In the month of May 2018, Nipah virus outbreak was reported from Kozhikode district in Kerala. It was the first of its kind to be reported in south India. The experience of the deadly disease shook the health system in order. The state witnessed 17 deaths and 18 confirmed cases by 1st June in 2018. Studies show that the fatality rate of the disease is 88.8% and mean incubation period is 9 days. Similar cases were reported in northern state of West Bengal in 2001 and 2007. In Siliguri, West Bengal the fatality rate was 68% compared to 77% in Bangladesh.

Nipah outbreak is happening consecutively third time since 2018, the latest being reported in 2023, September. The number of cases reported is six, including two deaths. The reports say that, the state was unable to identify the source of infection of the index case. It is important for the systems not to fail during such situations of emergency and the state has to address this concern with urgency. 

K.K Shylaja, former Health Minister says that, “The primal occurrence of Nipah increased the preparedness of the state to deal with highly contagious diseases. The idea of isolation, quarantine and protocols which had to be followed were already in place for the health department.” She also said that, every time it is a reminder for the people and the state to take precaution. As part of Nipah, people were instructed not to take half eaten fruits or intermingle with animals especially bats, as fruit eating bats were identified as primary carriers of the virus.

It is important to look at the paradox that, Kerala being the foremost state to achieve human development indicators such as education and health, still remains an attractive location for diseases such as dengue, chikungunya and jaundice. Morbidity rate in the state has increased from 110 to 308 per thousand population during1994-2014; the state is known as the most morbid state in the country. Study also shows that there is high inequality between the rich and poor, rural and urban, male and female categories in the state in prevalence of ailments and for accessing hospitals. It can be noted that, the state irrespective of increasing health sector expenditure were unable to keep the occurrences of diseases under control. The table shows single digit number except for the period of 2020-21.

Sub Sector-wise Expenditure in Health Sector



TP Ramakrishnan, MLA, Perambra says that, “Isolation unit in Taluk Hospital and Kozhikode Medical College were set up immediately. We had also instructed people in the district to use mask and avoid being in crowded places.” He also added that the local bodies and people are willing to take up any initiative from the health department to control the spreading and occurrence of such virus. Environment and climate change were identified as important reasons for the multiple outbreaks of Nipah.  As the report says, fruit bats which are the primary carriers of the virus cannot travel more than 50 kms; therefore, there are chances that a chain of bats could have been infected in a route and could have been mutating since 2018.

At this juncture, an important question that needs to be addressed is regarding the preparedness of the state to deal with yet another crisis. This calls for scientific research and investigation. Janaki forest is a natural habitat for a wide variety of birds and plants; Perambra is a hilly area sharing its border with Wayanad. The geographical location, climate and the lifestyle of people have to be studied in order to come up with a plan of action to restrain the incidence of Nipah.

Thangam, a resident of Maruthongara think of those days as an extreme situation of panic and fear. She says that, “We were scared to go out. I remember that it was for the first time that the whole district went on a long pause. We could not meet anyone; only those who visited us were Asha workers and health workers.”

Shiny, a resident of Changaroth recalls that, “Everything stopped functioning suddenly. We had to call off my daughter’s wedding and there was uncertainty around. This incident created an unexpected delay in everyone’s life and the situation was even more during covid, but we were familiar with quarantine and isolation by then.”

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Rajesh, a shopkeeper in Perambra says that, “When Nipah occurs almost every year it is scary for the residents of this area. It would be better if we can understand what more precautions, we need to take in order to avoid such incidents. Otherwise, every year we will lose members from our own family and neighbourhood.”

Rajeev Sadanandan, healthcare policy maker and former advisor to Health Minister in Kerala, opined that Kerala lacks a proper detecting and managing system when it comes to virus outbreak. The infection prevention in government hospitals is not appropriate in the state and there is no proper surveillance when it comes to virus outbreaks like Nipah. He also added that the expert information must only be publicised instead of uninformed over reaction among the bureaucrats and officials.

The state has a better system for reporting of health conditions compared to other states; but what needs to be focused upon is the alertness of the state to health emergencies. The state need to invest more on building lifesaving units where more infrastructure and budget allocation has to be made available. The state has an excellent information system in place, what needs to be concentrated is in building infrastructure for surveillance and management.

Dr. Sreedevi RS is an Assistant Professor in the Department of Economics, Christ Deemed to be University, Bengaluru. Her research interests are health, gender, labour migration, development studies and public policy.