG Kuznik A Hamza M et al.Snakebite is under appreciated: appraisal of burden from west Africa.PLoS Negl Trop Dis. 2015; 9: e0004088Crossref PubMed Scopus (93) Google Scholar Nepal (200 799 DALYs; 103 138–357 805),4Babo Martins S Bolon I Alcoba G et al.Assessment of the effect of snakebite on health and socioeconomic factors using a One Health perspective in the Terai region of Nepal: a cross-sectional study.Lancet Glob Health. 2022; 10: e409-e415Summary Full Text Full Text PDF PubMed Scopus (16) Google Scholar and the Association of Southeast Asian Nations (10 countries; 391 979 DALYs; 187 261–836 559)5Patikorn C Blessmann J Nwe MT et al.Estimating economic and disease burden of snakebite in ASEAN countries using a decision analytic model.PLoS Negl Trop Dis. 2022; 16: e0010775Crossref Scopus (14) Google Scholar have revealed substantial annual snakebite envenoming loads. However, there are no DALY estimation studies for India, which accounts for almost half of the global deaths from snakebite envenoming. The low number of victims seeking care at health facilities, which is compounded by the absence of a robust surveillance system and crippled reporting mechanisms, weakens India's data on snakebite envenoming. The situation is not dissimilar in other countries with high envenoming burdens. The resulting data disparity affects crucial aspects of management, including fund allocation and the manufacturing and distribution of anti-venom. To achieve the ambitious 2030 target set by WHO, national and global policy makers should ensure that they are not mischaracterising existing data. Relying on pseudofactual reference values will inversely affect our ability to gauge the progression of strategy implementation and the credibility of the achieved goal. The authorities in LMICs must invest in creating reliable data sources both from health systems and communities to ensure that every case of snakebite envenoming and death from snakebite envenoming is accounted for. Countries such as India, which do not have robust data recording mechanisms, should designate snakebite envenoming as a notifiable disease.6Gajbhiye RK Munshi H Bawaskar HS National programme for prevention and control of snakebite in India: key challenges and recommendations.Indian J Med Res. 2023; 157: 271-275Google Scholar This notification should be complemented by the creation of population-based snakebite registries in the most affected regions and provinces. Although the WHO Snakebite Information and Data Platform provides an overview of venomous snake species and their distributions, member states must also be encouraged to share national data on snakebite envenomation. South Asia, which has 70% of global deaths from snakebite envenoming, must take concrete steps to develop a collaborative and comprehensive data collection ecosystem; and India with its burden and resources, must lead this consortium for regional cooperation to address common challenges. On the basis of our research experience in snakebite envenoming in India, we have found that training Community Health Workers, such as accredited social health activists, involving local snake catchers and traditional faith healers, and sensitising medical officers to the importance of reliable data all play crucial roles in strengthening community surveillance networks.6Gajbhiye RK Munshi H Bawaskar HS National programme for prevention and control of snakebite in India: key challenges and recommendations.Indian J Med Res. 2023; 157: 271-275Google Scholar The Indian Council of Medical Research in New Delhi funds two nationally representative studies focusing on hospital and community-based snakebite envenoming data collection.7Gajbhiye RK Chaaithanya IK Munshi H et al.National snakebite project on capacity building of health system on prevention and management of snakebite envenoming including its complications in selected districts of Maharashtra and Odisha in India: a study protocol.PLoS One. 2023; 18: e0281809Crossref Scopus (5) Google Scholar, 8Menon JC Bharti OK Dhaliwal RS et al.ICMR task force project- survey of the incidence, mortality, morbidity and socio-economic burden of snakebite in India: a study protocol.PLoS One. 2022; 17: e0270735Crossref Scopus (3) Google Scholar These studies have the potential to revolutionise evidence-based decision making in India regarding snakebite envenoming. If successful, they should be integrated into a single model that can be replicated across south Asia. The urgency of these actions cannot be overstated, as revealing the true burden later, when resources are nearly depleted, would severely hinder global efforts for the prevention and control of snakebite envenoming. Establishing a coalition of global experts, capable of influencing national policy decisions, could bring about transformative change by translating WHO recommendations into action. We declare no competing interests. For more on the WHO-listed neglected tropical diseases see https://www.who.int/health-topics/neglected-tropical-diseasesFor more on the Snakebite Information and Data Platform see https://www.who.int/health-topics/neglected-tropical-diseasesFor more on the World Health Statistics 2023 report see https://www.who.int/publications/i/item/9789240074323For more on the Global Report on Neglected Tropical Diseases 2023 see https://www.who.int/teams/control-of-neglected-tropical-diseases/global-report-on-neglected-tropical-diseases-202 For more on the WHO-listed neglected tropical diseases see https://www.who.int/health-topics/neglected-tropical-diseases For more on the Snakebite Information and Data Platform see https://www.who.int/health-topics/neglected-tropical-diseases For more on the World Health Statistics 2023 report see https://www.who.int/publications/i/item/9789240074323 For more on the Global Report on Neglected Tropical Diseases 2023 see https://www.who.int/teams/control-of-neglected-tropical-diseases/global-report-on-neglected-tropical-diseases-202 Download .pdf (.13 MB) Help with pdf files Supplementary appendix