7 ms·

Vipers, mambas and taipans: the escalating health crisis over snakebites

hellrich 10y ago
So why is no African government / company stepping in to produce antivenoms, if the technology is supposed to be 80 years old and rather basic?
- mhuffman 10y ago
  Well, this is going to be an unpopular opinion I'm sure, but a lot of Sub-Saharan African countries seem to be shuffling Health and Human Services off to Western countries to handle, while they use economic aid for more "corrupt" purposes. On the one hand it is always good to help people in need (especially children), but on the other hand, since it is just "given help" and not infrastructure development -- it tends to just kick the can down the road a little further. Worse, sometimes aid even helps to stimulate corruption and economic imbalance that keeps many of those countries trapped in a borderline desperate cycle. Here is an older, but still relevant, Wall Street Journal article that discusses the predicament from an economic standpoint[1]. [1] http://www.wsj.com/articles/SB123758895999200083 http://www.wsj.com/articles/SB123758895999200083
  - mafribe 10y ago
    Development aid also undermines democracy in developing countries because the elites focus on pleasing foreign donor organisations, rather than being accountable to their own population. There is also a tendency of aid to destroy local economic structure, as the local producers can often not compete on price with free aid. If you look at countries that managed to develop (e.g. South Korea or China in recent years), then they all did it without substantial involvement of foreign aid. It is interesting to reflect on why development aid is so popular in the developed countries despite its obvious failures. Here are some reasons. - Development organisations serve as levers of soft power. (If you give us XYZ, we'll fund your railway/sewage treatment plant/school). - On-the-ground workers of development organisations are convenient sources of information and can often be used to supply false IDs for spies, military operatives and the like. - Multi-national companies regularly support development aid, because it's good and cheap PR. - Aid organisations are lucrative sources of income for their senior staff in the developed world, and they well-oiled PR machines to keep the funds flowing, and mute criticisms.
    - zeveb 10y ago
      > Development aid also undermines democracy in developing countries because the elites focus on pleasing foreign donor organisations, rather than being accountable to their own population. Of course, it can be good to undermine democracy, when the majority of the population support e.g. female genital mutilation or burning witches.
- matt_wulfeck 10y ago
  I'm wondering that myself. If we can't find a reliable place within the continent of Africa to produce this anti-venom then something is seriously wrong.
harshreality 10y ago
It should surprise no one that in much of Africa there are economic and sociopolitical challenges involved in supplying antivenin. It's an economic challenge even in first world countries, and antivenin is expensive as a result. There's no mention of what the snakes are doing in the first place when humans run across them and get bitten, or how much good those snakes are doing by saving people in those countries from a host of rodent-transmitted diseases. The article seems to focus on two things: 1. Focus less on advanced gene-splicing antivenin R&D, and more on traditional antivenin production, because Africa has unmet demand. This is merely a coy way of saying [more] developed countries should supply and subsidize antivenin for less developed countries that can't pay. Rather than blame developed countries for focusing on R&D that doesn't solve Africa's immediate problem, some understanding would be in order. Genetic engineering approaches, once R&D is done, probably scale better than the traditional way of producing antivenin. Furthermore, anaphylaxis is a common problem with many kinds of antivenin and other vaccines. Genetic engineering approaches, which don't rely on purification of antibodies from animal blood, lead to fewer, and perhaps not any, extraneous proteins in the antivenin. That means less risk of an allergic reaction. I don't know if that's the entire reason, but pharma companies don't intentionally throw away money on R&D. If they're funding something, there's a good reason. 2. Improve the economics, politics, and scientific awareness of developing regions of Africa (that is to say, most of it). I'm sure nobody has thought of that before. "Africa has an antivenin supply problem, and all we have to do to fix it is modernize, educate, and politically stabilize those countries." Oh, that's all? Why didn't someone say something before? Such an easy and obvious solution to all those untreated snakebites.
- vacri 10y ago
  > It's an economic challenge even in first world countries, and antivenin is expensive as a result. Here in Australia, the funnelweb spider (around Sydney) is our only particularly lethal arachnid. Recently they've been struggling to find enough spiders to milk for the antivenom, and so have started to ask the general public to lend a hand in catching the damn things. http://www.smh.com.au/environment/nsw-reminded-to-help-catch-funnel-web-spiders-to-help-with-antivenom-stocks-20151010-gk5wbj.html http://www.smh.com.au/environment/nsw-reminded-to-help-catch... Interestingly, the 'spider safety kit' in that article is "a glass jar and a plastic ruler" :)
danielbarla 10y ago
Something doesn't seem right with the statistics used here. 5 million bites sounds very high. The likely difference is the disclaimer from the article "these numbers reflect estimated, rather than reported, cases". My guess is that non-reporting is very prevalent, but it's disproportionately likely for non-serious bites. Deaths and very serious bites probably do get reported much more frequently. As a counterpoint, take this article investigating South Africa's KZN province [1]. This province has most of SA's most venomous snakes, and also some of the highest incidences of snake bites in SA. The article estimates this at 24 to 34 bites per 100,000 people per year. The mortality rate is between 1 to 2% of these reported cases, bringing the total to 49 to 69 people per year, in a province of just over 10 million. It's easy to see why snake bites are not a particular focus; there are 9 different species venomous snakes in a geographically large province. Contrasted with HIV / AIDS which kills many tens of thousands a year in the same province, the difference is stark. I'm honestly not sure why there's such a difference between the numbers in these articles, but it's day and night. [1] http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009001100024 http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S...
- harshreality 10y ago
  Why are you focusing only on SA? SA is not representative of Africa as a whole, much less Asia. https://en.wikipedia.org/wiki/Epidemiology_of_snakebites https://en.wikipedia.org/wiki/Epidemiology_of_snakebites paragraphs 2 and 3. https://en.wikipedia.org/wiki/Epidemiology_of_snakebites#/media/File:Number_of_snake_envenomings.svg https://en.wikipedia.org/wiki/Epidemiology_of_snakebites#/me...
  - danielbarla 10y ago
    SA is simply where I live / have some heresay experience with. While snake bites are not unheard of, they are not exactly common either, so I'm skeptical on the topic. Nevertheless, I still think the poster on the original article is misleading. It headlines with "~5 million snake bites", while your citation puts it at anything between 1.2 to 5.4. Actual envenomings are between 420K to 1.8 million. That's a huge variance in itself, and the uncertainty is not reflected in the article much. My point is also that if they're inflating the estimated deaths by as much as the reported bites to estimated bites, it's likely incredibly incorrect. Deaths generally get investigated and reported, while lesser bites would not necessarily.
GrumpyNl 10y ago
I don't believe the header so i don't believe the article. The header claim, tens of thousands, "tens of thousands" - 20,000 to 99,999 kills a year. I call bs.
- 205guy 10y ago
  Yeah Science: http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0001018 http://journals.plos.org/plosntds/article?id=10.1371/journal... It was linked from the footnotes. Your uninformed beliefs or opinions are irrelevant and your "bs" bravado is juvenile.
RobertoG 10y ago
I can't avoid to think that, at least in the case they use to illustrate the problem at the start of the article, the problem would be solved with boots, not with expensive antivenin.
- manarth 10y ago
  That's partly economic: to be effective, you'd need to provide all of the at-risk population with boots, whilst with antivenin, the cost is treatment for those affected. It wouldn't surprise me if the cost of prevention was higher than the cost of treatment. Secondly, there's also a cultural/environmental question: if the population generally wear sandals or go barefoot, could they be easily persuaded to don protective boots - especially if their feet are then continually hot and wet? A Discomfort aside, could the boots increase the risk of other issues, such as trenchfoot?
- nickthemagicman 10y ago
  These are a lot of agricultural workers. I'm sure they get alot of hand and arm bites as well bending over doing labor outside.
hackaflocka 10y ago
According to Nassim Taleb, when all the lions were killed in the Middle East, the goats multiplied, and they apparently love tree roots, which led to the Middle East turning into desert (not sure if it's true, but he says it is and I'm inclined to believe it). Does anyone know what could be some unintended negative consequences of exterminating all snakes? It always amazes me that in North America, they exterminated Wolves from most of place, and so were able to create a safe working environment for farming. Although the deer population is a little out of control, it's not a as bad as goats turning the land into desert.
- acveilleux 10y ago
  To a large extent, humans took the place of wolves (and other predators) in North America.
  - hga 10y ago
    Exactly, we are the apex predator, even if deer are the most deadly animal in the US (from car crashes). I can't quickly find any details on the total annual harvest, but it looks like there are about 10 million of us hunting deer every year. And in general we control the populations of various animals in all sorts of ways (sometimes unfortunate ones, e.g. changes in farming practices have virtually eliminated quail hunting in my part of SW Missouri).
- sravfeyn 10y ago
  Snakes kill rodents that transmit various diseases (mentioned in the article)
  - zeveb 10y ago
    Could domestic animals (e.g. cats & dogs) keep the rodent populations in check? Would they get out of hand?
    - tunap 10y ago
      Perhaps if it was managed properly, ie: spay/neuter before release & replenish the 'supply', as needed. For example, without natural predators the Hawaiian islands are now swarming with feral cats, albeit theirs started as a human problem(abandonment): https://encrypted.google.com/search?q=hawaii+cat+problem&gbv=1&prmd=ivns&tbas=0&source=lnt&sa=X&ved=0ahUKEwjYgcaDhe3OAhVM2WMKHdVPBysQpwUIDQ https://encrypted.google.com/search?q=hawaii+cat+problem&gbv...

So why is no African government / company stepping in to produce antivenoms, if the technology is supposed to be 80 years old and rather basic?

mhuffman 10y ago
Well, this is going to be an unpopular opinion I'm sure, but a lot of Sub-Saharan African countries seem to be shuffling Health and Human Services off to Western countries to handle, while they use economic aid for more "corrupt" purposes. On the one hand it is always good to help people in need (especially children), but on the other hand, since it is just "given help" and not infrastructure development -- it tends to just kick the can down the road a little further. Worse, sometimes aid even helps to stimulate corruption and economic imbalance that keeps many of those countries trapped in a borderline desperate cycle. Here is an older, but still relevant, Wall Street Journal article that discusses the predicament from an economic standpoint[1]. [1] http://www.wsj.com/articles/SB123758895999200083 http://www.wsj.com/articles/SB123758895999200083
- mafribe 10y ago
  Development aid also undermines democracy in developing countries because the elites focus on pleasing foreign donor organisations, rather than being accountable to their own population. There is also a tendency of aid to destroy local economic structure, as the local producers can often not compete on price with free aid. If you look at countries that managed to develop (e.g. South Korea or China in recent years), then they all did it without substantial involvement of foreign aid. It is interesting to reflect on why development aid is so popular in the developed countries despite its obvious failures. Here are some reasons. - Development organisations serve as levers of soft power. (If you give us XYZ, we'll fund your railway/sewage treatment plant/school). - On-the-ground workers of development organisations are convenient sources of information and can often be used to supply false IDs for spies, military operatives and the like. - Multi-national companies regularly support development aid, because it's good and cheap PR. - Aid organisations are lucrative sources of income for their senior staff in the developed world, and they well-oiled PR machines to keep the funds flowing, and mute criticisms.
  - zeveb 10y ago
    > Development aid also undermines democracy in developing countries because the elites focus on pleasing foreign donor organisations, rather than being accountable to their own population. Of course, it can be good to undermine democracy, when the majority of the population support e.g. female genital mutilation or burning witches.
matt_wulfeck 10y ago
I'm wondering that myself. If we can't find a reliable place within the continent of Africa to produce this anti-venom then something is seriously wrong.

harshreality 10y ago

It should surprise no one that in much of Africa there are economic and sociopolitical challenges involved in supplying antivenin. It's an economic challenge even in first world countries, and antivenin is expensive as a result. There's no mention of what the snakes are doing in the first place when humans run across them and get bitten, or how much good those snakes are doing by saving people in those countries from a host of rodent-transmitted diseases. The article seems to focus on two things: 1. Focus less on advanced gene-splicing antivenin R&D, and more on traditional antivenin production, because Africa has unmet demand. This is merely a coy way of saying [more] developed countries should supply and subsidize antivenin for less developed countries that can't pay. Rather than blame developed countries for focusing on R&D that doesn't solve Africa's immediate problem, some understanding would be in order. Genetic engineering approaches, once R&D is done, probably scale better than the traditional way of producing antivenin. Furthermore, anaphylaxis is a common problem with many kinds of antivenin and other vaccines. Genetic engineering approaches, which don't rely on purification of antibodies from animal blood, lead to fewer, and perhaps not any, extraneous proteins in the antivenin. That means less risk of an allergic reaction. I don't know if that's the entire reason, but pharma companies don't intentionally throw away money on R&D. If they're funding something, there's a good reason. 2. Improve the economics, politics, and scientific awareness of developing regions of Africa (that is to say, most of it). I'm sure nobody has thought of that before. "Africa has an antivenin supply problem, and all we have to do to fix it is modernize, educate, and politically stabilize those countries." Oh, that's all? Why didn't someone say something before? Such an easy and obvious solution to all those untreated snakebites.

vacri 10y ago
> It's an economic challenge even in first world countries, and antivenin is expensive as a result. Here in Australia, the funnelweb spider (around Sydney) is our only particularly lethal arachnid. Recently they've been struggling to find enough spiders to milk for the antivenom, and so have started to ask the general public to lend a hand in catching the damn things. http://www.smh.com.au/environment/nsw-reminded-to-help-catch-funnel-web-spiders-to-help-with-antivenom-stocks-20151010-gk5wbj.html http://www.smh.com.au/environment/nsw-reminded-to-help-catch... Interestingly, the 'spider safety kit' in that article is "a glass jar and a plastic ruler" :)

danielbarla 10y ago

Something doesn't seem right with the statistics used here. 5 million bites sounds very high. The likely difference is the disclaimer from the article "these numbers reflect estimated, rather than reported, cases". My guess is that non-reporting is very prevalent, but it's disproportionately likely for non-serious bites. Deaths and very serious bites probably do get reported much more frequently. As a counterpoint, take this article investigating South Africa's KZN province [1]. This province has most of SA's most venomous snakes, and also some of the highest incidences of snake bites in SA. The article estimates this at 24 to 34 bites per 100,000 people per year. The mortality rate is between 1 to 2% of these reported cases, bringing the total to 49 to 69 people per year, in a province of just over 10 million. It's easy to see why snake bites are not a particular focus; there are 9 different species venomous snakes in a geographically large province. Contrasted with HIV / AIDS which kills many tens of thousands a year in the same province, the difference is stark. I'm honestly not sure why there's such a difference between the numbers in these articles, but it's day and night. [1] http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742009001100024 http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S...

harshreality 10y ago
Why are you focusing only on SA? SA is not representative of Africa as a whole, much less Asia. https://en.wikipedia.org/wiki/Epidemiology_of_snakebites https://en.wikipedia.org/wiki/Epidemiology_of_snakebites paragraphs 2 and 3. https://en.wikipedia.org/wiki/Epidemiology_of_snakebites#/media/File:Number_of_snake_envenomings.svg https://en.wikipedia.org/wiki/Epidemiology_of_snakebites#/me...
- danielbarla 10y ago
  SA is simply where I live / have some heresay experience with. While snake bites are not unheard of, they are not exactly common either, so I'm skeptical on the topic. Nevertheless, I still think the poster on the original article is misleading. It headlines with "~5 million snake bites", while your citation puts it at anything between 1.2 to 5.4. Actual envenomings are between 420K to 1.8 million. That's a huge variance in itself, and the uncertainty is not reflected in the article much. My point is also that if they're inflating the estimated deaths by as much as the reported bites to estimated bites, it's likely incredibly incorrect. Deaths generally get investigated and reported, while lesser bites would not necessarily.

GrumpyNl 10y ago

I don't believe the header so i don't believe the article. The header claim, tens of thousands, "tens of thousands" - 20,000 to 99,999 kills a year. I call bs.

205guy 10y ago
Yeah Science: http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0001018 http://journals.plos.org/plosntds/article?id=10.1371/journal... It was linked from the footnotes. Your uninformed beliefs or opinions are irrelevant and your "bs" bravado is juvenile.

RobertoG 10y ago

I can't avoid to think that, at least in the case they use to illustrate the problem at the start of the article, the problem would be solved with boots, not with expensive antivenin.

manarth 10y ago
That's partly economic: to be effective, you'd need to provide all of the at-risk population with boots, whilst with antivenin, the cost is treatment for those affected. It wouldn't surprise me if the cost of prevention was higher than the cost of treatment. Secondly, there's also a cultural/environmental question: if the population generally wear sandals or go barefoot, could they be easily persuaded to don protective boots - especially if their feet are then continually hot and wet? A Discomfort aside, could the boots increase the risk of other issues, such as trenchfoot?
nickthemagicman 10y ago
These are a lot of agricultural workers. I'm sure they get alot of hand and arm bites as well bending over doing labor outside.

hackaflocka 10y ago

According to Nassim Taleb, when all the lions were killed in the Middle East, the goats multiplied, and they apparently love tree roots, which led to the Middle East turning into desert (not sure if it's true, but he says it is and I'm inclined to believe it). Does anyone know what could be some unintended negative consequences of exterminating all snakes? It always amazes me that in North America, they exterminated Wolves from most of place, and so were able to create a safe working environment for farming. Although the deer population is a little out of control, it's not a as bad as goats turning the land into desert.

acveilleux 10y ago
To a large extent, humans took the place of wolves (and other predators) in North America.
- hga 10y ago
  Exactly, we are the apex predator, even if deer are the most deadly animal in the US (from car crashes). I can't quickly find any details on the total annual harvest, but it looks like there are about 10 million of us hunting deer every year. And in general we control the populations of various animals in all sorts of ways (sometimes unfortunate ones, e.g. changes in farming practices have virtually eliminated quail hunting in my part of SW Missouri).
sravfeyn 10y ago
Snakes kill rodents that transmit various diseases (mentioned in the article)
- zeveb 10y ago
  Could domestic animals (e.g. cats & dogs) keep the rodent populations in check? Would they get out of hand?
  - tunap 10y ago
    Perhaps if it was managed properly, ie: spay/neuter before release & replenish the 'supply', as needed. For example, without natural predators the Hawaiian islands are now swarming with feral cats, albeit theirs started as a human problem(abandonment): https://encrypted.google.com/search?q=hawaii+cat+problem&gbv=1&prmd=ivns&tbas=0&source=lnt&sa=X&ved=0ahUKEwjYgcaDhe3OAhVM2WMKHdVPBysQpwUIDQ https://encrypted.google.com/search?q=hawaii+cat+problem&gbv...