How Finding Effective Snake Bite Treatment Could Help Fight Covid
Covid-19 has been a bitter pill for all of us to swallow. However, its impact has been felt most acutely by those who already face infectious diseases, such as HIV, tuberculosis (TB) and malaria, as well as chronic diseases such as diabetes and hypertension.
But the new coronavirus has also become a double burden among the most vulnerable, the “last billion” of people worldwide who are vulnerable to neglected tropical diseases (NTDs) such as snakebites.
Former UN chief Kofi Annan called tropical snake bites “the biggest tropical disease you’ve never heard of.” Tropical snake bites kill 138,000 people and leave up to 400,000 victims permanently disfigured or disabled each year.
These are the same people who will likely be the last to line up for Covid -19 interventions and, in light of national lockdown policies and diverted resources, will continue to bear a high disease burden with reduced access to clinics and life-saving therapies.
Snakebites are caused by poisoning with toxins that can lead to serious health problems and death. Treatment has changed little since the late 19th century when serum therapy, which is produced by giving large mammals small – or sublethal – doses of snake venom, was developed.
Arguably, one of the first treatments for Covid-19, convalescent plasma, borrows from this history serum snakebite therapies. Unlike snakebites, however, therapies for Covid-19 have progressed much faster with the availability of effective (albeit expensive) monoclonal antibodies and small molecule drugs.
Such treatments could make a huge difference for snakebite victims, but there has been little appetite to invest in the research and development of these next-generation snakebite therapies, confining the disease to the margin.
In recent years, things have started to improve. In 2017, the World Health Organization (WHO) officially recognized snakebites as a disease threat and, two years later, launched a strategy for a globally coordinated response to envenomation by snakebites, with the goal of halving the number of snakebite deaths and disabilities by 2030.
The UK government has become one of the first countries to join the cause, investing £ 9.6million to develop and deliver a new snakebite therapy based on monoclonal antibodies. For snakebite envenomation, the goal is to discover, optimize and develop antibodies that could neutralize a variety of snake toxins and be used as a safe and effective therapy for all snake species and geographic areas.
Funding from the UK’s Foreign, Commonwealth and Development Office (FCDO) led to the creation of a consortium bringing together antibody technology expertise from the IAVI, a non-profit research organization, in snakebite research from the Liverpool School of Tropical Medicine and partners in Kenya, Nigeria and India – countries where snakebites are prevalent. Although the program has got off to a promising start, its success depends on continued funding.
Wellcome Trust’s £ 80million investment in snakebites goes in part, but questions remain about the UK government’s commitment to the dramatic cuts in aid spending announced last year.
Other NTD programs have already been affected by the cuts and all health and R&D related funds are likely to be a priority for Covid-19.
The answers to the two actually overlap – investments in snakebites and other NTDs could also lead to collateral benefits for the global fight against Covid-19.
Convalescent plasma (from donors with high levels of anti-SARS-CoV-2 antibodies) was quickly recognized as an effective treatment for sick patients. This approach originated in the treatment of snakebite victims with very high levels of anti-venom antibodies purified from the blood of horses immunized with snake venom.
In addition, innovative approaches developed through the experimental use of specific camelid (llama) antibodies for the treatment of snakebites are being reoriented to better fight against Covid-19.
Second, reaching patients in remote rural communities in low-income countries has always been one of the biggest obstacles to the deployment of effective disease interventions, such as HIV drugs and vaccines.
International Snakebite Awareness Day on September 19 can be a reminder of pioneering research in the NTD sector to identify some of the most isolated and poorest communities on the planet. The Covid-19 vaccination program can use this vital knowledge to identify people who need a vaccine.
There has been a lot of talk over the years about the need for those of us in public health to work from our home patches and forge new partnerships to deal with emerging disease threats. It’s potentially as good a start as any. Snakebite could lead the way.
- Devin Sok is the Executive Director of IAVI Antibody Discovery and Development, Neutralizing Antibody Center. Robert Harrison is the deputy director of the Snakebite Research and Intervention Center at the Liverpool School of Tropical Medicine
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