Devendra, a farmer in India, remembers a snake’s fangs digging into his leg while he was picking mulberry leaves.
“Four days after I was bitten, I went to hospital and the pain was unbearable. But the delay cost me a leg,” he said in a short film released by the Global Snakebite Task Force (GST), which works to reduce casualties from snakebites.
But Devendra remains one of the lucky few who survived. According to the federal government, about 50,000 Indians die from snake bites every year, accounting for about half of the global death toll. Some estimates suggest the death toll may be higher: A 2020 study said as many as 1.2 million people may have died in India between 2000 and 2019, an average of 58,000 per year.
Now, a new report by GST has found that 99% of healthcare workers in India face the challenge of using antivenom, the life-saving antibodies that neutralize the toxins in venom. Researchers surveyed 904 medical professionals in India, Brazil, Indonesia and Nigeria, the countries most affected by snake bites, and found similar barriers: poor infrastructure, limited access to antivenom and inadequate training.
Nearly half of professionals said delays in treatment resulted in serious complications for patients, including amputation, surgery or lifelong immobility.
In 2017, the World Health Organization (WHO) officially listed snakebite or envenoming as a “highest priority neglected tropical disease” due to its high death toll. According to the World Health Organization, an estimated 5.4 million people are bitten by snakes every year around the world, and more than 100,000 people die each year.
The report also notes that snake bites disproportionately affect poor rural communities in low- and middle-income countries.
Devendra was bitten by a snake while picking mulberry leaves and had to have his leg amputated [Strike Out Snakebite]
Dr Yogesh Jain, member of the GST and a practitioner in central Chhattisgarh, said that in India, there is a high concentration of snake bite deaths and injuries reported in the central and eastern regions. People working on farms, including those from poor tribal communities, remain the most vulnerable, he added.
In 2024, India launched the National Action Plan for Prevention and Control of Snake Bite Envenomation (NAPSE) with the goal of halving snake bite deaths by 2030. The plan focuses on better surveillance, improved antivenom supply and research, enhanced medical capabilities and public awareness campaigns.
Experts agree it’s a step in the right direction, but implementation has been inconsistent.
“In India, snake bites are seen as a poor people’s problem,” Jain said. “That’s why there’s not enough outrage or action taken against these completely avoidable deaths. When it comes to treating snake bites, every second counts.”
He explained that snake venom enters the bloodstream within minutes and attacks nerves, cells or the circulatory system, depending on the species of snake. Delayed administration of antivenom may result in respiratory failure, paralysis, irreversible tissue damage, or organ failure.
However, delays in hospitalization are common in rural India, where poor road conditions, remote hospitals and a lack of ambulance services prevent timely treatment.
In September last year, a pregnant woman in Gujarat state reportedly died on her way to hospital, with her family having to carry her 5 kilometers (3 miles) in a cloth sling because there were no vehicles to reach their village.
Jain said some states are trying to improve access by stocking antivenom at primary and community health centres. But managing it properly remains a significant challenge.
Many health workers are not trained professionals and fear giving antivenom because patients sometimes experience adverse reactions.
“The antivenom is mixed with saline and administered intravenously over an hour, but many centers are not equipped to deal with the side effects,” Jain said.
Another problem, he added, is that many people in rural India still rely on faith healers or local medical practices and only go to hospital when symptoms worsen, which can be fatal.
Gerry Martin’s The Liana Trust has been researching antidotes for local snake bites [The Liana Trust]
Gerry Martin, co-founder of the Liana Trust, which works to reduce human-snake conflict in Karnataka, said another major hurdle is the availability of high-quality antivenom.
Currently, antivenoms in India only protect against the “big four” snakes – cobras, kraits, Russell’s vipers and saw-scaled vipers – which are believed to cause most bites. Martin explained that antivenom is produced by injecting the venom of these snakes into horses, and then using their antibodies for treatment in humans.
But India does not yet have targeted antivenom for dozens of other venomous snake species. These include the green viper common in the northern states of Himachal Pradesh, the Malabar viper and the hump-nosed viper found in the southern states and many other species in the northeastern states.
Last year, a study by Aiims (All India Institute of Medical Sciences) in Jodhpur, Rajasthan, highlighted this issue. The study found that when 105 snakebite patients (the species of snake was unknown) were given antivenom used to treat saw-scaled viper bites, two-thirds did not respond well to the treatment.
The study concluded that “region-specific antivenoms are urgently needed in western India”.
For the past five years, the Liana Trust has been studying the venom of species outside the big four to develop antidotes for them. But progress has been slow, Martin said, because the process is laborious and time-consuming.
He called on states to follow a 2024 order issued by the government of the southern state of Karnataka, which made snake bites a “notifiable disease” and required health professionals to report them to authorities to combat under-reporting.
Jain agrees. “Snake bite deaths begin when political will ends,” he said.
“The government should make sure that poor people don’t get a bad health care system. They deserve better.”
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