Reducing the threat of snakebites

Awareness may still be the best tool for rural areas to guard against a neglected problem underfoot

By Kamala Thiagarajan

On a rainy morning two years ago, Mariamma caught a glimpse of something moving between the wood piled in her kitchen in southern India. Thinking she’d imagined it, she reached for an armful of twigs to light her stove and felt a stab of pain in her right hand. It took her a moment to realize she’d been bitten by a snake.

Unable to identify the kind of snake and afraid the venom would spread, her daughter tore off a piece of her sari and fashioned it into a tourniquet, tying it around Mariamma’s arm. It was a grave mistake. The makeshift tourniquet concentrated the venom, and when they reached a hospital, half an hour away, Mariamma’s hand was completely numb. She was dizzy and nauseous, had blurred vision, and struggled to breathe.

Mariamma received antivenom through an IV, but doctors had to amputate two fingers. “Nothing has ever been the same since,” says Mariamma, who goes by a single name. She had to give up her job as a construction worker in the town of Tirumangalam and now gets by with odd jobs. “I’m grateful I’m alive, but the right side of my body feels weaker. I am slower and struggle with daily tasks.”

Snakebites are a major cause of death and disability among residents of the world’s poor rural areas, killing between 81,000 and 138,000 people a year and causing as many as 400,000 amputations and other cases of permanent disability. Yet snakebites are one of the most neglected public health issues globally, says Gnaneswar Ch, leader of the snakebite prevention project at the Madras Crocodile Bank Trust and Centre for Herpetology near Chennai, India.

The lack of attention to the problem has stifled access to antivenom and efforts to develop more effective, less costly, and more accessible treatments. On top of that, habitat loss and climate change are expected to alter where and how often people encounter snakes, leading to increased exposure to bites in some regions. Many consider prevention and education campaigns by community-based organizations, including Rotary clubs, to be the best — and often only — answer.

A lack of antivenom

For over a century, the main treatment has been antivenom, produced in a painstaking method that has remained largely unchanged. Venom is extracted, or “milked,” by taking the snake by its head and forcing it to bite the lip of a jar, causing venom to drip from its fangs. A small amount of the venom is then injected into horses, with the resulting antibodies harvested and added to IV solutions. When given to humans, these antibodies can boost an immune response and attach to and neutralize foreign substances, such as toxins. But the treatment has drawbacks.

Some patients have adverse reactions ranging from severe nausea and headaches to anaphylactic shock, meaning antivenom should be administered only in a hospital. Add to that the high financial cost for many people. Antivenom produced in one part of the world may not work well in another, since it’s generally only effective to treat bites from the same type of snake from which it was produced. Supplies can be scarce, because making the drug has thin profit margins that discourage larger companies from taking on mass production. In India, only a few companies make it.

Most of India’s venom supply comes from a single source: a snake catchers’ industrial cooperative called the Irula Co-op, where the reptiles are stored in wide-brimmed earthen pots, fastened shut with cotton cloth and string. Located at the Madras Crocodile Bank Trust, the co-op is run by 350 members of the Irula tribal group who are adept at safely catching venomous snakes.

India, which accounts for at least a third of snakebite fatalities, uses a polyvalent antivenom developed from multiple species that can treat a range of snakebites, which is useful when people don’t know what type of snake bit them. In India, it’s produced for bites from the “big four”: the spectacled cobra, common krait, Russell’s viper, and saw-scaled viper. However, it is not always effective if someone is bitten by one of the many other types of snakes in India.

Few efforts have been made to modernize treatment. But researchers are testing a medicine that could be injected with a preloaded device similar to an EpiPen. And the biggest advance may come from a drug for snakebites in clinical trials called varespladib. It comes in pill form, making it easy to take at the time of a bite. It blocks and neutralizes a family of enzymes that are the most lethal component of venom and are present in 95 percent of the world’s venomous snakes. The medicine doesn’t require refrigeration like antivenom.

Stay alert

For now, avoiding a snakebite in the first place is the best solution, experts say. Most bites happen when snakes are accidentally disturbed. “People in rural areas, having outdoor toilets or who work in agricultural fields, tend to be more vulnerable,” Gnaneswar Ch says. “They can be exposed to snakes without even realizing it.”

Vedhapriya Ganesan, a wildlife rehabilitator who works with the Rotary Club of Madras Coromandel, India, on environmental education projects, rescues snakes in Chennai. She receives frantic calls when people encounter them in homes or public spaces. As part of her work supported by the club, she speaks to hundreds of students at schools and colleges about snakebites. “Children are more vulnerable,” she says.

She teaches them to be alert to their surroundings and not to panic. “I tell them to keep your distance and if the snake is too close, then stay still as a statue,” she says. “It won’t bite unless it feels threatened.”

Snakebites will continue to be a global problem, she says, as long as our cities keep expanding into the animals’ natural habitat. “Now snakes are adapting to live alongside humans. And climate change, which makes severe cyclones and floods more frequent, increases our exposure too,” she says. “In such a situation, awareness is a powerful tool.”

Rotary clubs step up

Rotary clubs in Nepal and Australia have also been campaigning to create awareness. In 2019, the Rotary Club of Kathmandu Mid-Town held a conference on snakebite prevention with international experts. In 2020, the club received a Rotary Foundation global grant of $84,000 to support a four-year awareness project including radio spots.

An absence of robust data on snakebite cases, which are underreported, is a challenge in Nepal, says Nirmal Rijal, a member of the Kathmandu club. He works with other members to gather data and direct victims to the 120 health facilities in Nepal designated as snakebite treatment centers, with stocks of antivenom.

Aiding their efforts is the World Health Organization’s Geographic Information System Centre for Health, which uses open data and geospatial tracking to connect victims with antivenom. The effort includes updated range maps of all venomous snakes and a database of available antivenoms that will eventually offer information on providers.

In Australia, the Rotary Club of Melbourne is supporting the Papua New Guinea Snakebite Partnership, an initiative of both countries’ governments, with resources including solar-powered refrigerators, mobile ventilators for ambulances, and training. In some parts of Papua New Guinea, deaths from snakebite are three times higher than those from malaria or tuberculosis. “To date over 2,000 lives have been saved,” says Melbourne club member Anthony Battaini.

Despite her pain and loss, Mariamma is grateful to have survived her ordeal. Now, she advises her neighbors to clean up around their homes. “Look for places where snakes could hide and pay attention to where you’re putting your hands and feet, especially at night,” she tells them. “Even a little awareness can save life and limb.”

This story originally appeared in the May 2025 issue of Rotary magazine.