Snakebite Gets Attention Of WHO Executive Board, Draft Resolution Approved

A resolution to address the issue of snakebites, mainly in developing countries, was met with undisputed approval last week at the World Health Organization Executive Board. Some countries suggested that scorpion bites be mentioned in the resolution, which was deemed premature.

With an estimated 81,000 to 138,000 deaths per year worldwide due to snakebites, and physical and psychological disability for close to 400,000 survivors of snake attacks, the time seemed ripe for the WHO to step in.

The Executive Board approved recommendation of a resolution [pdf] on global snakebite burden to be confirmed by the World Health Assembly, taking place from 21-26 May, recognising that snakebite envenoming has been “largely overlooked” by the global health community.

The resolution requests that member states assess the burden of snakebite, improve the availability, accessibility, and affordability of antivenoms to populations at risk, and promote the transfer of knowledge and technology between member states to improve the global availability of antivenoms.

It also asks that the WHO foster international efforts aimed at improving the availability, accessibility, and affordability of safe and effective antivenoms for all, and offers technical support to institutions working on research into snakebite envenoming, including WHO collaborating centres.

The WHO would have to report on progress of this resolution implementation to the 73rd WHA (2020).

The resolution adopted follows a draft proposal by a number of countries, tabled at the beginning of the Executive Board meeting, which took place from 22-27 January.

The initial co-sponsors of the draft resolution were Angola, Australia, Benin, Brazil, Burkina Faso, Colombia, Costa Rica, Ecuador, France, Gabon, Guatemala, Honduras, India, Jamaica, Kenya, Mexico, the Netherlands, Nigeria, Pakistan, Panama, Peru, Philippines, Senegal, Thailand, and Zambia (IPW, WHO, 23 January 2018).

Some other countries joined as co-sponsors as the draft resolution was discussed during the Board meeting, such as Vietnam, the Dominican Republic, and Algeria. And others supported it, such as Jordan, Bangladesh, and Morocco.

A number of countries described the snakebite burden in their country and region, such as Benin for the African region, who said most African countries are affected by the issue. There is a need to collect data to understand the actual scope of the issue, the Benin delegate said. Zambia concurred and said getting accurate data is a challenge.

Colombia for the Americas region said snakebite envenoming has a major impact on the economy of countries in the region, although major efforts have been deployed to fight the issue, including surveillance and the production of antivenom.

Indonesia, not a Board member, called for WHO to encourage the production of affordable antivenoms.

A South American delegate told Intellectual Property Watch afterward that this measure is a “step”, but developing countries do not only want access to antivenom, but also support for more specialists, more etymologists and snake experts, more local knowledge and understanding about the many species of insect and snake that can affect human health.

Without that, and by only focusing support on accessing treatments, “We are again creating a dependency” on something that must be obtained from industry and other countries.

People need to know how to take care of themselves, or how to identify if a bite will have a side effect in the long term, the official said, so “it’s more about primary healthcare.”

Scorpion Bites, Not Yet

Some Board members suggested that scorpion bites be added to snakebites in the resolution, such as Jordan, Iraq, Algeria, and Bahrain. Zambia suggested expanding the actions to other venomous animals.

Morocco and Mexico, non-Board members, also concurred with the suggestion of including scorpion bites.

Brazil, which said they have scorpion bites issues as well, suggested keeping the resolution focused on snakebites, as the issue has been discussed for some time, but said it is important to start a similar process for discussing the scorpion bite burden as well as other venomous animals, and to help countries to develop antivenoms.

Ren Minghui, WHO assistant director-general for communicable diseases, said adding scorpion bites to the resolution would be premature, as there is very limited information about other animal bites, in particular scorpions. There are also important differences in terms of mortality, disability, and access to antivenoms, he said, underlining the need for a detailed analysis of the issue.

Initial Consultations, Challenges

According to the WHO, initial consultations on the development of the draft resolution were begun by Costa Rica and Colombia.

Snakebites were removed from the WTO Neglected Tropical Diseases list in 2013, according to an article of the Journal of Venomous Animals and Toxins including Tropical Diseases posted on the WHO website.

It was then put back in the list in June 2017.

According to the article, one of the major challenges is to improve the accessibility of antivenoms, which is a “complex biological product that is neither a drug nor a vaccine.” Antivenoms cannot be generics, it says, because “the antibodies that compose it are produced by an animal (most often a horse) after it has been immunized with the appropriate venoms.” The article describes the complexity of processing antivenoms and having them validated by a clinical study in humans before coming into the market.

The article pays tribute to civil society who advocated for the recognition of the snakebite burden, including Médecins Sans Frontières (MSF, Doctors Without Borders), Health Action International (HAI), and the Global Snakebite Initiative (GSI). The article also says “great credit is also due to the numerous doctors, scientists, and health authorities who have kept the field alive for decades in the absence of proper recognition, and to grassroots organizations.”

The Text of the Draft Resolution is reprinted below:

“…Recognizing the lack of statistics and accurate information and the need to further improve data on the epidemiology of snakebite envenoming for a better understanding of the disease and its control;

Aware that early diagnosis and treatment are essential for reducing the morbidity, disability and mortality that snakebite envenoming can cause;

Noting with satisfaction the progress made by some Member States with regard to research into snakebite envenoming and improved case management;

Acknowledging the urgent need to improve access to safe, effective and affordable treatments in all regions of the world where snakebite envenoming is endemic;

Recognizing the work of WHO towards developing guidelines for the diagnosis and management of snakebite envenoming and for the production, control and regulation of antivenoms and the need to make these available to all regions of the world;

Mindful that achievement of the Sustainable Development Goals of the 2030 Agenda for Sustainable Development, particularly those concerning poverty, hunger, health and education, may be hampered by the negative impact of neglected diseases of the poor, including snakebite envenoming,

1. URGES Member States:

(1) to assess the burden of snakebite and, where necessary, establish and/or strengthen surveillance, prevention, treatment and rehabilitation programmes;

(2) to improve the availability, accessibility and affordability of antivenoms to populations at risk, and develop mechanisms to ensure that additional costs related to the treatment and rehabilitation after snakebite envenoming are affordable for all;

(3) to promote the transfer of knowledge and technology between Member States in order to improve the global availability of antivenoms and the effective management of cases;

(4) to integrate, where possible and appropriate, efforts to control snakebite envenoming with other relevant disease-control activities;

(5) to improve access to specific treatment and rehabilitation services for the individuals affected by snakebite envenoming, by mobilizing national resources;

(6) to provide training to relevant health workers on the diagnosis and management of snakebite envenoming, with particular emphasis in regions of high incidence;

(7) to intensify and support research on snakebite envenoming, particularly in order to develop new tools to diagnose, treat, prevent and measure the burden of the disease;

(8) to promote community awareness of snakebite envenoming, through culturally contextualized public campaigns, in support of early treatment and prevention, and intensify community participation in awareness and prevention efforts;

(9) to foster cooperation and collaboration among Member States, the international community and relevant stakeholders in order to strengthen national capacities to control, prevent and treat snakebite envenoming;

2. REQUESTS the Director-General:

(1) to accelerate global efforts and provide coordination to the control of snakebite envenoming, ensuring the quality and safety of antivenoms and other treatments and prioritization of high impact interventions;

(2) to continue to offer technical support to institutions working on research into snakebite envenoming, including WHO collaborating centres, in support of improved, evidence-based disease control efforts;

(3) to foster international efforts aimed at improving the availability, accessibility and affordability of safe and effective antivenoms for all;

(4) to provide support to Member States for strengthening their capacities for improving awareness, prevention and access to treatment and for reducing and controlling snakebite envenoming;

(5) to foster technical cooperation among Member States as a means of strengthening surveillance, treatment and rehabilitation services;

(6) to cooperate, as appropriate and in accordance with their respective mandates, with international agencies, nongovernmental organizations, foundations and research institutions, directly to provide support to Member States in which snakebite envenoming is prevalent, upon request, in order to strengthen snakebite management activities;

(7) to report on progress in implementing this resolution to the Seventy-third World Health Assembly.”

William New contributed to this report.

 

Image Credits: Flickr – Wplynn