The deadly outbreak of Primary Amoebic Meningoencephalitis (PAM) in Kozhikode, Kerala has shattered complacency around freshwater safety. Although India has recorded only 17 cases with seven survivors, the situation demands urgent attention. Global evidence shows that the etiological agent of PAM - Naegleria fowleri — is present in all continents except Antarctica. Since 1965, 381 cases were documented, rising by 1.6 per cent annually. By 2023, Pakistan had reported over 140 cases, while the US, Australia and India also reported significant numbers, signalling its growing global footprint.
What might appear a medical oddity is in fact an ecological alarm. India, the world’s largest groundwater user, abstracts about 250 km³ per year, much of it from shallow aquifers. These volatile systems, when neglected, can become pathogenic breeding grounds. National water surveys and investigative reporting reveal widespread urban well degradation. In Kerala, early findings indicate half the wells across 10 districts as contaminated. The Kozhikode cases, including a three-month-old infant exposed only to well water not only highlight the fragility of shallow aquifers but also underscore how groundwater can turn hazardous under lapse of oversight.
This, however, is not just an Indian risk. Climate change is amplifying global pathogenic activity. Over the past 150 years, global surface temperatures have risen at an unprecedented rate. IPCC notes that 3.5 billion people live in climate-vulnerable contexts, with warming and shifting rainfall expanding pathogen ranges and heightening global health risks. COVID-19 showed how pathogens emerge at the intersection of ecological disruption and human activity. With cases like PAM and recent outbreaks like Guillain-Barre Syndrome in Pune, India’s next health crises may well be waterborne and not airborne. The risks posed by PAM are deeply connected to how climate change, land-use shifts, and urban design shape ecological health. Landscape modifications through deforestation, urbanisation, and habitat destruction intensify pathogenic risks, contributing to nearly 30 per cent of emerging infections. Planning must shift from disaster recovery to designing pathogenic-resilient landscapes integrating One Health approach. This requires site-specific understanding of pathogenic spread to inform resilience strategies. Ecological interventions can reduce spillover risks more effectively than techno fixes like GMOs, requiring water systems to be re-imagined from mere infrastructure to living, participatory, public-health assets.
Building Resilience Through Groundwater Stewardship
At the grassroots, India must shift from unconscious consumption to mindful conservation. This is the focus of Shallow Aquifer Management (SAM) initiative – a pioneering approach to urban groundwater management by National Institute of Urban Affairs (NIUA) under Ministry of Housing and Urban Affairs (MoHUA)’s AMRUT 2.0. Piloted in 10 cities and now scaling to 75, SAM integrates aquifer recharge, climate resilience and participatory governance. This approach has already shown promise in urban wells restoration and healthier hydrological systems.
At its core is the Urban River Management Plan (URMP) Framework – a 10 point agenda by NIUA and National Mission for Clean Ganga (NMCG) under the aegis of MoHUA and Ministry of Jal Shakti (MoJS) respectively. Rooted in the idea that healthy rivers ensure urban liveability, it encourages river–aquifer interactions that prevent stagnation, a pathogenic risk factor. Both SAM and URMP reframe rivers as integrated living systems — linking aquifers, wetlands, and waterbodies — rather than siloed resources.
Likewise real-time data on water quality, usage, and behaviour trends can help municipalities and citizens preempt outbreaks. The City Water Information Network (CWIN), developed by NIUA with UNESCO Delhi and piloted in Gwalior, integrates an entire urban water ecosystem — resources, supply networks, used water, storm water, and spatial data — into a dynamic real-time dashboard. By tracking recharge hotspots and vulnerable zones, it shifts cities from firefighting to proactive, inclusive water e-governance. Similarly, Kerala’s Neerarivu Census (ongoing), led by Kudumbashree workers; documenting well depth, recharge and quality, prove how community-led monitoring can strengthen water security. Together these initiatives embody the takeaways that COVID-19 taught us: Effective governance that integrates water, health, climate, and landscapes with support from communities continue to prevail in the face of adversity.
A National Call for One Health Governance
Outbreaks like PAM signify a clear need for India to reorganize its water narrative around One Health governance, wherein groundwater stewardship, river health, climate preparedness, and public health surveillance can form a single, cohesive framework. Policy levers such as AMRUT 2.0 offer an enabling environment for scaling aquifer-based resilience, but scaling requires political will, institutional alignment, and ecological intelligence.
Groundwater’s hostility reflects societal failure, not microbial inevitability. In an era of climate instability and increasing infections, India can no longer isolate water as a disconnected entity. It must be managed as a living landscape – monitored and protected according to the health of both humans and allied ecosystems. Championing nature-based, biomimetic solutions over habitat disruption can ensure sustainable coexistence. This requires better understanding of disease ecology, long-term monitoring, and adaptive strategies. The time to act is now, before another invisible threat becomes tomorrow’s headline.