Lessons from the Nipah outbreak in India

Lessons from the Nipah outbreak in India
Key to the response was Kerala’s past investments in education and health—the state ranks 10th in GDP among Indian states and territories, but first in human development.

Health experts are rightly alarmed that the world is unprepared for the next pandemic. So, when the rare and deadly Nipah virus broke out in the southern Indian state of Kerala , many feared that it would spread on the scale of SARS in China or Ebola in West Africa. But the authorities and the public controlled its spread. Key to the response was Kerala’s past investments in education and health—the state ranks 10th in GDP among Indian states and territories, but first in human development.

A Nipah infection leads to acute respiratory problems and brain inflammation.

The virus—of which there is no vaccine yet—was first identified in among pig farmers in Malaysia, when it killed over 100 people in 1998. Cases now appear almost yearly in Bangladesh, and there were two previous occurrences in West Bengal, India. Its containment in Kerala was impressive because this Nipah strain was more deadly and infectious than the one in Malaysia.

Much has been learned about the links between the degree of preparedness and the effectiveness of the response to a break- out of infectious diseases. Being prepared involves vital elements ranging from laboratory surveillance to communication about the risks.

The key to containment in Kerala was the speed of detection. One reason the virus was contained was the relatively high proportion of doctors and nurses in Kerala, and that private spending on health is the highest in India. Kerala’s high literacy rate may not have the expected economic payoffs, as heavy regulations and labor laws have stifled growth. But its contribution to health care and participatory responses comes through in this recent experience.

The equal presence of women in the workforce enables the use of the full potential of the society’s human capital. Girls are educated as much as boys; a girl born in Kerala can expect to live to 78 years, comparable to upper middle- income countries. The line of command in the Nipah campaign included both men and women not only in senior health management but also among the doctors and paramedics involved in containing the spread of the virus.

Community spirit and societal resilience, underscored by a high degree of participatory style of governance, played a part as well. Kozhikode Medical College’s doctors, nurses, and administrators went into high gear. Notable was the mutual trust and social cohesion beyond religious divides in India’s most religiously diverse state.

Against these positives was the environmental destruction in Kerala, particularly related to garbage disposal in urban areas. Had the authorities not been able to quickly contain the virus, ecological factors would have spurred its spread. Worsening environmental degradation was connected to outbreaks of the mosquito-borne Chikungunya virus in Kerala and the Zika virus in Brazil. In both instances, reckless deforestation and urban decay played a role.

In the wake of worldwide threats of new viral outbreaks, Kerala’s experience holds lessons going forward. Disease prevention and rapid response, coupled with environmental protection, should be bigger priorities everywhere.

© brookings.edu/ Brookings Institution

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