Recurring outbreaks of the Nipah virus pose an unsettling challenge to Kerala’s healthcare system. More than the scale, the frequency is worrying. In the eighth outbreak since 2018, a teen girl from Malappuram died on July 1, and a woman from Palakkad is battling for life. Earlier in May, a Malappuram woman tested positive. As many as 499 people have been identified as contacts of those who have been infected. Seventeen people had died in the most severe outbreak in 2018, and since then, Kerala has reported Nipah infections every year, except in 2020 and 2022. Alarmingly, there were two outbreaks in 2024, and two again this year so far. This increased frequency could be the new normal in Kerala’s battle against Nipah.
The question that remains unanswered is why only Kerala appears so vulnerable to Nipah. One hypothesis is that the virus may have become endemic to the state. While the exact mechanism that leads to human infections and localised outbreaks remains poorly understood, experts say that deforestation has deprived fruit bats, said to be the natural reservoir of the virus, of their traditional habitats, leading to their shift to urban areas. A similar situation played out in Malaysia in 1998 when bats migrated to orchards following El Niño and deforestation in Kalimantan and Sumatra, leading to an outbreak. Factors like food scarcity, overcrowding, and the stress of habitat loss can also increase viral shedding, experts contend. It could also be a case of improved detection due to heightened surveillance and awareness; in Kerala, all acute encephalitis cases are also checked for Nipah.
Infectious diseases such as H1N1, Hepatitis A, and leptospirosis already infect thousands, killing dozens every year in Kerala. This underscores the need to strengthen disease monitoring systems, invest in early-warning infrastructure, and promote behavioural changes at the community level. Eradicating Nipah may not be realistic, but minimising its transmission is. Nipah cannot be seen as a consequence of man-animal conflict, but it does emphasise the need for a better understanding of the human-animal-environment relationship. The WHO’s ‘One Health’ approach, which links human, animal, and environmental health, offers a roadmap for long-term preparedness. Kerala must integrate this approach more systematically into its health governance. Nipah is here to stay. Kerala needs to learn to live with the virus safely.