One risks being mocked for juxtaposing snakes with the "Make in India" initiative which recently was spoken of in the same (albeit a bit laboured) breath as Apple Inc. Inspired by 'pop patriotism' many Indians are eager to sever from popular imagination any associations India has with snakes. But of course, snakes aren't going anywhere. Just because snakebites hardly occur in the posh neighbourhoods of Lutyens' Delhi or the cosy newsrooms of media-houses doesn't mean they have disappeared from India.
In fact, each hour snakes bite dozens of people and kill around five Indians (they kill about 45,000 annually). Tens of thousands lose limbs or are disfigured and disabled permanently. In comparison, there were 100,000 dengue cases last year, with 220 deaths. Which among the two gets more media coverage and political attention is anybody's guess. While this comparison doesn't intend to trivialize death, it helps us understand how we tend to prioritize India's health crises by location: dengue is primarily urban, while snakebites are rural. No wonder even the World Health Organization (WHO) labels snake envenoming as a "neglected" condition.
Snakebites kill about 45,000 Indians annually... In comparison, there were 220 dengue deaths last year... Which gets more media coverage and political attention?
Snakebites mainly affect children and young adults, age-groups which our Prime Minister has high hopes from. Though snakebites are an occupational hazard for farmers (a majority of bites occur while they are working in the fields), we rarely have public and political discussions on this daily danger they face. Imagine what a brouhaha would erupt if India's urban IT personnel were battling a similar occupational hazard that though it killed dozens and injured hundreds a day was easily curable and to an extent preventable.
I spent my childhood in Maharashtra's Konkan region. Snakes abound there, and I remember several occasions of suddenly spotting them on a path, especially during the monsoon, and being both frightened and enamoured by their slithering forms. Years later, while working at the Ratnagiri District Hospital in the region, I wasn't as enamoured: tens of patients, almost all of them villagers, would come in with excruciating pain from snakebites, and there would be occasional deaths. The most tragic thing with snakebite deaths, as against death from, say, dengue or most cancers, is that people die despite the presence of a proven cure: the snake antivenom.
Make in India has not yet been associated with any major public health project, and snake envenoming... is one of the perfect candidates for intervention and innovation.
When snake venom enters our blood and tissues, the antivenom, which neutralizes that venom, becomes a life-saving medication. It saves thousands of lives and many more limbs each year. But India (and the world) possesses woefully inadequate amounts of it. Last year when the pharma company Sanofi Pasteur announced it would halt production of its antivenom for Africa, experts warned of consequent "unnecessary deaths". Here is where Make in India comes in. The initiative has not yet been associated with any major public health project, and snake envenoming, a serious local as well as global problem, is one of the perfect candidates for intervention and innovation.
The production of high-quality and effective snake antivenom requires considerable investment and research. Our conventional antivenom is effective against the venoms of only four "medically most important" species of poisonous snakes of India. However, experts say either this number should be increased, or that we should have different antivenoms for different major regions of the country.
With the government being so loud about its Make in India agenda, the neglect of its own public sector pharma manufacturing is surprising.
Around 80% of the entire country's antivenom is made using venom of the snakes from, shockingly, just a few districts in Tamil Nadu (through the Irula Co-operative Society in Kancheepuram district). Hence, if you get bitten by a snake in Arunachal Pradesh or Bihar, chances are that the antivenom your doctor gives you might not work effectively -- and with snakebites, this means flirting with death. Besides, Indian manufacturers haven't yet embraced modern methods of production that reduce the occurrence of serious side effects to antivenoms.
In other words, we urgently need robust research on Indian snakes and their venom, as well as investment in antivenom production. For too long have we neglected this important need of rural India.
With the government being so loud about its Make in India agenda, the neglect of its own public sector pharma manufacturing is surprising. This April, a Parliamentary Committee report urged the government to make fully functional its large sera and vaccine units in Kasauli, Guindy and Coonoor, some of which also produce antivenom. Since snake antivenom is often out of stock in government rural health centres, where it is needed the most, manufacturing high-quality antivenom in public sector companies needs to be a priority. This will not only save lives (particularly of young farmers), but also prevent thousands of villagers from slipping into poverty, since treatments with private sector antivenoms at private hospitals are enormously impoverishing.
Make in India must also strive to benefit the "other" India, the India of its villagers.
In other words, Make in India must also strive to benefit the "other" India, the India of its villagers. Making state-of-the-art antivenom/s, which will be usable throughout India without any quality and efficacy issues, should become a high-priority project of the government. Through such needs-based (rather than only ambition-based) Make in India policies, more and more products could become valued desi commodities both within and outside the country.
Since low- and middle-income nations in Asia and Africa also require antivenom in huge quantities, investing in proper R&D can make India a world leader in snakebite saves, as against the currently dubious leadership in snakebite deaths. Last year, the British Medical Journal published an editorial titled "Snake bite: a global failure to act costs thousands of lives each year". India, possessing appropriate experience and influence, has an important opportunity to help reverse this failure, and we shouldn't let it go.
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