Global mortality of snakebite envenoming between 1990 and 2019

Snakebite envenoming is an important cause of preventable death. The World Health Organization (WHO) set a goal to halve snakebite mortality by 2030. We used verbal autopsy and vital registration data to model the proportion of venomous animal deaths due to snakes by location, age, year, and sex, and applied these proportions to venomous animal contact mortality estimates from the Global Burden of Disease 2019 study. In 2019, 63,400 people (95% uncertainty interval 38,900–78,600) died globally from snakebites, which was equal to an age-standardized mortality rate (ASMR) of 0.8 deaths (0.5–1.0) per 100,000 and represents a 36% (2–49) decrease in ASMR since 1990. India had the greatest number of deaths in 2019, equal to an ASMR of 4.0 per 100,000 (2.3—5.0). We forecast mortality will continue to decline, but not sufficiently to meet WHO’s goals. Improved data collection should be prioritized to help target interventions, improve burden estimation, and monitor progress.

Read the full paper published in Nature Communications (Open Access ) here

The impact of climate change on the burden of snakebite: Evidence synthesis and implications for primary healthcare

Snakebite is a public health problem in rural areas of South Asia, Africa and South America presenting mostly in primary care. Climate change and associated extreme weather events are expected to modify the snake-human-environment interface leading to a change in the burden of snakebite. Understanding this change is essential to ensure the preparedness of primary care and public health systems.

An evidence synthesis to better understand this aspect was published in Journal of Family Medicine and Primary Care and is available (open acess) here.

A Reporting Tool for Adapted Guidelines in Health Care: The RIGHT-Ad@pt Checklist

To maximize the efficiency of resources and reduce redundancy, organizations and countries may decide to adapt an existing practice guideline rather than developing a new one. The RIGHT (Reporting Items for practice Guidelines in HealThcare) statement currently informs the reporting of the guideline development; however, it does not cover reporting of steps that are specific to guideline adaptation.

A scientific workgroup, filled this gap and developed a new reporting tool designed to improve standardization and transparency of adapted health care guidelines. Called the RIGHT-Ad@pt Checklist, the tool focuses on improving the clarity and explicitness of recommendations that have been adapted for use in different health care systems, and of the guideline development process.

The RIGHT-Ad@pt Checklist was developed as an extension of the RIGHT statement through a multi-step process involving literature reviews and consensus building involving a range of stakeholders including guideline adaptation experts, users, journal editors, and policy makers. The checklist was designed to be used to guide the reporting of adapted guidelines, including adaptation process and the adapted recommendations. It can also be applied to assess the completeness of reporting and, in combination with available adaptation frameworks, to inform adaptation processes. Different audiences may use the RIGHT-Ad@pt checklist for different purposes:

  • Guideline developers could use the checklist to report their adapted guidelines;
  • Journal editors and reviewers could use the checklist to ensure the completeness and transparency of the reporting in the publication of adapted guidelines;
  • Clinicians could accurately identify and apply adapted recommendations to their clinical practice based on detailed and clear reporting; and
  • Policymakers could evaluate the feasibility of adapted recommendations for local implementation based on the reporting contents suggested by the checklist.

The checklist was published in Annals of Internal Medicine and is available here

Photo by Mikael Blomkvist on

Transitioning medical education towards trans-disciplinarity

Community medicine training consists of a bit of family medicine and a bit of public health- with no advanced competencies on either. Family medicine is now an established discipline with its own scholarly niche, a clear generalist approach towards clinical care rooted in the philosophy of primary care. Public health developed outside medical universities, and global scholarly work has meant it has a strong but continually evolving philosophical basis. Both family medicine and public health have some commonalities – they do not shy away from integrating concepts from various disciplines; are collaborative in nature; and its post-graduates are job-ready. Community medicine on the other end has been not able to move away from the clinical lens and has no clear philosophical leanings.[5] Surely teaching medical students alone cannot be an enough justification for continued investment on community medicine. 

The full article in Journal of Family Medicine & Primary Care is available open access here .

Photo by Polina Zimmerman on

COP26 Special Report on Climate Change and Health

The World Health Organization(WHO) has released a special Report on Climate Change and Health propose a set of priority actions from the global health community to governments and policy makers, calling on them to act with urgency on the current climate and health crises today (11th October 2021). The report lists 10 recommendations for priority action and is available here.

Prior to the publication a public consultation was conducted by the WHO in which I provided feedback in individual capacity (acknowledged in WHO report) . The feedback revolved around the following themes(full submission available for download):

  1. need for developing global, regional and national agendas for climate crisis preparedness, support for more interdisciplinary/transdisciplinary collaboration,
  2. recognition of rights and dignity of health workforce in our path to climate resilience,
  3. greater recognition of the impact of climate change on non-communicable diseases and injuries, particularly chronic kidney disease, snakebite, and cardiovascular diseases needs priority attention.
  4. higher taxation of app-based food delivery business which has higher carbon footprint;
  5. stop promotion of vegetarian diets which amounts to cultural imperialism by suppression of food practices of minorities, tribal, Adivasi and Indigenous populations who are being being attacked for their traditional meat-based food practices by removing words like “eating less meat” & “largely plant-based diet”;
  6. ensure food security of vulnerable people by providing guarantee against price fluctuations through development of appropriate investment and legal mechanisms.

It is pleasing to note that the WHO has involved stakeholders meaningfully and inculcated feedback in letter and spirit. The removal of terms “eating less meat” is welcome, but more work needs to be done to prevent climate action being used as an opportunity for cultural imperialism. Continuing to work with stakeholders to understand the several issues better, as evidence evolves will be key to climate action. We have to grapple the defining issue of our generation together.

Need for transdisciplinary systems thinking to address snakebite

Snakebite, a major public health issue but a hugely neglected problem continues to affect millions of people with death and disability worldwide. In 2018, the first ever International Snakebite Awareness Day was celebrated on September 19, to emphasize on awareness and actions needed to tackle the burden of snakebite. The George Institute for Global Health (TGI), will be organizing a seminar on the topic ‘Need for transdisciplinary approach for addressing snakebite burden’ on this day. The deliberations of the seminar aim to expand the lens from the current clinically dominant approach to address snakebite to include learnings from other disciplines and enable systems thinking to solve the issue.

Mark your calendars for 19th September 2021, Sunday, 14:00 -15:00 hours IST

Key Focus & Our Speakers 

  • Introduction to event: Snakebite – an issue like no other
  • Talk 1: Why ‘Neglected Tropical Disease’? The politics of ‘Otherization’ of snakebite in India
    • Dr Rahul Bhaumik, Department of History, Women’s College, University of Calcutta, West Bengal, India,
  • Talk 2: Snakebite & climate change: preparedness for the imminent crisis  
    • Dr Soumyadeep Bhaumik, Injury Division, The George Institute for Global Health, India; Meta-research and Evidence Synthesis Unit, The George Institute for Global Health
  • Talk 3: Using snake rescue data to develop snakebite mitigation strategies
    • Mr. Vishal Santra, Society for Nature Conservation, Research and Community Engagement, West Bengal, India; Captive and Field Herpetology, Wales, United Kingdom
  • Fireside Chat with audience interaction: Transdisciplinary systems approach for snakebite – challenges and way forward 

The session concludes with a Q&A session where the audience can engage with the panelists.

More information here . Register here .

Stronger together: a new pandemic agenda for South Asia

The global increase in COVID-19 cases in 2021 has primarily been due to an uncontrolled surge in South Asia. It is estimated that by 1 September 2021, approximately 1.4 million in South Asians will die due to COVID-19 alone. The total number of excess deaths will be much higher—including non-COVID causes, as health systems are on the brink of collapse. With 33.4% of South Asians being extremely poor and the large-scale loss of livelihood being reported, the region faces a potentially catastrophic future for the ongoing decade. However, countries in South Asia continue to remain divisive. This differs from other geographic ‘blocs’ that frequently cooperate on mutual interest issues. Tensions in South Asia are shaped by complex domestic, bilateral, intra-regional and international geopolitical factors, despite the region’s obvious geographic, economic and cultural interdependence. A key lesson from the current pandemic is that countries need to share lessons and actively coordinate, complement and supplement each other’s public health responses, especially between neighbours.

Read the Editorial published in BMJ Global Health with Dr Soumyadeep and his colleagues which presents a pragmatic ‘Stronger Together’ agenda on critical areas of concern for political, social, medical and public health leaders in South Asia to consider and build on here (open access)

Photo by Min An on

Going beyond access to health information: a pandemic call to action

About a decade earlier we brought to attention that the lack of access to health information is ‘a social injustice that the global health community cannot afford to ignore’. We argued that governments are morally and legally obliged to ensure access to health information. In the backdrop of the COVID-19 pandemic, we have seen significant investments from multinational agencies, governments, non-profits and private actors to disseminate health information. However, a narrow focus on providing access to health information alone, without any investment or thought on how information can be translated by people to meaningful health outcomes, is proving to be counterproductive.

Read the Editorial by Dr Soumyadeep Bhaumik and Dr Pranab Chatterjee in BMJ Global Health (Open access)

From trials to the bedside: convalescent plasma during the COVID-19 pandemic [Seminar]

Convalescent plasma has a long history in treatment of infectious diseases – being used  when other therapies are available .The use of plasma from patients who have recovered from COVID-19   was  used similarly as it can neutralize  viral particles and hence help patient care.   But many randomized controlled trials have now been completed and it is time now for using evidence to inform not only clinical care but also future research.

The International Severe Acute Respiratory and emerging Infection Consortium is organizing a seminar titled “Use of convalescent plasma in patients hospitalised with COVID-19” as a part of the Oxford University Tropical Medicine Seminar . The seminar is on Jun 10, 2021, 13:30 -14:30 hours Indian Standard Time.

The talk will have presentation’s from Dr Aparna Mukherjee (ICMR) and Professor Peter Horby ( Oxford University) and Dr Soumyadeep Bhaumik (The George Institute for Global Health, India). The seminar is moderated by Bharath Kumar Tirupakuzhi Vijayaraghavan (Apollo Hospitals, India)

Dr Soumyadeep Bhaumik will talk about ” From trials to the bedside: convalescent plasma during the COVID-19 pandemic

Abstract of talk

The use of convalescent plasma in hospitalized COVID-19 patients has started from the beginning of the pandemic. However, during the second wave of the COVID-19 pandemic – with a failing health system , with exhausted doctors and desperate patients – this meant  widespread irrational use . Patient and care-givers had to run pillar-to-post to secure plasma from COVID-survivors. The national guidelines remained unchanged and many doctors were confident about its utility . I will discuss the sum-total of evidence (from a systematic review), discuss about how confident we are about the results (through GRADE), and put it in the evidence-to-decision framework in the Indian context. I will also touch on problems in our current guidelines which exist in form of mere flowcharts.

Event is free to attend but requires pre-registration: Click

COVID-19 vaccination in India: we need equity

Just a few days after starting its own COVID-19 vaccination program , India provided vaccines as grant- in-aid to other countries1 . This was in sharp contrast to some high-income countries which stockpile vaccines,  and block proposals to suspend intellectual property rights in World Trade Organisation2. India now is in the midst of a humanitarian crisis 3 but its vaccination rates continue to fall. While it is not possible to go back in time and make amends to ensure availability for all, revising the current vaccination strategy (which is riddled with equity issues) can save lives ,  prevent health systems burdening and ensuring a functioning ecosystem during the pandemic .

Equity enables maximizing benefits from scarce resources

India’s original vaccination strategy was to sequentially vaccinate priority groups healthcare workers, frontline workers, people more than 50 years. of age and younger people with associated comorbid conditions (diabetes, hypertension, cancer, lung diseases) 4. In principle this invoked equity – prioritising those at highest risk. However, the Indian government continually changed its strategy – announcing more inclusive eligibility criteria for vaccination every month. The last of these came suddenly in the last week of April 2021, when the Indian government announced a new “liberal policy” for vaccination5.In midst of the current crisis, while already being riddled with shortages the new policy announced that everyone above 18 years will be eligible, and effectively removed any distribution or price controls for manufacturers. This is unparalleled – no other federal democracy is making citizens pay for COVID-19 vaccines or have states competing to secure supplies. The huge demand amid all the death and despair in th current wave meant that the two Indian vaccine manufactures resorted to differential and predatory pricing. They fixed prices for state governments which are almost twice of the price paid by the union government ; it is four times for private hospital 6. An immediate consequence of this was that most state governments were not able to offer vaccines for high-risk groups , while even richer people(who can pay ₹ 1600-2400 , £ 15 to £ 25)  in non-priority 18-45 years age group are able to access vaccines from private hospitals 7. The “liberal policy” also perpetuates regional inequities, wherein richer state governments will be able to buy more doses for non-priority groups while poorer states (with weaker health system) will have to wait for revenues to accrue for buying vaccines for priority groups.

The realities of vaccine shortage need to first publicly acknowledged, and a pragmatic and equity-based strategy needs to be adopted. As per media reports, only 37% of frontline and health workers had been fully vaccinated by mid-April 8 .

India needs to prioritise people “who matter and are in need” over the “rich and elite”. Vaccination of non-priority people in 18-45 years of age, should be stopped until adequate coverage of priority groups is acquired. A moral, social, and human rights lens is essential for the purpose. Younger people with mental health conditions, informal sanitation and cremation workers, families of frontline workers and healthcare workers, hawkers,  home-delivery workers, prisoners , homeless people, people living in slums and field journalists who are at higher risk 9 10 11 need to be under priority groups. Some of the re-defining of priority groups has been done by states like West Bengal and Delhi – but this is not uniform across the country.

Adopting a “One Nation – One Price – One Vaccine Buyer” policy such that the Government of India buys and makes it free for all citizens of India is the need for the hour. To overcome shortage, it can issue compulsory licenses (under Section 92 of the Indian Patent Act for public health emergencies) for all COVID-19 vaccines. A single buyer and a fixed price of ₹ 150 (£ 1.5 ;  current price paid by the Union government) for the entire nation would prevent pandemic profiteering.

Putting equity in the heart and soul of COVID-19 vaccination policy in India
Digital health driven inequity

Vaccination in India require pre-registration through a centralized online digital system called Co-WIN. With only 20% of Indians using internet12 the implementation strategy is not in touch with ground realities. The “digital divide” is even greater in rural areas, particularly in women, tribal/Adivasi people, and the urban poor13 who remain clueless about the system. Urban youth are travelling to rural areas to get vaccines14 –potentially transmitting COVID-19 to villages. Micro-planning 15 and participatory community engagement16 is crucial for successful implementation. India has in the past used them successfully without any digital tools. The Co-WIN based registration and tracking system needs to be stop and time-tested walk-in and community outreach (for disabled, homeless, very old people and other equity groups) needs to be adopted.

Instead of investing in digital health, government needs to invest in employing more vaccinators and vaccination officers. The current strategy of drawing into existing human resources has led to disruptions in routine service delivery 17 18 .

The way forward

Mahatma Gandhi’s maxim that a “nation’s greatness is measured by how it treats its weakest members” should  guide the overhauling of the COVID-19 vaccination policy. Getting the vaccination program right in India is crucial for the pandemic endgame too. There is not a moment to waste.

About the Author

Dr Soumyadeep Bhaumik is a medical doctor and international public health specialist working in The George Institute for Global Health India. He is also associate editor of BMJ Global Health. Views are personal and not necessarily reflective of employer or the BMJ Global Health. He tweets at @DrSoumyadeepB

Competing interests: I have read the BMJ Group Conflict of Interests and declare no competing interests.

Funding : None

Acknowledgment : Dr Sambit Dash from Melaka Manipal Medical College, India with whom author had a discussion.

Provenance : The article is not peer-reviewed.

The article was originally published in BMJ GH Blogs and is published here under CC-BY-NC-SA


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