Here’s a prediction for the summer that’s much more reliable than anything you’ll get from the Met Office: in Britain, no one will die of a snakebite. The only venomous snakes on these shores are adders. Not only are their numbers in decline but they are timid and bite as a last resort. Each year, roughly a hundred people are bitten by adders in the UK but as few as 12 people have died in the past century as a result. The most recent death was in 1975.
If only that were true elsewhere. Snakebites kill up to 94,000 people and necessitate hundreds of thousands of amputations every year. Children and young people are most likely to be bitten and in some countries snakes kill as many people as Aids. Globally, the number of fatalities is up to 30 times that of landmines.
One of the biggest problems in treating snakebite is recognising which antivenom is needed. The mechanism by which the venom causes paralysis varies from species to species and giving the wrong antivenom can be worse than useless. Often, victims have to wait for the results of blood tests before the appropriate antivenom can be identified. But research published last month in the Journal of Tropical Medicine shows that it might be possible to create a universal antivenom that can be administered straight away as a simple nasal spray.
Before this paper was published, the universal antivenom neostigmine had already passed a couple of tests. In 2013, researchers injected a volunteer with a venom mimic, which caused a creeping paralysis that moved from the eyes to the diaphragm, causing difficulty in breathing. Twenty minutes after administration of the neostigmine nasal spray, the patient had completely recovered.
The second test was not a controlled experiment. It was carried out on a woman who was hooked up to a life-support machine after a snakebite in India. She had received 30
doses of antivenom but still had facial paralysis. The nasal spray relieved this after 30 minutes. Two weeks later, she was back at work.
In the latest study, mice were the unfortunate victims. They were given a lethal dose of cobra venom, followed by a single nasal dose of neostigmine ten minutes later. Two-thirds survived. The spray also allowed mice given ten times the lethal dose of cobra venom to survive six times longer than they otherwise would have. This suggests that even when it is not an instant cure, the spray could give people time to get to a hospital.
There’s still a long way to go, however. The researchers weren’t able to check the effectiveness of the nasal spray against different kinds of venom due to “limitations of funding”. Of even more concern is their admission that: “Both the efficacy and optimal uses of . . . therapies for neurotoxic snakebite remain unproven even after decades of widespread use.” In other words, hospitals have antivenoms but nobody is doing the studies that will show us how best to use them and how effective they are.
That’s almost certainly because 98 per cent of snakebite victims live in poverty, and treatment (and thus research) is largely paid by the victims or their family. Many bite victims are left disfigured or unable to work because of amputation or permanent paralysis and have to take out loans, sell livestock or crops and even pull their children out of school to get the cash they need. The World Health Organisation has called snakebites a “neglected threat to public health”. It is time for that neglect to end.
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