Category: Health and Wellness

  • Why some viruses are so difficult to stamp out

    Why some viruses are so difficult to stamp out

    The United States is fighting an unexpectedly big measles outbreak, with hundreds of cases in the state of Texas alone. Health experts expect it will last for a year or longer, because the virus has a long incubation period — people can be infected for days before they begin to show symptoms. That, in turn, means it can spread silently.

    Another virus that’s spreading silently right now is polio. Tests of wastewater around the world have turned up alarming levels of the virus, notorious for paralyzing children, in Afghanistan and Pakistan, according to the World Health Organization (WHO), but also in Europe, in Spain, Poland, Germany, the United Kingdom and Finland.

    These two viruses should not still be around. They only infect human beings, and mass vaccination campaigns have been ongoing for decades to try to wipe them out. And the medical profession keeps coming so close to success. 

    And where do these viruses come from that keep returning despite our attempts to wipe them out? The answer is from us — from other people.

    Smallpox is the only human disease to have been completely eradicated. That was done with a dedicated global vaccination effort in 1972. Because the smallpox virus doesn’t infect any other animal, there wasn’t another place for it to survive and come back to reinfect people. 

    The same should be true for measles and polio, but war, disruption, poverty and a mistrust of vaccines make it difficult.

    Where viruses hide

    So even as vaccine campaigns come close to succeeding, the viruses can still hide out in unvaccinated and undervaccinated people. Travel and human contact do the rest to keep both measles and polio circulating. When an infected traveler hits a community of unvaccinated people — say a neighborhood of ultra-Orthodox Jews in London or a rural West Texas county full of vaccine skeptics — a contagious virus such as measles or polio can take off. 

    With both measles and polio, it takes immunization rates of more than 90% to protect a population. When rates drop below that, a community becomes vulnerable to outbreaks. A virus can take hold and spread among people, picking up steam.

    That’s happened in Pakistan and Afghanistan with polio, where efforts to reach remote populations fall short because of geography, conflict and mistrust. And in Gaza, where continuous Israeli attacks have destroyed virtually all healthcare facilities, United Nations agencies have struggled to vaccinate Palestinian children against polio outbreaks. 

    Polio is also complicated because of the different vaccine types. One of the vaccines is given orally, and it’s made using a live, but weakened, form of the virus. This gives good immunity but in rare cases the virus can mutate in someone’s body and return to infectious strength — becoming what’s called vaccine-derived virus. 

    A follow-up vaccination with a second type of vaccine made using a fully killed virus will protect against this, but when vaccine campaigns can’t be completed, vaccine-derived viruses can emerge.

    How viruses spread

    In Europe, no cases of polio have been seen, but wastewater evidence suggests the virus is surviving in people’s bodies, and could burst out to cause sickness if it gets to someone unvaccinated. Polio spreads via the fecal-oral route — in contaminated water, via poorly washed hands, on surfaces and also via sneezes and coughs.

    Fully vaccinated communities are safe but in 2022, an unvaccinated man in New York State became paralyzed after he caught polio. Investigation showed a vaccine-derived strain had been spreading quietly in the state.

    Measles is the most infectious disease known and that makes it particularly hard to eradicate. In a podcast interview I did for for One World, One Health, Dr. Peter Hotez, a pediatrician and vaccine scientist at the Baylor College of Medicine, explained just how infectious it is. 

    “If someone has measles, and especially before they get the virus and stop feeling very sick, they’re releasing the virus into the atmosphere,” Hotez said. 

    Even if they leave the room, that virus will linger in the atmosphere for a couple of hours.

    “So you can walk into an empty room that has the measles virus from someone who was there a couple of hours before and become infected,” he said, noting that one measles patient will infect up to 18 other people.

    A virus reemerges.

    Nine out of 10 unvaccinated people who are exposed to the measles virus will become infected. What is disappointing to public health experts in the latest U.S. outbreak is that so many people have become infected when measles was eliminated in the United States in 2000 and in all of the Americas in 2016.

    But pockets of people who are not vaccinated against measles can act like tinder. The spark is usually a traveler who goes to a country where measles is still common because vaccination rates are low — usually due to poverty. 

    In a November 2024 report the WHO said that measles is still common in many places, particularly in parts of Africa, the Middle East and Asia.

    “The overwhelming majority of measles deaths occur in countries with low per capita incomes or weak health infrastructures that struggle to reach all children with immunization,” the report said. Measles kills more than 100,000 people a year, mostly children. But before the vaccine was introduced in the early 1960s, it killed 2.6 million a year.

    The COVID-19 pandemic badly hurt all childhood immunization efforts, WHO and other global health authorities say. Routine childhood vaccines have not caught back up to where they were before the pandemic, leaving children and adults susceptible to vaccine-preventable diseases including measles and polio but also meningitis, hepatitis, tetanus, cervical cancer and rotavirus — a disease that causes diarrhea and vomiting in babies and young children. 

    The retreat of the United States from global health efforts — the dismantling of the U.S. Agency for International Development, its plan to cut $1 billion in funding to Gavi, the Vaccine Alliance, and its withdrawal from the World Health Organization — will further weaken global vaccination, experts say.

    And that means many more children will likely die who might otherwise live healthy lives. 

     

    Three questions to consider:

    1. How can vaccines help prevent the spread of diseases?

    2. What role should personal choice play in being vaccinated against deadly diseases?

    3. How can global cooperation help in fighting the spread of disease?

     

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  • When musicians get the blues

    When musicians get the blues

    Music is known to boost cognitive and emotional wellbeing, yet those who pursue it professionally experience greater levels of psychological distress compared to the general population.

    Psychological distress among professional musicians is a global phenomenon, shown in studies from Norway, the United Kingdom, Australia and South Korea. More than two-thirds of professional musicians in the UK suffer from depression, according to a 2016 study involving over 2,000 musicians. In Canada, as many as one in five professional musicians experience suicidal ideation.

    Now, musicians are calling on the industry for change. In February, Grammy-winning artist Chappell Roan used her Best New Artist acceptance speech to advocate for healthcare and a living wage for developing artists.

    “I told myself if I ever won a Grammy, and I got to stand up here in front of the most powerful people in music, I would demand that labels in the industry profiting millions of dollars off of artists would offer a livable wage and healthcare, especially to developing artists,” Roan said.

    Major record labels have now provided commitments to the mental health of their artists. Universal Music Group recently partnered with Music Health Alliance to launch the Music Industry Mental Health Fund, which provides a new suite of outpatient mental health support for musicians.

    A lack of support systems

    Musicians’ mental health suffers from a paucity of institutional protections for freelancers, irregular work schedules and profound financial instability. This is often exacerbated by high instances of performance anxiety and perfectionism among professional musicians, said Dr. George Musgrave, senior lecturer in cultural sociology at Goldsmiths, University of London.

    “When people talk about music being good for health and wellbeing, they’re not talking about working musicians,” Musgrave said. “Those who are doing it for leisure or creation are not anxious and depressed in the same way that those who do it for their job are.”

    Unpredictability also characterizes the career trajectories of many professional musicians, said Noah Fralick, artist manager at Huxley Management.

    “You don’t really go to school, get training, then work your way into the workforce and slowly build up,” Fralick said. “There’s no linear path. You might go from total obscurity to huge amounts of popularity quite quickly.”

    Emotional labour is also inherent in this line of work, which can put musicians at risk for mental health pressures, said Dr. Sally Anne Gross, principal lecturer at the University of Westminster.

    “There’s an interrelatedness to sport, where the body’s running so fast and in doing that, you would expect it to get injured,” Gross said. “If you’re working with your emotions in your working environment … you can expect that you might have emotional injuries.”

    The strains of a music career

    The traditional trope of the “tortured artist” — the idea that an artist must suffer pain to generate authentic creative output — has taken on new significance in the digital age.

    “The digital world is desperate for real things,” Gross said. “The artist now has to be larger than life …  in this atmosphere, at this point in time, if you are a young emerging artist or a current artist, you have to engage in a way that is seen to be authentic and there’s nothing more authentic than pain.”

    Mass democratization of music creation has made it easier than ever for musicians to enter the industry, but with no guarantee that their music will find an audience. Musicians feel pressure to show vulnerability as a way to stand out in a market flooded with options.

    “About 100,000 new songs are uploaded to Spotify every day,” Fralick said. “Streaming has sort of eliminated the barrier to access the music industry, but diluted the potential for any one [musician] to be successful.”

    This creates an environment in which consumers fall back to familiar tunes and artists, as deciding between a multitude of new options can feel overwhelming. As a result, it’s a rare artist who becomes a star. But these success stories become well-known, and the dramatic publicization of those who succeed can explain part of the allure of the music business, Fralick said.

    “I always use this analogy of a lottery winner, and the way that lotteries are set up, we see the winner,” Fralick said. “We think ‘I’m going to buy a ticket because that could be me,’ because your brain is only seeing the success story.”

    Pressure to succeed

    Musgrave said that this mindset can be detrimental for musicians. “Many of them are afflicted with what I’ve referred to as cruel optimism. The optimism is cruel because it’s keeping them tethered to an unrealizable ideal,” he said.

    Aside from emotional investment, launching a professional music career can also entail hefty financial costs. These costs could include paying distributors, shooting music videos, receiving coaching and joining premium memberships.

    The opportunity cost can also be significant. “You give up a lot of earning potential in order to invest in this craft,” Musgrave said. 

    For female musicians, age can be a critical stressor and determining factor of success. As the marketability of their music often hinges upon maintaining a youthful image, it can place additional pressures to find success faster.

    Many female musicians see the age of 30 as a hard cut-off, Musgrave said. “Age is a spectre that haunts women’s musical lives in a way that doesn’t haunt men’s,” he said. 

    Getting help to those who need it

    The last 10 years has seen a sea of change regarding mental health interventions for musicians. 

    In the UK, all three major record labels — Universal Music Group, Warner Music and Sony — have mental health support offerings either in-house or through outsourcing. But in-house mental health counselling could present potentially challenging scenarios for conflict of interest, Musgrave said.

    Currently, the biggest source of musicians’ mental health support is the charitable sector. Organizations such as MusiCares, Music Minds Matter, Music Support and the Man Down Programme provide various offerings such as weekly support groups, 24/7 crisis support lines and training packages for music industry workers.

    Gross said that while poor mental health among professional musicians is an urgent concern, that shouldn’t stop schools from providing music education. Instead, the occupational health hazards of professional music careers should be clearly communicated, so that young people can make informed decisions.

    “I think we have to reassess and re-evaluate the ways in which creative industry jobs have been sold to the next generation,” Gross said. “We have to really think about what’s happening in the educational space … and it’s absolutely essential that we deal with the issues and challenges of the working environment for all professionals.”  

     

    Three questions to consider:

    1. What unique pressures do professional musicians face?

    2. What is meant by the term “cruel optimism”?

    3. Why do so many people dream of becoming famous performers?

     

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  • Too much of what’s healthy can be harmful

    Too much of what’s healthy can be harmful

    Some TikTok videos about health and fitness are hard to resist. People describe how they lost weight by eating only raw fruits and vegetables for a month or by substituting protein powder in place of flour or sugar. How many people take these recommendations to heart? What happens if they do?

    Jason Wood was one of them. “I would sprinkle [protein powder] on top of a peanut butter sandwich or a yogurt just to make what I was eating seem healthier,” he said.

    But Wood’s practice of adding protein powder to make his foods healthier wasn’t healthy. Eventually, Wood was diagnosed with orthorexia, an obsession with nutrition. Orthorexia is an eating disorder that differs significantly from better-known eating disorders like bulimia — bingeing and vomiting the food afterwards — and anorexia — not eating at all.

    Wood now works with the National Association of Anorexia Nervosa and Associated Disorders and speaks to audiences about eating disorders. 

    Studies in Australia, Turkey and the United States have found that the viewership of TikTok lifestyle influencers has led to an increase in orthorexia symptoms, which are not well understood by popular culture and are not explicitly defined in psychiatric textbooks. 

    Avoiding what’s bad isn’t always good.

    Rachel Hogg, psychologist and researcher at Charles Sturt University School of Psychology in Australia, defines orthorexia as “the avoidance of foods that are unhealthy or impure.” 

    The term was first coined in 1996 by California doctor Steven Bratman after he decided to eat only clean, nutritious foods. Eventually his research led him to narrow his food options so much that he cut out entire food groups which caused him physical suffering.

    Wood recalls being freezing cold in the middle of summer with his whole body hurting and frequent dizzy spells. Because it’s an outgrowth of healthy eating, the condition is difficult to identify, says Hogg, who calls it “the wolf in sheep’s clothing.”

    Experts feel it is time people paid attention to the risk of developing orthorexia when exposed to high amounts of TikTok content. 

    Todd Minor Sr. lost his youngest son Matthew in 2019 to the TikTok “Blackout Challenge”; people who took the “challenge” would have themselves choked till they blacked out. In a January 2025 edition of Tech Policy Press, Minor called for social media warning labels as a public health tool. “These labels have a proven track record of raising awareness about the risks of dangerous products, especially among young people,” he wrote. 

    People don’t know what’s bad for them.

    Warning labels inform the consumer of the potential risk of product use and advise limiting dangerous exposure to vulnerable groups of people to avoid premature death or disability. According to orthorexia experts, all of these needs exist when it comes to TikTok. 

    Hadassah Johanna Hazan, a licensed clinical social worker in Jerusalem, knows firsthand how the public is painfully unaware of the dangers of orthorexia from talking to her patients. She describes how over the last 10 years ideal beauty has increasingly been defined as a fit and toned physique for both men and women. 

    This has led people to normalize eating patterns that Hazan describes as “very limiting at best and very harmful and unhealthy at worst.” She said constant and regular avoidance of food groups such as carbs or regularly substituting protein powders for ingredients such as sugar become addictions that her patients do not know how to stop. 

    Even those who teach healthy eating can fall into the orthorexia trap. Research published in the June 2021 supplement of American Society of Nutrition by a group of researchers in the U.S. state of Washington indicated that knowledge of orthorexia was low both in the general public sample group and in the sample group of nutrition students.  

    In fairness to TikTok, the social media giant has established an eating disorder safety page but the term orthorexia is never mentioned and there is no mention of content on TikTok being linked to eating disorders. 

    A balanced diet is best.

    Another group of people who seem ignorant of the risk is the group of TikTok health and fitness influencers who are the ones putting out #WIEIAD (What I Eat In A Day) video diaries and other similar content. 

    Elaina Efird, registered dietician nutritionist and TikTok body positivity influencer, said that influencers don’t realize how much they are entrenched in the problem. What motivates these influencers, she said, is that they either truly believe what they are advertising is healthy or they are so distressed by the alternative of being in a larger body that they overlook the harm in what they promote.

    As a TikTok influencer, Efird creates a space where all body sizes are valued and she wants viewership of her positive message to grow. But as a provider of healthcare to eating disorder patients, she also recognizes her moral responsibility.

    “I tell my clients that if they’re struggling, don’t be on TikTok,” she said. This insight comes from an understanding that certain groups of people are at a higher risk of being triggered by TikTok videos than others. 

    Hogg shares this understanding and even used it when co-designing a research study with fellow researcher Madison R. Blackburn that was published in the peer-reviewed journal PLOS One in August 2024. 

    Each participant was screened to make sure they did not have past or present eating disorders before being asked to watch up to eight minutes of TikTok content, which is the equivalent of just over 50 videos. 

    Algorithms don’t know what’s best for us.

    Hogg said that the sad truth is that an eating disorder patient in remission might search for a body positive video but then suggestions pop up on the TikTok homepage, which is called #ForYou, that might tout orthorexia.  She called the algorithm of TikTok a “blunt instrument.”

    Another vulnerable population with strong connections to TikTok are teens and pre-teens. According to a Statistica 2022 survey, 68% of pre-teens were using social media applications and 47% of respondents ages 11–12 were using TikTok in particular.  As Hogg put it, TikTok is powered by “young people creating content for young people.” 

    The disturbing reality known by psychiatrists is that pre-teens are at the highest risk of developing eating disorders because symptoms manifest typically during adolescence. 

    But what scares the public most about any disease is its lethality. According to an article published in February 2021 by the American Society of Nutrition, some 10,200 people die each year in the United States from eating disorders. 

    Even when death is avoided, an obsession with nutrition can lead to nutritional deficiencies, compromised bone mass, extreme weight loss and malnourishment, including brain starvation, even if that seems counterintuitive. And none of that even touches on the effects on mental or emotional wellbeing. 

    Now that Wood is in remission he wants the label “healthy” to be redefined to indicate support of mental, emotional, social and spiritual health and not just support of physical health. 

    Individuals, he said, should stick to positive reasons for engaging with social media such as community building and avoid using it to make harmful comparisons. 


    Questions to consider:

    1.  How do psychologists define orthorexia?
    2. How does orthorexia differ from anorexia or bulimia?
    3. Has social media influenced what you eat? 

     



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  • What’s all the flap about bird flu?

    What’s all the flap about bird flu?

    Avian influenza has scared doctors and scientists for a generation. But its arrival in the United States might finally give the H5N1 bird flu virus the combination of factors it needs to cause a global pandemic.

    Those factors include a new carrier; dairy cattle; a regulatory system that protects farmers at the expense of human health; and a government bent on taking down an already weak public health infrastructure.

    The H5N1 avian influenza virus making headlines around the world — and driving up the price of eggs — in the United States is no youngster. It’s been around since at least 1996, when it was first spotted in a flock of geese in Guangdong in southern China.

    Since then it has spread around the entire world, tearing through flocks of poultry in Asia, Europe and the Americas and wiping out birds and mammals on every continent, including Antarctica. H5N1 bird flu only rarely infects people but as of the end of January 2025, the World Health Organization reported 964 human cases globally and 466 deaths, although many milder cases are likely to have been missed.

    Vets and virus experts have had their eyes on H5N1, in particular, for decades. It didn’t look like a serious threat when it killed geese in 1996. But the next year the virus caused an outbreak in people just over the border from Guangdong in Hong Kong.

    It infected 18 people and killed six of them before it was stopped. That got people’s attention. A 30% fatality rate is exceptionally high for a virus — something approaching the mortality of smallpox.

    Mutations and swap meets

    The virus gets its name from two prominent structures: the hemagglutinin, or H designation, and the neuraminidase, or N. All influenza A viruses get an HxNx name. The current circulating viruses causing human flu misery right now are H1N1 and H3N2, for example, as well as influenza B, which doesn’t get any fancy name.

    But influenza viruses are exceptionally mutation-prone, and even the extra designation doesn’t tell the whole story about the changes the virus has undergone. Every time a flu virus replicates itself, it can make a mistake and change a little. This is called antigenic shift. As if this wasn’t enough, flu viruses can also meet up inside an animal and swap large chunks of genetic material.

    The result? The H5N1 viruses now circulating are very different from those that were seen back in 1996 and 1997, even though they have the same name.

    This is what’s been going on over the past 30 years. H5N1 has been cooking along merrily in birds around the world. So, after the 1997 outbreak, not much was seen of H5N1 until 2003, when it caused widespread outbreaks in poultry in China. Researchers discovered it could infect wild waterfowl without making them sick, but it made chickens very sick, very fast. And those sick chickens could infect people.

    The best way to control its spread among poultry was to cull entire flocks, but if people doing the culling didn’t take the right precautions, they could get infected, and the virus caused serious, often fatal infections. Doctors began to worry that the virus would infect pigs. Pigs are often farmed alongside chickens and ducks, and they’re a traditional “mixing vessel” for flu viruses. If a pig catches an avian flu virus, it can evolve inside the animal to adapt more easily to mammals such as humans. Pigs have been the source of more than one influenza pandemic.

    Pandemic planning

    In the early 2000s, scientists and public health officials took H5N1 so seriously that they held pandemic exercises based on the premise that H5N1 would cause a full-blown pandemic. (Journalists were included in some of these exercises, and I took part in a few.)

    But it didn’t cause a pandemic. Vaccines were developed and stockpiled. Pandemic plans were eventually discarded, ironically just ahead of the Covid pandemic.

    However, flu viruses are best known for their confounding behavior, and H5N1 has always been full of surprises. It has evolved as it has spread, sometimes popping up and sometimes disappearing, but never causing the feared human pandemic. It has not spread widely among pigs although it has occasionally infected people around the world, as well as pet cats, zoo animals, wild seals, polar bears, many different species of birds and, most lately, dairy cattle.

    It’s this development that might finally be a turning point for H5N1.

    For a virus to start a human pandemic, it must acquire the ability to infect people easily; it must then pass easily from person to person; and it must cause significant illness.

    Competing interests

    So far, this hasn’t happened with H5N1. It has infected 68 people in the United States, mostly poultry or dairy workers. Mostly, it causes an eye infection called conjunctivitis, although it killed one Louisiana man. But it is spreading in a never-before-seen way — on milking equipment and in the raw milk of the infected cattle.

    “The more it spreads within mammals, that gives it more chances to mutate,” said Nita Madhav, a former U.S. Centers for Disease Control and Prevention researcher who is now senior director of epidemiology and modeling at Ginkgo Biosecurity. I interviewed her for a podcast for One World One Health Trust. “As it mutates, as it changes, there is a greater chance it can infect humans. If it gains the ability to spread efficiently from person to person, then it would be hard to stop,” Madhav said.

    And while some states are working to detect and control its spread, the federal government is not doing as much as public health experts say it should. Two agencies are involved: the U.S. Department of Agriculture (USDA) and the Centers for Disease Control (CDC).

    Dr. John Swartzberg, a health sciences clinical professor emeritus at the University of California, Berkeley said in an interview with the UC Berkeley School of Public Health that the USDA is charged with two responsibilities that only sometimes work in concert.

    “One of the responsibilities they have is to assure a healthy agricultural industry for the United States,” Swartzberg said. “The second responsibility is to assure safety of the human beings who consume agricultural products in the United States.”

    More information, not less, is needed.

    Dairy farmers feared they’d lose money if their farms were identified as sources of infection. And it’s a lot more expensive to cull cattle than it is to cull chickens.

    “And I think what we’ve seen with this bird flu problem is that the USDA is tilted in favor of protecting the industry, as opposed to protecting the health of humans,” Swartzberg said. “CDC is also involved, but the CDC has no authority to go into states and tell them what to do. It has to be done state by state.”

    On top of that, U.S. President Donald Trump has ordered the CDC to take down websites reporting on avian flu and other issues. He is withdrawing U.S. membership from WHO, crippling the ability to coordinate with other countries on controlling outbreaks of disease.

    He notably tried to suppress reporting about Covid during his previous presidency and promoted unproven and disproven treatments.

    His newly confirmed Health and Human Services Secretary, who will oversee CDC and other agencies charged with human health, Robert F. Kennedy, Jr, is a vaccine denier, proponent of raw milk and has no public health qualifications.

    The stubbornness of people in the United States doesn’t help. When public health officials warned against drinking raw milk last year, raw milk sales actually went up.

    “Food safety experts like me are just simply left shaking their heads,” Donald Schaffner, a Rutgers University food science professor, told PBS News.

    The big fear? That in flu season, someone will catch both seasonal flu and H5N1, giving the viruses a chance to make friends in the body, swap genetic material and make a deadly new virus that can infect people easily.

     

    Three questions to consider:

    1. How can politics affect public health risk?
    2. How does public understanding and trust affect the risk of disease?
    3. Countries often blame one another for the spread of disease, but should they?

     

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  • Decoder Replay: Bacteria doesn’t stop at the border

    Decoder Replay: Bacteria doesn’t stop at the border

    During the Covid pandemic, nations realized they needed to work together to keep their people safe. That’s where the World Health Organization comes in. 

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  • Bite of the Big Four: India’s deadly snakebite crisis

    Bite of the Big Four: India’s deadly snakebite crisis

    Every year, an estimated 5.4 million people worldwide are bitten by snakes, resulting in as many as 138,000 deaths and three times as many cases of permanent disability.

    The World Health Organization classified snakebite as a neglected tropical disease in 2017 and set a target to halve related deaths by 2030.

    India, home to over 300 snake species, is at the heart of this global health issue, accounting for half of all snakebite-related deaths.

    While 95% of Indian snakes are non-venomous, it’s “The Big Four” species — the Indian cobra, common krait, Russell’s viper and saw-scaled viper — that cause the most harm said Dr. Sushil John, a public health doctor and amateur herpetologist from Vellore.

    “These snakes cohabit in the same spaces as humans, thriving in India’s agricultural fields, forests and urban outskirts,” said John. “So, they often come into close contact with people and might bite them.”

    A study conducted between 1998 and 2014, called the Million Death Study, found that almost 58,000 people in India died from snakebite each year. Second to India in recorded snakebite deaths is Nigeria, with a reported 1,460 deaths per year. 

    The missing data

    “Though India had a severe snakebite problem, accurate data on snakebite deaths in India was elusive for a long time,” said Dr. Ravikar Ralph, a physician at the Poison Control Centre at CMC Vellore.

    In 2011, the official reported number of snakebite deaths was only 11,000. The deaths reported in the Million Death Study highlighted the severe underreporting of snakebite mortality in the country.

    “This is because most studies available at the time were hospital-based, which led to the gross under-reporting of this issue,” said Ralph. “We knew from grassroots work that most patients were not reaching hospitals on time.”

    “Either people didn’t realize that being bitten by a snake required medical management, or they went to traditional healers, causing fatal delays in hospital-based care,” said Ralph. “The Million Death Study used community-based data collection to circumvent that barrier and document accurate numbers.”

    Harvesting the cure

    Snakebites are unique compared to other health issues. Snake venom, a potent mix of proteins, can destroy tissue, paralyze muscles and impair blood clotting, often leading to severe disability which is most likely loss of limbs which were bitten or death if untreated.

    “Unlike diseases caused by other agents such as viruses or bacteria where one can eliminate the causing agent, a similar approach cannot be taken for snakebites,” Ralph said.

    Antivenom is the only specific treatment that can prevent or reverse many of the effects of snakebite, when given early and in the right dosage.

    To produce antivenom, snake venom must be first collected, or “milked,” from live snakes kept in a specialized facility. Only one facility in India, located in Tamilnadu, harvests venom for anti-venom production in India.

    The venom is then diluted and injected in small doses into animals like horses, prompting their immune systems to produce antibodies. These antibodies are then harvested, purified and processed into antivenom.

    But India’s only anti-snake venom treatment targets only The Big Four snakes.

    “There are over 50 venomous snake species in India,” said Gnaneshwar Ch, project lead of the Snake Conservation and Snakebite Mitigation project at the Madras Crocodile Bank Trust.

    “The anti-snake venom’s limited scope means bites from less common species remain inadequately treated,” he said

    Despite its importance, antivenom is also not widely available, and its cost can be prohibitive for many rural families. The gaps in stocking and distribution further worsen the issue.

    While many countries produce antivenom, they tend to cater to the locally available species of snakes making it impractical to import it from other countries to India in order to solve the availability crisis.

    A national action plan

    The WHO has called for concerted global action to reduce deaths and disability in priority nations. In 2019, the WHO launched an international strategy for preventing and controlling snakebite, which was then regionally adapted for Southeast Asia and published in 2022.

    The Indian Union Health Ministry then launched the National Action Plan for the Prevention and Control of Snakebite Envenoming (NAPSE) in March 2024. The NAPSE aligns strategically with the WHO’s global roadmap and its regional adaptation for Southeast Asia.

    Many stakeholders need to join forces in order to balance snakebite mitigation with snake conservation, experts say.

    “Snakes tend to be very important to every ecosystem they are found in,” said Dr. Sushil John. “If snake numbers fall, we would see an increase in rodents which the snakes keep in check by eating. They would then destroy crops and spread diseases to animals and people.”

    While this strategy appears to be heading in the right direction, some experts caution that there might be barriers to implementation.

    “While public hospitals may adopt the reporting system, many Indians seek private health care,” said Professor Sakthivel Vaiyapuri, a venom pharmacologist at the University of Reading in England. “Mechanisms to ensure private hospitals comply with reporting requirements are essential.”

    Vaiyapuri helped work on the National Action Plan. He said health workers who are to report snakebite must understand the significance of their role which will motivate them to record the data accurately. He also said someone must verify the entered data independently to ensure accuracy. He suggests developing a mobile app to streamline data collection.

    While Vaiyapuri worries about the logistics of implementing such a plan for massive surveillance, there are also other worries about unintended consequences for snakebite victims, according to Dr. Anand Zachariah, a toxicologist at CMC Vellore.

    “When India made maternal deaths notifiable, many private clinics in India stopped treating high-risk pregnancies because they worried about the reporting process getting them in trouble if something went south,” said Zachariah. “I fear snakebite becoming a notifiable disease might trigger such defensive practices among physicians.”

    But he admits that at this point, the fear is only theoretical; what will eventually happen remains to be seen.

    “Despite the challenges, I think [the National Action Plan] is a pivotal initiative in tackling snakebite envenomation in India,” Vaiyapuri said.

    “By fostering accurate data collection, promoting intersectoral collaboration and engaging communities, the plan holds significant potential to drive meaningful change — ensuring effective prevention, timely treatment and a significant reduction in snakebite-related deaths and disabilities,” Vaiyapuri said.

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