Snakebites kill hundreds of thousands, so the scarcity of proper treatment is a global tragedy. Time to bring in the law, say Nick Brown and Dev Kevat
SNAKEBITE is one of the world鈥檚 most neglected health issues. In 2009, the World Health Organization (WHO) declared it a 鈥渘eglected tropical disease鈥�. Yet this devastating problem is ignored by governments, research funders and public health organisations, leaving millions without adequate treatment.
In allowing this tragic situation to exist, governments are not only ignoring persuasive moral and economic reasons to improve treatment, but may also be in violation of legal obligations to provide access to antivenom.
Advertisement
The extent of the problem is difficult to quantify, but the estimates there are 5 million cases annually worldwide, with up to half of victims experiencing effects from venom. Snakebites cause at least 100,000 deaths and up to 400,000 amputations each year. Millions more are bitten by spiders, scorpions and other venomous creatures, also without access to adequate medical care.
It is probable that snakebite causes more deaths and disability than many other tropical diseases, including dengue fever, Chagas鈥� disease and leishmaniasis (). Despite this, snakebite treatment programmes receive little public health funding and struggle to attract the research effort and political resolve necessary to improve treatment options.
Antivenoms are a proven approach to reducing death and disability from snakebites, but safe and effective sources are in decline. In many parts of the developing world, access to antivenom is virtually impossible. Even where it is available it is sometimes not used, or used inappropriately, because of inadequate experience and a lack of equipment to administer it.
Moreover, a lack of investment and innovation has seen the proliferation of poorly manufactured, ineffective, expensive and sometimes dangerous antivenoms. Unscrupulous marketing of unsuitable and mislabelled antivenoms is not uncommon in some countries (). Not surprisingly, these factors serve to undermine confidence in antivenoms.
There is no need for this. High quality antivenoms can be produced at reasonable cost. For example, funding from the UK鈥檚 Engineering and Physical Sciences Research Council, the Biotechnology and Biological Sciences Research Council, the Nigerian Ministry of Health and companies in Wales and Costa Rica led to the successful development of improved antivenoms against the West African carpet viper, Echis ocellatus, one of the world鈥檚 deadliest snakes ().
One such antivenom developed by the consortium is marketed for less than $40 per patient. At this price, more lives can be saved and disability averted per dollar spent on antivenom than with most other treatment programmes. Owing to its curative nature and relatively rapid effects, antivenom is one of the most cost-effective treatments available. Compared to HIV drugs, for example, it is at least 30 times more cost-effective in preventing death and disability ().
There are also strong arguments that governments are legally obliged to provide access to antivenom. More than 160 countries are signatories to the UN鈥檚 International Covenant on Economic, Social and Cultural Rights (ICESCR), which includes the right to health. This does not mean an individual has the 鈥渞ight鈥� to be healthy, but that governments have an obligation to protect the health of their citizens.
All signatories must meet certain baseline obligations regardless of their economic status. One of these is to provide safe and effective essential drugs as defined by the WHO Action Programme on Essential Drugs, which since 2005 has included some antivenoms . Under the ICESCR, when a country fails to meet a core obligation it must demonstrate that every effort has been made to use every resource at its disposal to satisfy this obligation as a matter of priority.
While the UN has a committee that monitors implementation of ICESCR obligations, international treaties can be difficult to enforce. However, more than 100 countries also have a 鈥渞ight to health鈥� enshrined in their constitutions, which are usually the highest law of a country. Of the countries with a constitutional right to health, a number experience high rates of untreated snakebites, most notably in Asia, Africa and South America. The shortage of life-saving antivenom in these countries means that not only are governments contravening international laws to uphold the health of their people, but, depending on the rulings of national constitutional courts, they could also be found to be failing to meet national legal obligations.
鈥淭he shortage of life-saving antivenom in many countries contravenes international law鈥�
Snakebites are terrifying ordeals with significant humanitarian consequences that outweigh those of many other tropical diseases. For millions of people, the inability to access antivenoms is an infringement of their right to health.
The arguments that support improved access to quality antivenoms give cause to ponder whether such a crisis would exist if snakebite was a problem affecting wealthy countries. It also makes one consider whether hitherto untried legal avenues may be more successful in improving the plight of the victims of snake venom.
