‘You won’t see tomorrow’ unless there’s a remedy in the Snake Belt
The race is on to halve the deaths from the world’s biggest hidden health crisis
Three-year-old Shaibu Musa lies on a hospital trolley, his terrified eyes staring at his swollen right arm.
The burning pain seems out of all proportion to the pinpricks left on his hand by the intruder in his bed last night.
All he knows is that when he awoke screaming, a small, brown creature no longer than his forearm slithered away.
His parents realised it was probably a carpet viper – a common killer here in northeast Nigeria and one of the world’s deadliest snakes.
The spartan 200-bed Snakebite Treatment and Research Hospital in Kaltungo does not look state-of-the-art, but its doctors are true specialists.
Here in the “Snake Belt” – as this arid, reptile-friendly region is known – more people suffer snake bites than in any other corner of the world.
Also on the hospital trolley, severed in two pieces and inside a Coca-Cola bottle, is the serpent from last night.
Its coils bear the brown, diamond-hued patterning – reminiscent of a 1970s floor covering – that gives the carpet or saw-scaled viper its name.
In the Hausa language, its name means: “You will not see tomorrow.”
“It’s a very aggressive snake, and it will often bite even if not provoked,” said Dr Sulaiman Muhammad, one of the clinic’s senior medics.
“The venom is haemotoxic, which means it stops the blood from clotting. That can lead to patients bleeding from the mouth, nose and internally, including in the brain. If it isn’t treated, they can die within hours.”
Snakebite is arguably the world’s biggest hidden health crisis.
Every year 5.4-million people are bitten by snakes with between 81,000 and 138,000 dying.
Of those who survive, 400,000 suffer life-changing injuries such as amputations, nerve damage, sight loss and terrible open ulcers that never heal.
The burden of death and disability is greater than any other neglected tropical disease and equal to that of prostate or cervical cancer worldwide.
Despite these numbers, snakebite has received little attention from the international health community.
A condition of the rural poor in remote parts of Africa, Asia and South America, it has been easy to dismiss as just another unfortunate fact of life.
But now that is set to change.
Two years ago the World Health Organisation formally classified snakebite as a neglected tropical disease, and will later this month launch a global strategy that aims to halve the numbers of deaths and cases of disability by 2030.
Then on Wednesday came two funding announcements the experts describe as “game changing”.
The Wellcome Trust, one of the world’s largest biomedical charities, announced an £80m programme to transform the way snakebite is managed globally.
And the UK department for international development (DfID) released £9m to fund the development of the holy grail of snakebite treatments – a universal snake antivenom.
“These investments are profound,” said Professor Robert Harrison, the head of the Centre for Snakebite Research and Interventions at the Liverpool School of Tropical Medicine (LSTM).
“For the first time in my lifetime, there is a coordinated global strategy and the money to back it.”
There is a “global crisis” in the manufacture and supply of antivenoms.
Most imagine a simple injection carried in a rucksack can reverse the effects of any snakebite, but the truth is very different.
Antivenoms are made by injecting horses or sheep with tiny amounts of venom, then bleeding them to collect the antibodies they produce.
The laborious process has not changed much since the 1800s and has no common production, safety or efficacy standards. In Africa, up to 90% of it is thought to be ineffective.
Even the best antivenoms protect against only a handful of the 250 different venomous snakes and often need to be administered in huge doses.
Severe reactions, some life-threatening, are so common that antivenoms can only be used in hospitals or clinics with resuscitation facilities.
The new funding, it is hoped, will allow scientists to take a twin approach: one group will focus on improving the manufacture, regulation and distribution of traditional animal-derived antivenoms for particular snakes, while another will seek to develop a “humanised” product offering “near-universal protection” against snakebites.
“The ultimate aim is to have a product that can be easily carried and administered in a field or on a roadside without the risk of provoking an adverse reaction,” said Harrison.
The scientific challenge in creating a universal vaccine is not insignificant. Snake venom is as multivarious as it is toxic, with each species and subspecies of venomous snake carrying a unique poison refined over millions of years of evolution.
Some bites result in tissue damage, causing flesh and muscle around the bite to blister and liquefy, often resulting in permanent lesions or, if untreated, gangrene, amputations and death.
Others induce so-called “systemic effects” where the poison destroys or shuts down one or more of the victim’s vital systems.
The fangs of cobras and mambas, for example, inject neurotoxins that stop electrical signals being transmitted through the nervous system.
Victims remain fully conscious, but become paralysed and die through suffocation.
There are stories of jungle explorers being kept alive for days in this helpless state while their companions take turns to pump their chest to keep them ticking over.
Vipers and adders, on the other hand, typically deliver haemotoxins, poisons that course through the veins, causing red blood cells to burst or clump together.
Victims die from widespread internal bleeding, organ failure or clots that cause a stroke or heart attack.
Harrison and his team know these risks well. In their Liverpool office is a herpetarium housing more than 100 venomous snakes.
Contained (we are assured) in plastic boxes and glass-faced tanks, they are the stuff of nightmares: cobras that track the glint of your eyes with the precision of a robot and spit a jet of neurotoxin at them if you make the slightest move forward; a puff adder so eager to strike that its window is covered with a curtain; and rattlers that sound a terrifying alarm the moment you step in their direction.
In the drive to produce a universal vaccine, scientists will leverage the technology that led to the discovery of drugs to combat HIV.
The International Aids Vaccine Initiative – in partnership with LSTM and snakebite specialists from Kenya, Nigeria, USA and India – will work together to identify and synthetically produce antibodies capable of neutralising all major snake venom.Once the antibodies are identified, they will be “humanised” to reduce the risk of toxic shock that comes with products derived from animals.
The consortium is funded by DfID, and will run until March 2021 when a preclinical prototype of the antivenom is expected to be produced.
Clinical trials would then follow.
Rory Stewart, the International Development secretary, said on Sunday that, if successful, the project could save hundreds of thousands of lives.
“More than 80,000 people die every year from snakebites and because of the huge variety of snake venoms, people often do not get the treatment they need in time, if at all,” he said.
“UK aid has invested in [this] research to identify the complex antibodies needed to develop an affordable, accessible, effective treatment.”
In Nigeria’s Snake Belt the initiative is welcome but will not come soon enough for many.
May and June are a “peak season” for the clinic, when the start of the farming season leads to labourers getting bitten as they clear areas of grassland and bush. Sometimes a dozen patients arrive every day.
Those who reach the clinic are treated with basic antivenoms for free.Yet many victims choose to remain at home, putting their faith in traditional remedies.One such case is Emmanuel Samuel, 12, who was bitten on the foot by a carpet viper four nights ago.
The creature clung to his foot with its fangs, meaning it probably delivered a full dose of venom, but for the first 12 hours his grandmother treated him by feeding him garlic paste.
“Luckily a member of our own staff happens to live in his village, and when they found out they told him to come here straight away,” said Muhammad.
“By the time he got here he was hardly able to speak. If he’d stayed at home he would have died.”
– © Telegraph Media Group Limited (2019)