World Snake Day: Assam charts path towards zero preventable snakebite deaths

Dr Surajit Giri

Demow comprehensive model emerges as a national example for tackling one of India’s most neglected public health challenges

Snakebite is called the poor man’s acute health emergency. India is the world’s ‘Snakebite Capital’ with 2.8 million bites a year, with 35,000–50,000 people dying per year, according to the World Health Organization (WHO). Lack of coordinated comprehensive care in snakebite management is the key factor in the highest numbers of deaths and morbidity in India and Assam. India and our state, Assam, too, lack a comprehensive care model in snakebite management. But we are happy with the progress of our state activity in the years 2024, 2025 and 2026.

Assam, with its diverse ecosystem and large farming population, has long been among the states bearing a significant burden of snakebite. This World Snake Day, however, Assam has a story of hope to tell: a story of how a comprehensive, evidence-based approach is transforming snakebite care and bringing the state closer to the goal of zero preventable snakebite deaths.

At the heart of this transformation is the Demow Comprehensive Model, an integrated strategy that addresses every stage of snakebite management, from prevention and first response to definitive hospital care.

The first pillar of the model focuses on pre-hospital management. Community-based venom response teams have been established to ensure that snakebite victims receive immediate assistance and are transported quickly to appropriate health facilities. Alongside these initiatives, extensive public education and awareness campaigns have been conducted to dispel myths, discourage harmful traditional practices, promote safe behaviours, and encourage early hospital treatment. These sustained efforts have led to greater awareness and confidence among communities across Assam, resulting in more snakebite victims reporting to hospitals and increased hospitalisation since 2022. This is a positive indicator that people are seeking timely medical care.

The second pillar focuses on strengthening Assam’s healthcare system. With the support of the Government of Assam, under the leadership of the Chief Minister of Assam, Dr Himanta Biswa Sharma; the National Health Mission (NHM), Assam; and the State Nodal Officer for Snakebite Management, Dr S.A. Lashkar, a comprehensive roadmap has been developed to improve snakebite care across the state in rural health centres. An Assam-specific Standard Operating Procedure (SOP) now guides healthcare professionals in providing standardised, evidence-based treatment. Assam is the first state to modify the national guidelines and SOP according to the available venomous snakes in the state.

One of the most remarkable achievements has been the extensive capacity building of the healthcare workforce.  More than 5,000 doctors have been trained in scientific snakebite management both in offline and online modes, and today every government rural hospital up to Community Health Centres (CHCs) and distant tertiary hospitals, resulting in precious time being lost, in Assam is equipped to treat snakebite victims. This represents a major shift from earlier practices, where patients were often referred from CHCs to distant tertiary hospitals, resulting in precious time being lost and to distant tertiary hospitals, resulting in precious time being lost and resulting in the mortality of the victim.

A significant change in clinical practice A simple yet powerful message captures a significant change in clinical practice: “Refer Kills, Shift Saves”. Rather than referring snakebite victims elsewhere without treatment, rural healthcare facilities now stabilise patients, administer appropriate Anti-Snake Venom (ASV), and shift only if the patient’s health condition doesn’t improve with ASV & other ancillary medical therapy. Our doctors and staff across Assam now believe that there is no need for intensive care (ICU) if a patient attends hospital early. This shift in mindset has dramatically improved survival while strengthening confidence within the public health system across Assam.

The results have been encouraging. With increased reporting and hospitalisation of snakebite cases, seven snakebite deaths have been recorded under this model in 2026. Sevenhat timely treatment and a coordinated healthcare response can save lives. Out of these four, who attended the hospital in a brought-dead situation, and who delayed hospital admission?

The success of the Demow Comprehensive Model has attracted national attention. Recognizing its potential, the Indian Council of Medical Research (ICMR) has adopted the model for further study and implementation in six additional states, Kerala, Himachal Pradesh, Odisha, Jharkhand, Maharashtra and West Bengal, highlighting Assam’s leadership in addressing snakebite as a public health priority.

Supporting these efforts is the ICMR SARPA Assam team, led by Dr Surajit Giri and including key members Dr Rafika Yasmin, Ms Sukanya Bhagawati, Ms Aksheta Sharma, Mr Manjeet Neog and Mr Partha Protim Boruah. This team has been working relentlessly toward the shared vision of eliminating preventable snakebite deaths. Their initiatives include continuous public sensitisation, training of healthcare professionals, operating a 24×7 SARPA helpline to support snakebite victims and healthcare providers, promotion of preventive measures, and sustained efforts to encourage behavioural change within communities.

The experience from Assam demonstrates that reducing snakebite mortality requires much more than the availability of anti-snake venom. It demands informed communities, trained healthcare professionals, standardized treatment protocols, responsive emergency systems, and unwavering political commitment. By bringing these elements together, the Demow Comprehensive Model has created a continuum of care that begins in the village and extends to the hospital bedside.

Ten reasons why Assam can achieve zero death by 2030

1. Assam has identified venomous snakes of this region.

2. Assam has studied the venom of these venomous snakes.

3. In Tezpur University and IASST (Institute of Advanced Study in Science & Technology), Guwahati, a venom study is going on.

4. Assam has its own Assam-specific SOP.

5. Assam has trained 5000+ medical officers & TOTs for all districts.

6. Up to CHC-level ASV and other logistics are freely available.

7. A few remote PHCs also have ASV and logistics.

8. The public started to visit nearby rural hospitals instead of faith healers.

9. The government of Assam is supporting this project.

10. Mapping of all districts of Assam in relation to prevalent venomous snakes is done (according to patient turnover to hospitals).

As the world observes World Snake Day, Assam’s journey offers an inspiring message: Snakebite deaths are not inevitable. However, through community participation, scientific management, and a strengthened public health system, the state is proving that every preventable snakebite death can be, and should be, avoided. What began as a local initiative in Demow is now influencing national policy and has the potential to become a model for snakebite-endemic regions across India. The goal is ambitious, but Assam has shown that it is achievable:  Approaching Zero Snakebite Deaths is no longer a vision; it is becoming a reality.