Why India is finding it difficult to handle Nipah
India is one of the handful of countries in South Asia that have still not had Joint External Evaluation (JEE), a standardised external evaluation conducted by the World Health Organization to assess a countries’ core capacities to prevent, detect, and respond to public health emergencies.
Today, as the world is confronted with another Ebola outbreak this time in the Democratic Republic of Congo, India is dealing with a microscopic demon of its own: a Nipah virus outbreak in Kerala, resulting in 16 deaths (at the time of going to press). As with most epidemics, the economic effects of fear and misinformation regarding the disease outweighs the immediate health risks of the outbreak itself. Even as India is investigating the disease’s outbreak, one question lingers on. How prepared is the country to respond to other emerging epidemic-potential diseases? Does India have what it takes to protect its population and economy from the aftermath of an epidemic?
Two years ago, I was involved in a health security scenario-planning exercise with five other young global health professionals selected from across the world as Global Governance Futures Fellows for the Bosch Foundation. One of the scenarios we developed and described in our report, Pandemonium, was about a Nipah epidemic in India. Our scenario described how a Nipah outbreak in the country could swiftly lead to significant economic repercussions due to fear and misinformation, with notable impacts on trade, tourism and agriculture.
For instance, we assumed a situation where people stopped eating poultry due to a rumour on social media, adversely affecting the fortunes of poultry farmers. With the Nipah outbreak in Kerala, I see our scenario playing out despite swift efforts to contain the disease. Social media and WhatsApp rumors are making the rounds with false information on the villages affected, of fake spiritual therapies, and on Nipah’s supposed origins in chicken broilers. The economic consequences are being felt. The UAE has banned the import of fruits from Kerala, and the state’s tourism industry has taken a hit. There have even been calls for extreme measures such as the mass culling of bats. But the question remains: how prepared are we? More importantly, why should we care?
While epidemiologists are stilling trying to ascertain the transmission route of the disease in Kerala, a few things are clear. First, there is a significant need to understand the human-animal-environment interface or “one health” aspects of Nipah’s transmission. This is especially relevant given the virus’s reservoir in the Pteropus fruit bats, the evidence of disease in pigs and other domestic animals, and the association of anthropogenic or man-made factors with the emergence of novel diseases.
Furthermore, India needs to bolster its efforts to protect its population and economy from emerging diseases. The recent Nipah outbreaks are a repeat of Siliguri in 2001 and West Bengal in 2007. South Asia is, in fact, a major hotspot for both the emergence of zoonotic (animal-borne) diseases and climate change impacts. High density of population, rapid urbanisation, climate intensification, mobility, and close proximity with livestock are all factors that make South Asia vulnerable to emerging zoonoses and their aftermath.
Yet, India is one of the handful of countries in South Asia that have still not had Joint External Evaluation (JEE), a standardised external evaluation conducted by the World Health Organization to assess a countries’ core capacities to prevent, detect, and respond to public health emergencies. The capacities measured by the JEE are a crucial metric of a country’s resilience to health emergencies and include aspects of preparedness, surveillance, laboratories, human resources, risk communication, emergency response and zoonotic diseases. The JEE process helps countries assess, plan, and implement priority actions for strengthening health security. Over 70 countries worldwide have conducted the JEE, including most of India’s neighbours. But the questions over India’s preparedness for epidemic and health emergencies remain. The JEE process is, in part, an answer.
Given India’s prominent status in the region, it is time the country leads the march towards achieving health security. I am encouraged to see India’s recent commitments to Universal Health Coverage, yet it is pertinent to remember that protection of vulnerable populations against health risks and epidemics through pandemic preparedness is a crucial component in achieving health for all. India must take all the measures it can to protect lives and livelihoods from potential epidemics. Conducting JEE and creating a national action plan for health security will be a critical step in that direction.
Sulzhan Bali is an independent public health consultant specialising in health security and pandemic preparedness
The views expressed are personal