The Nipah virus (NiV) poses a serious threat to public health, particularly in South and Southeast Asia. NiV is a zoonotic paramyxovirus with a high case fatality rate (40–75%) and currently has no licensed vaccines or specific antiviral therapy1. Since its discovery in Malaysia in 1998, repeated outbreaks in Bangladesh and India have demonstrated the virus’s potential for both endemicity and epidemic spread2, 3. Transmission occurs from fruit bats (Pteropus spp. ), the natural reservoirs, to humans via contaminated food, direct contact with infected animals, or occasionally, human-to-human transmission4, 5. The clinical effect of NiV is dramatic and often manifests with neurological and respiratory disease. The disease usually manifests with fever, headache, and myalgia that can rapidly evolve to acute encephalitis, seizures, confusion, and coma4. Respiratory symptoms, such as coughing, shortness of breath, and acute respiratory distress, are frequent, especially in outbreaks that present with high mortality2, 4. Survivors often experience long-term sequelae in the central nervous system, including cognitive deficits and motor abnormalities, emphasizing the morbidity of the virus4. It is important to delineate the pathogenesis and transmission of NiV, as this could greatly aid in prevention and control. Viral entry is mediated by ephrin-B2 and -B3 receptor-dependent endothelial, epithelial, and neural cells, which can result in wide-ranging viral replication and inflammation5. As a result, environmental phenomena, such as deforestation, expansion of agriculture, and increased human-bat contact, can enhance the risk of spillover and recurrent losses in endemic areas6. Despite being less efficient compared to respiratory airborne viruses, human-to-human transmission has been reported within household and healthcare environments3, 5. Significant research gaps and preparedness deficits persist, with no available vaccines or specific antivirals and treatments, despite a defined epidemic potential1. A few vaccine candidates are being tested, but advances are impeded due to the unpredictable occurrence of infection and financial limitations5, 7. A portfolio of important candidates is being utilized by the Coalition for Epidemic Preparedness Innovations (CEPI) to expedite the development of a Nipah vaccine. Phase II studies for the ChAdOx1 Nipah B candidate, which was created by the University of Oxford in partnership with the Serum Institute of India, have been funded with 7. 3 million8. To facilitate quick outbreak deployment, a research reserve with up to 100 000 doses has been set up. Another contender, PHV02, created by Public Health Vaccines, has received 17. 3 million in funding for its Phase II trials assessing safety and immunogenicity9. These programs, which have about 575 Bangladeshi participants, use COVID-proven systems to fill financing gaps and facilitate quick scale-up in high-risk locations. There are diagnostic techniques, but these may be unavailable in resource-limited settings, delaying early detection and isolation of cases2, 5. Although surveillance systems have been strengthened in Bangladesh and India, they continue to struggle with the timely detection of outbreaks and environmental reservoir monitoring2, 3. Besides scientific advancement, regulatory readiness will determine how quickly Nipah vaccine deployment progresses. Ordinary large-scale efficacy trials may not be achievable because outbreaks occur sporadically and unpredictably. Emergency use authorizations, adaptive trial designs, and immunobridging should be prioritized in regulatory strategies. Many international initiatives, including the WHO R&D Blueprint and CEPI’s 100 Days Mission, call for expedited regulatory pathways to enable rapid vaccine development and distribution during times when new infectious diseases arise10, 11. Coordinating national regulatory authorities with international health organizations is vital to providing timely access as soon as vaccine candidates are found to be safe and effective. Equitable distribution of future Nipah vaccines, once available, is a critical consideration. The COVID-19 pandemic exposed significant differences in global vaccine supply, especially among low- and middle-income countries that have the highest risk of zoonotic disease spillovers. To avoid these same inequities in future pandemics, proactive strategies (such as regional production, technology transfer, and advance purchase mechanisms) must be implemented. It will also be necessary to improve the capacity to produce vaccines in endemic countries, with the help of both international partnerships and funding organizations, so as to provide vaccines in a timely and cost-effective manner12, 13. In light of the delayed responses, urgent action is needed. Accelerated vaccine development and clinical trials are crucial, with platforms that have already demonstrated their usefulness during COVID-19 (e. g. , mRNA or viral vectors) being given priority7. Strengthening international collaborative research, increasing funding for therapeutics development, and enhancing molecular surveillance can contribute to filling critical gaps5, 7. Public health interventions, such as community education, safe treatment of food products (e. g. , date palm sap), and bat population surveillance, are critical to avoiding spillover2, 3. The absence of appropriate interventions will lead to a significant and ongoing recurrent threat to regional and global health security1–3. The Nipah viral disease remains an under-recognized global health threat that can lead to disastrous outcomes. Targeted and coordinated efforts to vaccinate against Nipah will need to take place if the described threats are to be addressed effectively through the use of successful vaccines. As part of this coordinated global vaccination effort, it is important to conduct clinical studies quickly, strengthen regulations for the approval of vaccines for Nipah, enhance surveillance systems, and deliver vaccines equitably to those requiring vaccinations. Without global commitment to these efforts, the Nipah viral disease will remain a recurring threat to health security at both regional and global levels.
Ahmed et al. (2026) studied this question.