It is because polyvalent antivenom is produced using venom from the 'Big Four' snakes found mostly in southern and western regions, so it is less effective against many local species in northern and eastern states. The Indian Council of Medical Research is now working on region-specific antivenoms. In my corporate hospital in Chennai, we see excellent efficacy with the current antivenom, but my colleagues from rural postings in Odisha and Bihar tell harrowing stories of its failure—that disparity haunts me.
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