Antidotes: Where are they when needed?

It is estimated that nearly 45,900 people in India die of snake bite,—the highest mortality rate in the world for snake bite.[1] Those who die are from the lower socioeconomic groups, such as farmers, villagers, children, and those with very little publicity value for the media. Polyvalent antisnake venom (ASV) is widely available, manufactured in India and is the antidote of choice. Yet, primary health centres (PHCs) stock one or two ASV vials at any given point of time. This is not enough even for a single patient. The reasons why large amounts of ASV are not stocked in PHCs are varied. ASV is a costly medicine, and chief medical officers are hesitant to leave large stocks in the PHCs for fear of misuse/pilferage by the personnel. At times these drugs are not used till they are found to have expired, which provokes an audit objection, which in turn starts a circle of queries that everyone wants to avoid. Therefore, PHCs are stocked with just one or two vials of ASV, a volume too small for the management of snake‑bite, but enough to satisfy audits by higher authorities when asked whether ASV is available in the PHC. Precious little is being done to address the issue of unavailability of ASV in adequate dosage at the point of first contact for care.[2] This is poverty amidst plenty playing out with a deadly outcome. It seems rather sad that at a time when noncommunicable diseases and other lifestyle diseases are getting the attention of health policy makers, this neglected problem is remaining exactly the same. There have been questions in the Lok Sabha from time to time regarding death due to snake bite and the availability of ASV.[3] However, the answers to the questions are cloaked in politically correct language which neither mirrors nor distorts