Remarkable progress against snakebite in eSwatini has been abruptly curtailed by the Trump administration’s funding cuts to US foreign aid, and the closure of the main snakebite treatment centre in the country.
Snakebite is a major killer in many African countries, where effective treatment has been plagued with issues for years, killing around 20 000 people in sub-Saharan Africa in 2023.
An investigation by the Mail & Guardian’s Bureau of Investigative Journalism (TBIJ) recently found that the anti-venom market in the region is blighted by ineffective medicines, bad regulation and fraudulent research.
eSwatini, however, is in marked contrast, and recorded zero snakebite deaths for the first time in its recent summer season, when rates are typically high. At its peak, the disease is estimated to have caused more than 60 deaths a year in the country.
Central to this progress has been The Luke Commission, an NGO which has been delivering in-patient and outpatient care for 20 years, its hospital being the country’s go-to referral destination for people with serious snakebites.
But earlier this month it closed its doors after sudden cuts to its funding from USAID, telling TBIJ that the abrupt cessation of the financial support was just one of several factors leading to the closure.
The country’s leading snakebite expert, Thea Litschka-Koen, said: “We’re at risk of going back to the dark ages. Now we’ve got nowhere to send (snakebite patients). We’ll go back to losing more than 60 lives a year.”
eSwatini’s success in tackling snakebites has been described by the World Health Organisation’s expert on snakebite, Dr David Williams, as “an example to the rest of Africa and to the world”.
Much of eSwatini’s healthcare for snakebites has come via The Luke Commission, which Litschka-Koen says had treated more than 1 000 patients over the past six years.
At the end of January, however, management received written notice from the US Government of an immediate pause in its support. In a statement posted on its website on 15 February, it said: “Due to the (USAID) funding pause and a written stop order requiring immediate compliance, we have temporarily closed the campus to most patients.”
The Luke Commission told TBIJ it had received money from USAID for more than 15 years, and the support accounted for about a quarter of its total funding. The money allowed the hospital to allocate unrestricted funding to its snakebite programme.
It told TBIJ the cuts from USAID came on the heels of the long-term financial strain of Covid and issues with other funding allocations.
It was “doing everything in its power” to keep its snakebite programme running but admitted that “sustainability remains a serious concern … without sustained resources, this progress is at risk”.
“I am broken,” said Litschka-Koen, who founded and runs the eSwatini Anti-venom Foundation.
“It’s a tragedy,” said Philip Price, scientific director of anti-venom company EchiTAb-Plus-ICP. “eSwatini had achieved the impossible.”
EchiTAb-Plus-ICP is the global distributor in an anti-venom project that has played a central role in the turnaround in eSwatini. Along with the eSwatini Anti-venom Foundation, The Luke Commission is one of the main buyers of the Echitab anti-venom for eSwatini, purchasing hundreds of vials per year to maintain a steady supply for the country.
“They’re selling it to us at cost,” said Litschka-Koen, who feared that if the anti-venom project didn’t have enough buyers, it could close down altogether.
Price said this wasn’t an immediate risk, but that “the basic problem we have with the market is the unstable demand”.
“This is a difficult moment,” The Luke Commission told TBIJ. “Not just for [the hospital] but most importantly for the patients we serve. We are deeply concerned about the impact on the most vulnerable members of our community.”
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