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Feature Neglected Diseases

The tale of snakebite’s fleeting spotlight—and why it encapsulates all that’s wrong with global health

BMJ 2023; 380 doi: (Published 27 February 2023) Cite this as: BMJ 2023;380:p306
  1. Robert Fortner, freelance journalist
  1. Portland, Oregon
  1. robertwfortner{at}

Snakebite is one of the world’s oldest and biggest killers. Yet, despite a shot in the arm five years ago, tackling the burden seems further away than ever. Robert Fortner reports on what happened—and why it epitomises the ownership issue plaguing the global health lobby

Snakebites may kill as many as 120 000 people a year. As the most recently recognised neglected tropical disease (NTD), declared in 2017, snakebite received a surge of funding and momentum in 2019 when the World Health Organization announced a goal to halve deaths from snakebite by 2030.1

And then . . . not much. Since 2017 there’s been a global pandemic to grab attention and funding. Yet snakebite’s spotlight was already dimming long before covid-19 emerged.

What caused this? The unfortunate complexity of treating snakebites, for one. But the estimates, interventions, and expertise on the burden of snakebite emanate almost entirely from donor nations—nations that don’t much suffer from the problem themselves.

Impossible to eradicate?

When WHO measured the burden of NTDs in 2007, snakebite went unmentioned.2 Its official list of NTDs, then numbering 14, didn’t include snakebite for another 10 years.3 The exclusion, wrote some disappointed advocates, came “because it is not an infectious disease [and] there is no potential for elimination or eradication of snakebites.”4

The goal of “eradication” had achieved a towering prominence in 2007: the Bill & Melinda Gates Foundation switched global malaria policy from control to eradication and then went all in on polio eradication, making that project its top priority.5 The foundation also moved decisively on NTDs, concentrating on vaccines. In 2012 it firmly placed its imprimatur on the NTD agenda with the London Declaration on Neglected Tropical Diseases,6 and advocates enthused at “the level of recognition that the NTD brand has now achieved.”7 But …

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