Pandharpur Pilgrimage (Wari): A Spiritual Journey with Potential Risks of Communicable Diseases

Dear Editor, Pandharpur Ashadhi Ekadashi Wari is one of India’s highly renowned pilgrimages, boasting a history of over 800 years. This annual event sees devotees’ journey to the revered Lord Vitthal temple in Pandharpur, Maharashtra, that is Western India.[1] It, attracts pilgrims from diverse castes, creeds, and socioeconomic backgrounds. Participants honor the tradition of carrying the paduka (footwear) of saints in a palakhi (palanquin). The pilgrimage involves a 21-day trek covering over 250 km, culminating on Ekadashi, the 11th day after the full moon in the month of Ashadha.[1,2] The warkaris (pilgrims) travel to Pandharpur on foot, spending nights in camps set up in various villages along the route [Figure 1]. Despite village management efforts, open-air defecation and inadequate toilet facilities are common, increasing the risk of food, air, and water-borne diseases among warkaris and the local population even after the pilgrimage has concluded.Figure 1: Warkaris (pilgrims) making their way to Pandharpur on foot. https://swarajyamag.com/culture/the-pandharpur-wari-the-journey-of-the-devout.The month of July marks the peak of the monsoon season in India, further heightening the risk of respiratory infections. Additionally, the 200 km walk leads to numerous foot and footwear-related problems.[3] The most prevalent health issues observed during the pilgrimage include diarrhea and respiratory tract infections. The Pandharpur Ashadhi Ekadashi Wari, despite its spiritual significance and long-standing tradition, poses several public health challenges, especially regarding communicable diseases. After the pilgrimage, there is a notable increase in the incidence of various communicable diseases among both the pilgrims and the local populations along the route.[4,5] Water-borne diseases such as diarrhea, cholera, and dysentery can be seen after wari. There may be food-borne diseases such as food poisoning and gastroenteritis. A study done by Khan et al. in 2018 concluded that a breathtaking surge of patients during mass gathering facilitates the transmission of communicable infections leading to physical and mental stress, as well as emotional fatigue, among health-care professionals. Respiratory infections, which are most prevalent and can easily be transmissible during this period, result in significant morbidity, place a heavy burden on present health facilities, incur enormous costs on health systems, and contribute to the globalization of multidrug-resistant pathogens.[5] Common cold and influenza are also common after Wari. Vector-borne diseases such as malaria, dengue, and skin infections including fungal and bacterial infections can also be spread after Wari. Addressing these health challenges requires coordinated efforts from health authorities, local government bodies, and the communities involved. Measures such as improved sanitation facilities, access to clean drinking water, proper waste disposal, and awareness campaigns on hygiene practices can significantly mitigate the risk of communicable diseases. In 2023, the Maharashtra state government established “Mahaaroygya Shivir,” over 5.5 lakh warkaris benefited with health check-up facility for communicable and noncommunicable diseases. This may serve as a central platform for screening of communicable diseases such as common flu and skin diseases which will give an insight about the distribution of disease patterns to help both health-care personnel and warkaris. However, the clinical data obtained during any pilgrimage cannot be overlooked and must be maintained to provide advantages such as tracking of health issues and resolving challenges for future disease outbreak. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.