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The Nipah virus has resurfaced amidst another monsoon, targeting the northern districts of Kerala. Following its second Nipah virus-related death in the last two weeks, Kerala placed over 600 people under surveillance after they were identified through contact tracing. This is Kerala’s seventh outbreak since 2018, highlighting unabating zoonotic spillover events and the pressing need for One Health initiatives and science diplomacy to develop vital countermeasures.
Nipah virus (NiV) is listed as a priority pathogen by the World Health Organization (WHO) owing to its potential to cause widespread epidemics. Fruit bats serve as natural reservoirs for NiV; secretions of the fruit bat can transmit the virus onto an intermediate host such as pigs, fruits, or date palm sap. Transmission to humans occurs when humans (1) consume contaminated fruit; (2) come into contact with infected intermediate hosts; (3) come into contact with bat guano or bat excrement (often used as a fertiliser); or (4) come into contact with the body fluids of a NiV-infected patient. NiV was first identified among pig farmers in Malaysia between 1998-1999, where direct contact with infected pigs caused over 100 fatalities. Subsequent outbreaks have been reported in South Asia, including Bangladesh and India, since 2001, with an alarming fatality rate of 40-75 percent. The present Kerala outbreak is likely to be linked to the consumption of contaminated fruit, but it is not yet definitive.
This highlights that zoonotic spillover events are unabating, necessitating the need for One Health initiatives to curb them. The transmission dynamics of NiV are critical to managing and predicting outbreaks. The convergence of economic practices, socio-cultural factors, climate change, and biodiversity contributes to changes in the fruit bat’s ecosystem and impacts viral transmission patterns. Consumption of NiV-contaminated fruit or date palm or contact with NiV-infected individuals is the primary driver of transmission. Previous studies highlighted the linkage of NiV transmission to cashew and areca plantation farms. This underscores the need to create community awareness over factors that trigger viral transmission and the adoption of behaviours that can prevent spillover events.
The convergence of economic practices, socio-cultural factors, climate change, and biodiversity contributes to changes in the fruit bat’s ecosystem and impacts viral transmission patterns.
One Health is incorporated into the global health security agenda; the One Health Joint Plan of Action outlines strategies to strengthen surveillance measures and response capabilities. India launched an inter-ministerial group一the National One Health Mission一to facilitate cutting-edge scientific studies on issues of public health concern. However, India’s ability to detect and respond rapidly to public health concerns like NiV outbreaks greatly depends on a unified legal framework that enables coordinated responses. A Public Health Emergency Management Act would enable the monitoring of human, animal, and environmental samples, operationalisation of early-warning systems with predictive capabilities, integration of data management portals, streamlining of public-private partnerships (PPP) for the development of emergency medical countermeasures, implementation of national biosecurity and biosafety networks, and facilitation of international cooperation initiatives.
The critical challenge with the Nipah virus response is the lack of licensed vaccines or therapeutics. Recognising the imperative for developing NiV-related healthcare, multiple stakeholders, including global health consortia such as Coalition for Epidemic Preparedness Innovations (CEPI), industry players, academic and research organisations, and national governments, facilitate science cooperation.
Multiple NiV vaccine candidates are in various stages of development. Of considerable interest is Public Health Vaccines’ candidate, PHV02, which is a viral-vector-based platform that cleared Phase I clinical trials in Bangladesh. CEPI will fund US$17.3 million to support PHV02’s progress to Phase II clinical trials. CEPI aims to form a stockpile of NiV vaccines in case of a widespread outbreak of the disease. Another CEPI-funded candidate, ChAdOx1 NipahB, is undergoing Phase I clinical trials and is led by the Oxford Vaccine Group. The candidate recently received priority designation by the European Medicines Agency (EMA) to accelerate its development and regulatory approval.
Significant research on NiV is dedicated towards antibody therapies as they offer scope for immunity to individuals who are at high risk of infection (e.g., a medical worker) during an outbreak, as immunity acquired through vaccines would take time for its effects to manifest. A notable experimental antibody therapy, m102.4, was acquired from Australia’s Queensland Department of Health during Kerala’s 2018 and 2023 outbreaks under compassionate grounds and is still under clinical development. Phase I clinical trials to determine the efficacy of another therapy, MBP1F5, which is developed by the United States’ Uniformed Services University, are set to be conducted in India and Bangladesh by ServareGMP and Mapp Biopharmaceuticals Inc. later this year. CEPI has pledged US$43.5 million for furthering its clinical development and production. At present, the therapy is undergoing safety testing by the US Department of Defense (US DoD), Joint Program Executive Office for Chemical, Biological, Radiological and Nuclear Defence, in collaboration with Mapp.
Advances in biomedical research and progress into clinical trials demonstrate that we are inching towards clinical therapies. There is, however, immense potential for further scientific collaboration to address the need for countermeasures, contributing to the expansion of India’s bioeconomy to the targeted US$300 billion.
In pre-clinical studies, researchers from Australia (University of Queensland and Commonwealth Scientific Industrial Research Organisation), in collaboration with researchers from Chile (Universidad Austral de Chile) and China (University of Science and Technology of China), developed a unique therapeutic that holds translational promise. Researchers developed a novel therapeutic, DS90, using nanobody technology that can selectively block the ability of NiV and another zoonotic virus, Hendra virus, from infecting cells. A wide array of nanobodies is in various stages of R&D spurred by the approval of nanobody-derived therapies including Caplacizumab for a rare blood disorder, Ozoralizumab for rheumatoid arthritis, and Envafolimab for solid tumours.
In India, to address the need for early containment, the Indian Council of Medical Research (ICMR) developed a cost-effective, portable NiV test kit using a Loop-Mediated Isothermal Amplification (LAMP) approach. The approach is simpler and serves as a low-cost alternative to polymerase chain reaction (PCR)-based techniques. Multiple NiV diagnostic kits were developed under the National Diagnostics Catapult programme, which was launched by the Centre for Cellular and Molecular Platforms (C-CAMP) to promote the indigenisation of diagnostic kits. Development of antiviral platform technologies against NiV is underway between India’s Translational Health Science and Technology Institute (THSTI) and the Rajiv Gandhi Centre for Biotechnology (RGCB).
Advances in biomedical research and progress into clinical trials demonstrate that we are inching towards clinical therapies. There is, however, immense potential for further scientific collaboration to address the need for countermeasures, contributing to the expansion of India’s bioeconomy to the targeted US$300 billion. This can be achieved through national directives by creating greater awareness amongst scientists about global challenges and foreign policy objectives, such as health diplomacy, to garner goodwill and to bridge the intellectual divide. Implementing brain gain policies, policies that favour the movement of skilled workers from highly industrialised countries to developing countries, like research fellowships, start-up grants, and visiting fellowships to young career researchers, will catalyse India’s efforts. Finally, adopting a bioeconomy-driven approach with India’s Biotechnology for Economy, Environment and Employment (BioE3)( policy and the Department of Biotechnology’s start-up support programme, Biotechnology Ignition Grant Scheme (BIG), can enable the bridging of PPPs where academic and research linkages with the industry can foster the development of useful healthcare technologies. The recent mobilisation of India’s Research Development Innovation (RDI) scheme, which has a one lakh crore corpus, can facilitate the prioritisation of critical healthcare technologies and encourage innovation within the biotech sector.
India’s cooperation with international partners enabled it to develop health technologies to address its own needs and contributed to its diplomatic endeavours in Africa and Asia. From a global vantage point, science diplomacy adds strategic value; it is the use of science to address national interests and global health challenges. In the current political climate, however, science is under strain, with the politicisation of scientific evidence and concerns over the legitimacy of international scientific organisations. Advancements in innovation and discovery are complexed with non-state actors taking on a prominent role, while the race for superpower status in science and technology has become competitive, and the dual-use capabilities of technologies like biotechnology and artificial intelligence (AI) spur suspicion over misuse.
From a global vantage point, science diplomacy adds strategic value; it is the use of science to address national interests and global health challenges.
Evidence-based policymaking and trust in science must be brought back into policy discourse. This can be achieved through safeguards for disruptive technologies, and greater transparency and accountability measures that take into account the knowledge-power dynamics of non-state actors. Most recently, the European Union (EU) advocated for science diplomacy to be incorporated at the core of foreign and security policy instead of resting at its fringe. Biotech initiatives like the EU-India Science and Technology Agreement, the UK-India Technology Security Initiative, US-India TRUST (Transforming the Relationship Utilising Strategic Technology), and Quad BioExplore hold immense potential for developing vital therapeutics.
Addressing priority infectious diseases like NiV requires a multi-pronged strategy. Owing to the debilitating nature of climate change and anthropogenic factors, the occurrence of NiV outbreaks remains high. A truly holistic One Health approach to mitigate and manage spillover events is essential. Development of life-saving therapeutics can be facilitated through strategically driven investments and will bolster the bioeconomy. Ultimately, science diplomacy, to tackle global health concerns like NiV, is a formidable challenge and underscores the need to visualise it as a tool that can enable countries to navigate global fault lines by identifying areas of cooperation to cater to the needs of the population.
Lakshmy Ramakrishnan is an Associate Fellow with the Health Initiative at the Observer Research Foundation.
The views expressed above belong to the author(s). ORF research and analyses now available on Telegram! Click here to access our curated content — blogs, longforms and interviews.
Lakshmy is an Associate Fellow with ORF’s Centre for New Economic Diplomacy. Her work focuses on the intersection of biotechnology, health, and international relations, with a ...
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