Emergence of diseases attributed to novel pathogens like Crimean-Congo haemorrhagic fever (CCHF), Chandipura virus, dengue, chikungunya, Japanese encephalitis and Kyasanur forest disease (KFD). As per a study published in 2019 in India Journal of Medical Research, respiratory viral infections, arboviral infections and bat-borne viral infections represent three major categories of emerging viral infections in India.
Various disease outbreaks in India
One of the earliest recorded major outbreaks in modern India is said to be the bubonic plague that struck in 1896 and lasted for several years. It first appeared in the city of Mumbai – then Bombay – but the disease spread rapidly throughout the other parts of the country. The plague took millions of lives, and the estimate says it killed around 10 million people over several decades. It spread rapidly because of poor sanitation and overcrowding of living conditions, and rats that bore the infection. The British colonial government decided on quarantine and mass evacuations, but this proved futile due to poor medical infrastructure.
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In 1918-1919, India was plunged into the ravages of the worldwide influenza commonly referred to as the Spanish Flu. India estimated that 10-20 million people died during the pandemic, which remains one of the deadliest in human history. This happened when soldiers returned from World War I to India, and brought the virus, and the latter rapidly spread in India. The Indian health system was not prepared for this kind of health crisis and a deficit of medical resources combined with rampant malnutrition served to fuel many more deaths.
Cholera has been a continually recurring problem in India, particularly over the 19th and early 20th centuries. The country experienced multiple outbreaks, including virulent epidemics during the 1820s, 1860s, and 1890s. Poor sanitation, impure water sources, and the absence of proper sewers in cities as well as villages remained an igniting agent for recurring bouts of cholera epidemics. While modern sanitation and water purification have diminished the rate of cholera infection, it still survives as an endemic in parts of India.
The 2009 H1N1 influenza pandemic, popularly known as swine flu, left deep marks on India, and thousands of cases were reported across the country. As devastating as the outbreak was not as fatal as previous influenza pandemics, this highlighted gaps in India’s healthcare infrastructure, with regard to new and emerging infectious diseases. The contagious nature of the virus spread widely through international travel; although the country was able to contain the outbreak in the end, it emphasized preparedness as the key to managing pandemics.
The recent ones
“We have witnessed several disease outbreaks in the past: Plague (1994) in Surat, SARS (2002-2004),Chikungunya and Dengue Outbreak (2006), Gujrat outbreak (2009), Odisha jaundice Outbreak (2014-2015), Swine flu (2014-15), encephalitis (2017), Nipah virus (2018), Coronavirus (2019). All this data indicates that the Indian population is very vulnerable to epidemics. The main factors which are responsible for these outbreaks are some human factors, & some environmental factors,” says Dr. Pooja Wadhwa, Clinical Director -Critical Care and Emergency, Marengo Asia Hospitals Gurugram.
“India has experienced the introduction of new illnesses and diseases in recent times. One such instance is the Nipah virus, which has caused epidemics in Kerala. Superbugs and drug-resistant illnesses like multidrug-resistant tuberculosis (MDR-TB) have also proliferated. Urbanization and climate change have led to an increase in mosquito-borne diseases including dengue and chikungunya. Although less frequent, the Zika virus has also been detected. In addition, during the COVID-19 pandemic, fungus illnesses such as mucormycosis (black fungus) increased dramatically. These infections underscore India’s susceptibility to changing diseases as a result of its difficult social, medical, and environmental conditions,” says Dr. Tushar Tayal, Lead Consultant, Department of Internal Medicine, CK Birla Hospital, Gurugram
What’s attracting new pathogens to India?
Experts say India’s growing population, rapid urbanization, environmental changes, and socio-economic conditions have created an environment conducive to the rise of new pathogens with epidemic potential. The convergence of factors like poor sanitation, inadequate healthcare, climate change, and increased human-animal interaction increases the risk of pathogen emergence and transmission.
“The human factors include population growth & its distribution. Large migrations from rural to urban areas lead to poor housing conditions, overcrowding, lack of safe water supplies & & sewage disposal. Rapid population growth leads to reduced immunity, it can overwhelm immunization efforts leading to making the population more vulnerable. Significant food borne diseases have been linked to food handler transmission and sewage contaminated food. The environmental factors responsible for the starting of the transmission of an epidemic are disruption of the equilibrium which Mother Nature maintains. We as humans artificially alter ecosystems to meet our own food demands or to supply food production chains,” says Dr. Wadhwa. The expert adds that the increased demand of food and housing leads to deforestation which results in contact of the humans with wildlife & the altered ecosystem results in the disease transmission from animals to humans.
“The chances of viral epidemics are high because viruses evolve and adapt very quickly making them resistant or difficult to treat,” she says.
“India’s rapidly urbanizing population, high population density, and widespread poor sanitation make it a perfect place for viruses to spread. Because of the country’s tropical environment, which encourages the growth of disease-causing organisms, containment is difficult due to crowded cities and limited healthcare infrastructure. The formation of new infectious diseases is further facilitated by the development of antibiotic resistance, frequent human-livestock contact, and environmental changes brought on by pollution and deforestation. These elements raise the possibility of pathogen evolution and the potential for epidemics in India, especially when paired with insufficient public health efforts,” explains Dr Tayal.
Addressing these challenges will require comprehensive public health reforms, improved infrastructure, investment in healthcare, and better environmental stewardship. Public health education and awareness, particularly regarding hygiene, sanitation, and antibiotic use, are crucial to preventing future outbreaks. Strengthening India’s healthcare system and bolstering its capacity for disease surveillance and response are vital steps in protecting the country—and the world—from the next potential epidemic.
