Bengaluru: Over 5,000 snakebite cases and 36 deaths have been reported in Karnataka in the first six months of 2024 alone—a sharp rise from the 6,596 cases and 19 deaths in the entirety of 2023. The number is only expected to rise in the coming months after the state made it mandatory in February for all private and government hospitals to report snakebite cases under the Integrated Disease Surveillance Program.
Karnataka is the first state to make snakebite a ‘notifiable disease’—thanks to the efforts of Sumanth Bindumadhav, Director of Wildlife at Humane Society International India, who lobbied officials at Karnataka’s Department of Health and Family Welfare to make it happen.
“Largely regarded as a ‘poor people’s problem’—affecting mainly farmers in rural areas—snakebite deaths still seem very minute for the central government to act on,” Bindumadhav said at a panel discussion titled ‘Venomous Threat: Tackling India’s Snakebite Crisis’.
Leading herpetologists in Karnataka, including Gerry Martin, ecological science professor Kartik Sunagar, and Bindumadhav, came together at Bangalore International Centre (BIC) on 20 August to highlight gaps in the reporting and treatment of snakebite cases.
“[Snakebites] cause more human deaths in India than all other forms of man-animal conflict combined and yet it isn’t part of any centre-states discussion or assembly debates,” Bindumadhav said.
The reported figures are just the tip of the iceberg. Not all hospitals have started reporting cases yet. And not all victims of snakebite choose to avail treatment in a hospital.
Martin said that this daunting challenge is not limited to Karnataka alone. India has the unfortunate title of being the world’s snakebite capital—with nearly half of the global deaths occurring here according to the World Health Organisation (WHO)—and yet, the true estimate of the country’s snakebite crisis has been elusive due to gaps in research, awareness, and treatment.
Outdated syllabus and treatments
Deaths due to snakebites are entirely preventable but only with the prompt availability of antivenom—the probability of death increases if it isn’t administered within six hours. Martin remarked that accessing antivenoms has proven to be “a race against time in rural areas”.
“Most doctors at PHCs in rural areas and other medical centres at the taluk level are unaware of how to manage snakebite cases…causing further delay in treating the victim and increasing the chances of death,” added Bindumadhav.
In India, snakebite is a medico-legal case—a practice dating back to the British era. Every snakebite, potentially fatal or not, requires a formal police report. Bindumadhav observed that in most cases, doctors refuse to treat snakebites out of fear of the bureaucratic rigmarole of legal procedures.
Although the health ministry issues revised guidelines for managing snakebites every few years, they are usually lost in communication at rural medical facilities due to a lack of translated versions of the documents and gaps in training for medical workers.
To add to the crisis, the information about snakebite cases in the country’s medical syllabus is heavily outdated and West-centric, predominantly describing cases common in Western countries that are not applicable to India.
“New doctors enter the medical profession with old protocols. They end up fearing snakebite cases and refer the victims to other hospitals,” Bindumadhav said. The delay continues, and so does the danger. Many victims—often breadwinners of the family—die in transit.
The struggle doesn’t end after death. The victim’s family has to jump through multiple hoops to obtain a no-objection certificate (NOC) from the police and doctor and avail ex-gratia. “The poor are made to spend more on obtaining these certificates than what they paid for treatment,” Bindumadhav added.
Martin observed that such bitter experiences erode a poor person’s faith in medical institutions and public health infrastructure.
“At least 75 per cent of victims rely on faith-healers or quacks, who prescribe irrational treatment measures like applying cow dung, lemon juice, or chillis… the list goes on,” he said.
Recalling one such story, Bindumadhav talked about a 27-year-old worker trained in ITI who was bitten by a snake outside his home. He was rushed everywhere apart from a hospital and spent three months away from his job that paid Rs 35,000 per month. By the time he got to a hospital, he had lost his job.
He now earns a meagre Rs 10,000 per month, working in a hardware shop. He has to feed a family of seven, get his limb treated, and pay back a loan of over Rs 3 lakh.
The scientific community has been deliberating on bringing quacks into its ambit and teaching them the right treatment practices, but Bindumadhav disagrees. At the discussion, he suggested alternative community-based interventions such as training the first responders on snakebite prevention and demystifying formal healthcare systems among rural communities.
Also Read: Snakebites kill more Indians than malaria, dengue. Blame the urban-rural divide
Unknown nature of the beast
Even though snakes kill six people per month in India, little is known about them.
For decades, when a snakebite case was reported at a hospital, doctors across the country would attempt to match the species with one of the infamous big four: spectacled cobra, Indian common krait, Russell’s viper, and Indian Saw-scaled viper. These have been found to cause a vast majority of, if not all, deaths due to snakebite. Hence, most antivenoms in India are created out of a mixture of venom extracted from the big four snakes.
However, Martin’s research revealed that none of these species exist in the Northeast. “The antivenoms that work in one part of the country where these species are found, will not necessarily work for other regions,” he said.
Moreover, these drugs, made from animal proteins, cause adverse immune reactions in some cases, including life-threatening anaphylaxis. Yet, they remain the standard treatment.
There is no silver bullet to addressing India’s snakebite crisis at the moment.
The panellists agreed that for a country as diverse as India, with at least 290 species of snakes, well-funded research and studies to produce localised antivenoms are of pressing need.
Sunagar, the founder of the Evolutionary Venomics Lab and the Director of Venom Institute for Snakebite Health and Advanced Medicine (VISHAM)—a first-of-its-kind serpentarium for snakebite education and research being established in Bengaluru—is currently working toward developing a next-generation snakebite treatment for India and sub-Saharan Africa.
“We still have a long way to go with conducting clinical trials but it is the first step,” he said.
Meanwhile, scientists have been advising the health ministry to nationally recognise the snakebite crisis as a notifiable disease on a priority basis. Bindumadhav urged the audience to demand the same from the government.
“The voices in this room are surely louder than those of the victims of snakebites.”
(Edited by Prasanna Bachchhav)