58,000 Indians Die Of Snakebites Every Year: Why Is It Still Neglected?

India accounts to more than half snakebite deaths in the world. What are the reasons behind this?

"A problem of the economically and socially backward, that no one wants to direct resources to" – is how scientists, and public health specialists describe snakebite-related deaths in India.

To put things into perspective: At least 1.2 million Indians lost their lives to snakebites from 2000 to 2019 – representing an average of 58,000 people per year. This data also shows that India accounts to more than half the snakebite deaths across the world.

But snakebite remains one of the country's most neglected tropical diseases – with the only representative data available being the Registrar General of India - 1 Million Death study, and another on mortality in Bihar.

Last week, the Indian Council of Medical Research (ICMR) announced a first of its kind study looking at incidence of snakebites covering 13 states in 5 zones of India, among a population of 84 million.

So why exactly are snakebites so neglected?

Who Is Susceptible to Snakebites?

Poisoning from snakebites or snakebite envenoming was classified by the World Health Organisation (WHO) as a high-priority neglected tropical disease only in 2017. But snakebites are as old as time itself.

In India, nine out of 10 snakebites occur in small villages, points out Dr SP Kalantri, who works at the Mahatma Gandhi Institute of Medical Sciences, in Maharashtra's Sevagram.

"India lives in villages and this is where snakes are around. For many people who are involved in agriculture and related fields, snakebite is a occupational hazard. In the rainy reason when they go to the field, they often run into venomous snakes. They also live in small huts where snakes can get in easily, these are people who also live in places where the roads are poorly lit, particularly during rainy reason."

Dr SP Kalantri to The Quint

Farmers, labourers, hunters, tribal and migrant populations, snake rescuers – and any community that has limited access to healthcare are listed as high-risk groups for snakebites. But another reason for increase in incidents is also due to human-environment conflict.

"A reason for snakebites, and the increase in the number of incidents over the years is due to human-environment conflict. As the population is increasing, and humans occupy what is traditionally the snake's habitat for over 1,000 years, the incidents of snakebites increase. Rapid urbanisation and industrialisation is the reason behind these incidents in India," Dr Soumyadeep Bhaumik, Co-Head, Meta-research and Evidence Synthesis Unit, George Institute for Global Health, India told The Quint.

Why Is This a Reason For Neglect

Speaking to The Quint, Dr Bhaumik explained that most people who are often victims of snakebites are from poor and politically voiceless communities – making it difficult for them to even reach hospitals on time, let alone influence policy change.

For example, he pointed that the process of manufacturing anti-venom to provide as an antidote has not changed for several years.

"Venom is drawn from snake, and is then injected into a horse to manufacture anti venom. This has not changed for the last 100 years because this is the disease of the people who do not have political clout. They cannot afford to pay big money to the drug companies – so this remains neglected."

Dr Bhowmik

Dr Kalantri seconds this. He points that the disease remains a part of neglected research area – with expensive and dated diagnostics.

"While the ICMR is planning to study the disease now, government agencies and the pharma industry is not interested in sponsoring research because it will actually bring in very little money."

The Different Kinds Of Snakebites – Do's & Don'ts

However, it is important to note that not all snakes are venomous. In India, and for most of the subcontinent, the most number of medically significant human snake bite cases are caused by what is called the 'Big Four':

• Russell's viper

• Common krait

• Indian cobra

• Indian saw-scaled viper

However, there is no way that one can immediately distinguish whether the snakebite is venomous or not.

"In case of a cobra, or a viper, the victim will have severe pain, swollen limbs, people vomit, and blood doesn't clot. They would need to be taken to hospitals immediately. However, a krait bite is the most dangerous, yet there's no pain immediately after the bite, in many cases even unaware that something has bitten the. But after a couple of hours, they experience neuromuscular paralysis and are unable to open their eyes or swallow. They need to be taken to the ICU immediately."

According to Dr Kalantri, here are some things one should keep in mind in case of a snakebite:

• Do not tie a tourniquet (a cloth or a band) around the wound – this will stop the blood flow, and could case gangrene. It is counter-productive

• Should not make an incision around the wound, this can lead to people bleeding torrentially, or even infect the wound further

• Take them as fast as possible to a primary health centre or to someone who is practicing modern medicine

Strengthening Public Healthcare

The intervention of modern medicine is crucial, say experts. But point out that this does not happen due to two reasons:

• Intricate faith in alternate medicine that they bypass faith in modern medicine

• Lack of primary health centre, or worse, lack of doctors at these places

"When it comes to snakebites, home-remedies or faith in alternate medicine takes precedence. There needs to be better recognition in the community on the dangers snakebites present."

"Ideally, the person who is bitten by a snake should be taken to the hospitals within one hour – so that they can get best possible intervention. But I cannot stress enough the importance of strengthening public health systems because most of these places lack it. Even if the person reaches the hospitals, there are no doctors of modern medicine to attend to them. If there is a doctor, there are issues like electricity and water supply that affect the treatment," says Dr Bhaumik, adding that strengthening public health systems can have a major impact in bringing down the number of deaths.

What's Needed to Fix This

Push For Better Diagnostics

Scientists and public health specialists, who focus on snakebites in India, have been pushing for better research into providing better diagnostics.

"Unlike of cancer, heart attack, there are no variety of diagnostics to identify snakebites. Research could help in a diagnostic method which will tell whether the snakebite is venomous or not, if yes, then what kind of snakebite it is. This can be made possible at the primary health centre level. Quick and early diagnosis can save lives," Dr Kalantri said.

Affordable Care Needed

He also pointed the dire need for more affordable care – pointing that three vials of anti-venom costs Rs 6,000 to Rs 7,000 and a patient would need at least 10 vials of the same. Further, in most cases, the patient needs tertiary-level care, that they are unable to afford.

"What people do not realise is that snakebite can cost more than treating a heart attack or a stroke. Often, people end up not going to hospitals fearing costs, and succumb to injuries," Dr Kalantri added.