When Paul Eccles, one of our global health reporters, approached me with an idea he had for an investigation, I was a bit sceptical. He wanted to look into how companies were selling dodgy snake antivenom around the world, leaving people to die when they got bitten.

That sounded awful, but felt a bit niche. Then he hit me with the numbers. The World Health Organization (WHO) says 5.4 million people are bitten each year. Estimates on global deaths range from 80,000 to 140,000.

How many people are really affected is a big unknown. Snake bites, and the deaths and injuries that result, often go unrecorded. That’s in part because most bites happen in rural areas of Africa or Asia.  

And as tragic as the deaths are, three times as many snakebite victims survive, but are left with permanent disabilities. Personally, I remember a man I knew growing up, who’d been bitten by a snake and was left with half an index finger.

This is a massively underreported issue that almost exclusively affects poorer people.

That’s what made this a story for TBIJ. And I was even more convinced once Paul, Rachel Schraer and Andjela Milivojevic properly started reporting and found doctors treating snakebite patients.  

What the team found was a “Wild West” of badly made, badly marketed and badly regulated antivenoms being sold across sub-Saharan Africa. Some are about as useful as injecting water, experts said.

“It’s a cowboy show out there,” said Thea Litschka-Koen, a leading snakebite expert in Eswatini, southern Africa. “Some of them are selling stuff that honestly, you may as well just pour down the drain.”

We examined seven cases where snakebite victims were left badly injured despite getting treatment. Two of them didn’t survive. 

Our team interviewed patients. One of them, a handyman from the south of Uganda, was treated with antivenom in a hospital, but it couldn’t stop the flesh-eating effect of the bite. People who’ve survived that kind of bite describe the feeling as like being injected with burning acid. The handyman still can’t use his arm properly and needs painkillers and sleeping pills.

Describing the problem is one thing, but accountability is key. We tracked down the companies manufacturing these drugs. Exposing them to scrutiny might force them to take more responsibility for their products. We certainly found an energised community of experts and doctors who are fighting to clean up the industry.

It’s an eye-opening investigation. It’s also filled with fascinating facts about why some snake antivenom works in one country but not another. 

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Each week we reveal a fascinating fact from our reporting…

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Sex is a trigger for about 60% of the women living with recurrent urinary tract infections (UTIs).

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One woman suffering from recurrent drug-resistant UTIs told us she began taking antibiotics every time she had sex to prevent an infection from happening again.

Recent studies have shown that more than half of the bacteria that cause UTIs can be resistant to antibiotics, and this resistance can increase as infections recur. 

Despite the severity of the issue, standard diagnostic testing for UTIs is currently simplistic, consisting of just a dipstick test, which often fails to pick up the presence of harmful bacteria.

Read more about recurrent UTIs here. 

For our snakebite investigation, we didn’t want people to simply tell us that the antivenoms were ineffective. We wanted to prove it.

So we decided to test the drugs. First we had to get our hands on the antivenoms, which we managed to do in Nigeria, Tanzania and Uganda. 

Then we went over to Valencia, Spain, to seek out one of the world’s leading experts on snake antivenom: Professor Juan Calvete. He runs a lab at the Instituto de Biomedicina de Valencia that is trusted as the sole source of the World Health Organization’s official assessments on antivenom quality.

Calvete took the antivenom in fine powder, weighed it, diluted it in a saline solution and tested how much of the key ingredients was in each vial.

Next, the team tested how well the antivenom would bind to the venoms of four of the most dangerous and widely found snakes in sub-Saharan Africa – the puff adder, black-necked spitting cobra, black mamba and the West African carpet viper. The binding capacity shows how much of the venom the antivenom will ‘stick’ to per unit. Roughly speaking, the more it can stick to, the better the antivenom works. Binding to the toxins in the venom is the first step to stopping them – if the antivenom can’t stick to them then it can’t neutralise them.

After testing, Calvete gave us his verdict on some of the antivenoms we brought him: “Giving a patient this antivenom will be almost as if you inject distilled water in the body.” 

He added: “There are no good words to describe this … [The producers] have been in the field for many years so they should know what they are doing.

“If this is the case, it should be investigated as a fraud because it would be criminal to sell a lifesaving product to a country where it will not work … If I had one of these people in front of me, I would say, ‘You are a son of a bitch.’ ”.

Between reporting, testing and hammering out the fine details, the investigation took almost a year of work from the team. We couldn’t have done it without support from our readers. If you want to see more work like this, consider becoming one of our Insiders and help us cover stories others won’t.