The state of Kerala has been witnessing the re-emergence of infectious diseases for the past one and a half decades. The re-emergence of infectious diseases in Kerala is of particular interest, considering the state's better socio-political environment, demographic outcomes, and health system. The present study focused on the re-emergence of four infectious diseases such as Chikungunya, Dengue, Malaria, and Leptospirosis to assess the vulnerabilities associated with the phenomenon of re-emerging infectious diseases in terms of morbidity, illness behaviour, and treatment cost.

The morbidity and illness behaviour associated with the re-emerging infectious diseases and their differentials have already been discussed in the previous seminar. This talk focuses on the cost of illness, coping, and catastrophic health expenditures associated with re-emerging infectious diseases and briefly discusses the state's risk governance mechanisms in the event of an illness outbreak. We place the discussion in the context of varied outbreaks of infectious diseases in Kerala, particularly that of Nipah in 2018 and the Covid-19 pandemic in 2020.

The study results show that the cost of illness was mediated by various individual, household, and illness-specific factors. 62% of the respondents have incurred catastrophic healthcare expenditure concerning the treatment of these diseases. Most of the out-of-pocket expenditure was attributed to spending on lab and diagnostic services (33.5%) and medicines (30%). 46.3% of the respondents borrowed money for high interest rates to meet treatment costs, and 50% pledged their assets for the same.

The study results also highlight the community networks the respondents could rely on based on their socio-economic location to cushion the effect of financial vulnerability.
It is understood from the results that these disease outbreaks have a profound and differential impact on the lives and livelihoods of the people affected. Against this backdrop, the present study scrutinises pertinent questions such as the role, structure, and functions of a public healthcare system in dealing with a health crisis and ensuring the life and safety of its citizens.