Eswatini’s success against snakebite under threat after USAID funding freeze

In Eswatini, remarkable progress has been made against snakebite, one of the world’s most deadly neglected diseases. Yet this success is now under urgent threat from funding cuts, intensified by Donald Trump’s recent freeze on US foreign aid.

Snakebite is a major killer in many African countries, where effective treatment has been plagued with issues for years. In 2023 it killed an estimated 20,000 people in sub-Saharan Africa alone. A major investigation by the Bureau of Investigative Journalism (TBIJ) this month revealed an antivenom market in sub-Saharan Africa blighted by ineffective medicines, bad regulation and fraudulent research.

Eswatini, however, stands in marked contrast to many of its neighbours as an extraordinary success story – 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, a hospital that has come to act as the country’s go-to referral destination for people with serious snakebites. Earlier this month it closed its doors to most patients following sudden cuts to its funding from USAID, the US government’s main overseas aid agency.

The hospital told TBIJ that the US funding cut was one of a number of factors that led to the closure.

“We’re at risk of going back to the dark ages,” said Thea Litschka-Koen, a leading snakebite expert in the country. “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 Organization’s leading expert on snakebite, Dr David Williams, as “an example to the rest of Africa, and to the world”.

He put it down to a “holistic approach” that incorporates educating people on how to respond to a snakebite alongside access to good-quality medicine and care.

Much of Eswatini’s healthcare for snakebite has come via the Luke Commission, which Litschka-Koen says has treated more than 1,000 snakebite patients over the past six years.

However on 6 February, the hospital closed its doors. At the end of January, management had received written notice from the US government of an immediate pause in its support. In a statement posted on its website on 15 February, the hospital said: “Due to the [USAID] funding pause and a written stop order requiring immediate compliance, we have temporarily closed the campus to most patients.”

It is among the many health facilities around the world whose futures have been thrown into uncertainty in the wake of Donald Trump’s move to shut down USAID altogether.

The Luke Commission told TBIJ that 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.

The hospital told TBIJ its closure is temporary. It also said cuts from USAID followed the long-term financial strain of Covid and issues with other funding allocations.

It said it is “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 Antivenom Foundation.

“It’s a terrible tragedy,” said Philip Price, scientific director of antivenom company EchiTAb-Plus-ICP. “Eswatini had achieved the impossible.”

EchiTAb-Plus-ICP is the global distributor in an antivenom project that has played a central role in the turnaround in Eswatini. Along with the Eswatini Antivenom Foundation, the Luke Commission is one of the main buyers of the Echitab antivenom for Eswatini, buying hundreds of vials per year in order to maintain a steady supply for the country.

“They’re selling it to us at cost,” said Litschka-Koen, who feared that if the antivenom project didn’t have enough buyers it could close down altogether. Price said this wasn’t an immediate risk, but did comment 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.”

A spokesperson for the US State Department told TBIJ that the government has paused all foreign aid for 90 days.

“This is not about ending foreign aid, but restructuring assistance to serve US interests, and to be sure the money spent on aid programmes actually reaches people in need,” they said. “This is a 90-day pause to allow a thorough review to occur. Programmes that serve the national interest will continue, those that don’t will not.”