Injury Division, The George Institute for Global Health, Faculty of Medicine, UNSW, Sydney, New South Wales, Australia
Meta-research and Evidence Synthesis Unit, The George Institute for Global Health, New Delhi, India.
BMJ Glob Health. 2023 Aug;8(8). doi: 10.1136/bmjgh-2023-011923.
Snakebite was added to the WHO neglected tropical disease (NTD) list in 2017, followed by a World Health Assembly resolution in 2018, and an explicit global target being set to reduce the burden in 2019. We aimed to understand how and why snakebite became a global health priority.
We conducted a policy case study, using in-depth interviews, and documents (peer-reviewed and grey literature) as data sources. We drew on Shiffman 's framework on global health network to guide the analysis.
We conducted 20 interviews and examined 91 documents. The prioritisation of snakebite occurred in four phases: pre-crescendo, crescendo, de-crescendo and re-crescendo. The core snakebite network consisted of academics, which expanded during the re-crescendo phase to include civil society organisations and state actors. The involvement of diverse stakeholders led to better understanding of WHO processes. The use of intersecting and layered issue framing, framing solutions around snake antivenoms, in a background of cross-cultural fascination and fear of snakes enabled prioritisation in the re-crescendo phase. Ebbs and flows in legitimacy of the network and reluctant acceptance of snakebite within the NTD community are challenges.
Our analyses imply a fragile placement of snakebite in the global agenda. We identify two challenges, which needs to be overcome. The study highlights the need to review the WHO criteria for classifying diseases as NTD. We propose that future prioritisation analysis should consider identifying temporal patterns, as well as integrating legitimacy dimensions, as in our study.
2017 年，蛇伤被世界卫生组织（WHO）列入被忽视热带病（NTD）名单，随后在 2018 年世界卫生大会通过了一项决议，并在 2019 年设定了明确的全球目标，以减轻其负担。我们旨在了解蛇伤是如何以及为何成为全球卫生重点的。
我们进行了一项政策案例研究，采用深入访谈和文件（同行评议和灰色文献）作为数据来源。我们借鉴 Shiffman 的全球卫生网络框架来指导分析。
我们进行了 20 次访谈，并检查了 91 份文件。蛇伤的优先排序发生在四个阶段：前期、高潮期、消退期和再高潮期。核心蛇伤网络由学者组成，在再高潮期扩大到包括民间社会组织和国家行为体。不同利益相关者的参与使人们更好地了解了世卫组织的进程。利用交叉和分层的问题框架，围绕蛇毒抗血清解决问题，在跨文化迷恋和对蛇的恐惧的背景下，使蛇伤在再高潮期得到优先考虑。网络合法性的起伏不定以及 NTD 社区对蛇伤的勉强接受是挑战。
我们的分析表明，蛇伤在全球议程中的地位很脆弱。我们确定了两个需要克服的挑战。该研究强调需要审查世卫组织将疾病归类为 NTD 的标准。我们建议，未来的优先排序分析应考虑识别时间模式，以及整合合法性维度，就像我们的研究一样。
