This study investigated farmers' strategies for coping with disease in large cardamom in eastern Nepal, which has undergone a tremendous decline in production. Conducting a political economy analysis on data from Ilam district, this study investigated the impact of crop disease on farmers' livelihoods, as well as both individual and institutional efforts to combat the disease. Strategies varied by household circumstances (size of landholding, alternative income sources, and access to supporting institutions). They included burning fields, changing land use patterns, diversifying crops, and seeking institutional support. Due to weak capacity, local government support was limited to providing training and distributing new varieties of cardamom. During a crisis, farmers expect government institutions to help, especially when customary practices have not solved the problem. To protect and improve farmers' livelihoods, institutional innovation at the community level is needed, along with policies that provide immediate and sustainable support during crises.