​Tough call: On India and snakebites

A combination of snakes being ectothermic, a hotter summer than usual, difficult decision-making, and gaps in clinical infrastructure has led to a situation in Kerala where the availability of anti-snake venom (ASV) has not been able to prevent all deaths from snakebites. Snakes are driven by the heat to seek refuge in cool, damp spaces, which means homes and storerooms with firewood and coconut husks. The State is also densely vegetated with substantial human-wildlife range overlap. April-May is also the pre-monsoon breeding season for many venomous snakes, which means that they move around more and tend to be defensive. However, about 70% of snakebite presentations involve non-venomous species, and roughly half of the rest are dry bites with no venom injected. A substantial number of patients thus do not warrant ASV. Caution against administering ASV willy-nilly is merited because these compounds can also induce anaphylactic reactions, which can be fatal. At the same time, there is no commercially available diagnostic kit in India to detect venom in a patient’s blood, and the diagnosis is entirely symptomatic. The ICMR has called this syndromic approach a systemic flaw, since by the time symptoms appear, the venom may already have damaged tissue irreversibly. Together with scarce ICU beds, a lack of ventilator backups, inadequate training in managing anaphylaxis, and limited lab support for monitoring, this approach has offset the benefits of the availability of ASV.

India accounts for nearly half of all snakebites in the world, with agricultural workers and children being the worst affected. Kerala is home to over 100 snake species, including the Big Four venomous snakes: the common krait, Russell’s viper, saw-scaled viper, and spectacled cobra. The State government has made snakebite a notifiable disease. It launched the ‘SARPA’ programme to professionalise snake rescue. The SARPA Padam and the upcoming SARPA Suraksha programmes also focus on assessing risk and conducting ward-level and school awareness campaigns. Progressive as the notification and ‘SARPA’ are relative to similar measures in the rest of India, the deaths are a sign that Kerala may be prevention-heavy and that it needs to reinforce the ‘cure’ as well. ASV is already widely available; the uncertainty that prevails over doctors’ decision-making at the first point of contact needs to be mitigated. Many experts have also called for the development and use of rapid venom detection diagnostics to eliminate the risks of the syndromic approach. This must be followed by increasing hospital capacity and the availability of skilled medical workers to manage the consequences of that decision.

Overall Analysis

This editorial examines the public health challenge of snakebite management in India, with a focus on Kerala. It begins by combining environmental, biological, and systemic factors to explain why snakebite deaths persist despite the availability of anti-snake venom (ASV). The language is analytical and layered, linking natural causes — such as snakes being ectothermic and increased summer heat — with human and institutional limitations. This multi-causal explanation gives the argument depth and avoids oversimplification.

The editorial carefully balances two competing concerns: the need to administer ASV promptly and the risks associated with its overuse. By explaining that many bites are either non-venomous or “dry bites,” the author highlights the complexity of clinical decision-making. The phrase “willy-nilly” introduces a cautionary tone, warning against indiscriminate use of treatment. At the same time, the absence of reliable diagnostic tools forces doctors to rely on symptoms, which may appear too late. This contradiction — between urgency and uncertainty — is central to the editorial’s argument.

The reference to Indian Council of Medical Research adds authority, especially in describing the “syndromic approach” as a systemic flaw. The language here becomes more critical, pointing to gaps in infrastructure such as inadequate ICU capacity, lack of ventilators, and insufficient training. These details shift the focus from individual cases to systemic healthcare deficiencies, reinforcing that the issue is not just medical but institutional.

In the second paragraph, the editorial broadens the scope to a national level, noting India’s disproportionately high share of global snakebite cases. It then returns to Kerala, acknowledging progressive measures like the ‘SARPA’ programme. This creates a contrast between policy intent and ground reality. The editorial appreciates preventive efforts but argues that they are insufficient without strengthening treatment systems. The phrase “prevention-heavy” succinctly captures this imbalance.

The final part adopts a solution-oriented tone, advocating for rapid diagnostic tools, improved hospital capacity, and better-trained personnel. The language is constructive yet firm, suggesting that without addressing these gaps, even well-intentioned policies will fail to reduce mortality. Overall, the editorial uses a balanced, evidence-based approach to highlight a complex healthcare dilemma and push for systemic reform.

Important Vocabulary (5)

1. Ectothermic – organisms that rely on external heat sources to regulate body temperature.
2. Anaphylactic – relating to a severe, potentially fatal allergic reaction.
3. Syndromic – based on identifying a condition through a group of symptoms rather than direct tests.
4. Merited – deserved or justified.
5. Mitigated – made less severe or serious.

Conclusion & Tone

The editorial argues that while preventive measures and ASV availability are important, India — particularly Kerala — must strengthen diagnostic tools and healthcare infrastructure to effectively manage snakebite cases. It emphasizes that better clinical decision-making and capacity building are essential to reduce deaths.

Tone: Analytical, balanced, and solution-oriented — with a critical edge toward systemic gaps in healthcare delivery.