![An expert holds a rattlesnake after venom was extracted from it at the Butantan Institute in Sao Paulo, Brazil](/https/www.telegraph.co.uk/content/dam/global-health/2024/04/10/TELEMMGLPICT000218658480_17127482416640_trans_NvBQzQNjv4BqOLSIyYLmkFq7W-G_CKMXcbeHsZFrEmHQDi0eQN40zhg.jpeg?imwidth=680)
A simple policy change could ‘eliminate’ snakebite deaths in the Amazon
The jungle is a hotspot for deadly serpents, but modelling now proves lives and money could be saved be expanding antivenom stocks
![An expert holds a rattlesnake after venom was extracted from it at the Butantan Institute in Sao Paulo, Brazil](/https/www.telegraph.co.uk/content/dam/global-health/2024/04/10/TELEMMGLPICT000218658480_17127482416640_trans_NvBQzQNjv4BqOLSIyYLmkFq7W-G_CKMXcbeHsZFrEmHQDi0eQN40zhg.jpeg?imwidth=680)
Brazil’s sprawling Amazon is home to some of the most terrifying snakes on the planet, from the highly venomous South American rattlesnake to the bushmaster, the world’s longest pit viper.
So perhaps it’s no surprise that 45 per cent of snakebites recorded in the vast country come from the jungle region, which is home to just nine per cent of Brazil’s population. On average, 122 people die after an attack from the slithering serpents in Amazonas each year, and hundreds more are left with debilitating disabilities.
“But this is a burden that should not exist at all,” said João Ricardo Nickenig Vissoci, an assistant professor of Emergency Medicine, Global Health and Neurosurgery at Duke University. “And [it] could be reduced – if not eliminated – by making the clinically efficacious treatment available to those who need it most.”
And now, there is finally data to back up this claim.
Brazil has ample antivenom – unlike many other countries with a high snakebite burden, the country manufactures its own products and provides it for free at hospitals.
But the remote health facilities nestled deep in the rainforest rarely have the antivenom they need to treat victims, forcing people to travel hours or even days for life-saving, time sensitive treatment. These delays dramatically reduce the chance of survival and make permanent disabilities or organ failure far more likely.
![The Itaquai River snakes through the Javari Valley Indigenous territory, Atalaia do Norte, Amazonas state, Brazil](/https/www.telegraph.co.uk/content/dam/global-health/2024/04/10/TELEMMGLPICT000299269350_17127500600650_trans_NvBQzQNjv4BqpVlberWd9EgFPZtcLiMQf0Rf_Wk3V23H2268P_XkPxc.jpeg?imwidth=350)
Earlier this year, Prof Vissoci and his colleagues in Brazil published a modelling study in the Lancet, which looked (for the first time) at the health and economic impact of scaling up antivenom availability under three scenarios.
In best-case scenario – where 95 per cent of hospitals and community health centres across the Amazonas region stocked antivenom – the team found that 114 deaths would be prevented every year, and millions of pounds saved.
“The whole rationale comes from the idea that remote health facilities also maintain vaccines,” Prof Vissoci told the Telegraph. “Brazil has a historically high vaccination rate, with very successful immunisation programs in remote areas. The antivenom uses the same cold chain, making it feasible [to stock the treatment].”
These results were “not surprising for us”, but Dr Vissoci said the scale of the potential change was surprising for policy makers and communities, and has proved critical in conversations persuading authorities to alter the status quo.
The team has also created a checklist of minimum requirements needed to actually administer antivenom, and assessed the risks involved in delivering the treatment outside specialist centres.
Traditionally, it is deemed unwise to do so due to the potential side effects of antivenom – an extremely toxic, snake-specific drug that has barely changed for a century.
“However, our data show that the complication rates are very small,” said Dr Vissoci. “Thus the tradeoff of having the policy [that] targets just high complexity centres is creating an access barrier.
“[My co-authors] are part of a working group that is discussing this policy now, engaging with local and federal authorities,” he said, adding that these conversations have so far been positive. “Our results show that this decentralisation is feasible and cost-effective… the path to change has been built.”
Across the globe, the World Health Organization estimates that between 1.8 and 2.7 million people are bitten by venomous snakes each year – with up to 138,000 people dying as a result. Yet it remains a neglected issue internationally.
The UN agency’s technical offer for antivenom, Dr David Williams, said that more ‘Big Data’ studies like this will be critical to reduce the death toll and medical burden caused by snakes.
“The more data that we can bring, the better,” Dr Williams told Think Global Health. “Snakebite is still massively under reported. It really is a disease of invisible communities – communities where it’s not necessarily easy to get the data, or ones that seem to always get forgotten when it’s time to collect data.”
Protect yourself and your family by learning more about Global Health Security