The deadly drink: Nipah virus transmission through date palm sap, cultural practices and the evolution of behavioral interventions in Bangladesh over two decades.

Nipah virus (NiV) has emerged as a significant public health threat, with recurring outbreaks in Bangladesh often linked to the consumption of raw date palm sap contaminated by fruit bats (Pteropus species). Over the past two decades, substantial efforts have been made to understand the cultural context of sap consumption, promoting behavior change and developing interventions to prevent NiV spillover. Despite these efforts, achieving sustainable change in sap consumption practices remains challenging due to deep-seated cultural practices, community perceptions of sap consumption, habitual behaviors, limited awareness of health risks and economic barriers. To prevent sap-borne transmission, future efforts should focus on affordable, community-led solutions while protecting local livelihoods. Promoting behavior change through trusted community education and safe harvesting practices must be supported by involving local health workers and community members in planning and evaluation. Long-term preparedness also requires investment in diagnostics, treatments and vaccines through inclusive, collaborative intersectoral research and one health approach.