The folks at the WHO have been busy lately, specifically the folks making up the Strategic and Technical Advisory Group for Neglected Tropical Diseases. At their 10th meeting, held 29-30 March 2017, the group increased the number of official Neglected Tropical Diseases from 17 to 20.
Previously I did a series of posts on the 17 NTDs that have been on the list for awhile: Buruli ulcer, Chagas disease, dengue and chikungunya, guinea-worm disease, echinococcosis, foodborne trematodiases, sleeping sickness, leishmaniasis, leprosy, elephantiasis, river blindness, rabies, schistosomiasis, soil-transmitted helminthiases, taeniasis/cysticercosis, trachoma, and yaws.
I’m sure you know what snakebites are, but you may be asking yourself, “What exactly is snakebite envenoming?”.
Good question. Let’s take a look.
According to a study done in 2006, snakebites cause at least 20,000 deaths and at least 421,000 people experience envenoming. However, these figures may be as high as 1,841,000 envenomings and 94,000 deaths, as accurate annual numbers are hard to obtain in some regions of the world. More current estimates put the death rate from snakebites at around 100,000 per year. According to the WHO, many victims are farmers and people living in low-resource, rural areas far from cities.
Snakebite envenoming happens when a venomous snake bites a person and the person is not able to access antivenom in a timely manner, so the venom causes substantial damage. Envenoming, depending on the snake species, can cause severe paralysis that may prevent breathing, bleeding disorders that can lead to fatal blood loss, kidney failure, and severe local tissue damage. Médecins Sans Frontières (Doctors Without Borders) works extensively with snakebite victims in countries such as the Central African Republic, Ethiopia, South Sudan, and in the Middle East, treating more than 2,000 victims per year. MSF provides free treatment in their facilities but when paid out-of-pocket that treatment can be more than $100, which makes it practically impossible for folks who live in low-resource settings to afford on their own.
While the WHO has started helping countries select safe antivenoms to work against local snake species, some manufacturers have stopped producing some antivenom products, furthering limiting access for affected individuals. On top of antivenom shortages, there can be issues with accurately diagnosing the responsible snake species, and a lack of understanding about the actual number and distribution of snakebite cases.
The hope of MSF is that by being formally included on the WHO NTDs list, that snakebites will receive the attention they deserve. Prevention is pretty basic: using flashlights when out at night, wearing boots and shoes, and educating people so they know to seek treatment as soon as possible. Additionally, with the WHO NTD designation, MSF hopes that donors and governments will take solid steps to address snakebites, including training and guidance for medical staff, better data to find hot spots and unmet needs, help cover treatment costs and support development of new tools.
I also hope that the addition of snakebites to the NTD list highlights this unmet need for suitable healthcare for snakebite victims. I am always a bit skeptical, however, of how much impact the addition of another disease to the NTD list really helps. I’m sure it adds a sense of notoriety and publicity to the disease that may not have existed before, but with the continued challenges the WHO faces regarding funding and priorities, I wonder how much money there is to go around for the increasing number of responsibilities the WHO is tasked with addressing.