Context: India has achieved a major decline in leprosy prevalence, childhood cases and Grade-2 disability (G2D) over the past decade, but active transmission continues in several pockets, threatening the targets of the National Strategic Plan (NSP) and Roadmap for Leprosy 2023–2027.
- The current strategy appropriately shifts emphasis from merely reducing prevalence to interrupting transmission, in line with the WHO approach.
India’s Leprosy Burden
- By 2005, India’s leprosy prevalence fell below 1 case per 10,000 population, leading WHO to recognise leprosy as having been “eliminated as a public health problem” at the national level.
- However, integrating leprosy surveillance into the general health system weakened dedicated surveillance, while multidrug therapy (MDT) shortened the period for which patients remained registered, reducing measured prevalence without necessarily stopping transmission.
- Grade-2 disability began increasing in the early 2010s, indicating delayed detection and treatment and prompting renewed door-to-door screening.
- The burden remains geographically uneven, with Chhattisgarh, Jharkhand, Odisha and Maharashtra accounting for disproportionate shares of cases.
- As per the 2025–26 National Leprosy Elimination Programme (NLEP) report, only 148 districts had achieved interruption of transmission (pending field verification), against a projected 300 districts.
Focus on Transmission Interruption
- The NSP 2023–2027 focuses on breaking transmission rather than relying solely on prevalence as the indicator of progress.
- This is particularly important because India continues to contribute substantially to childhood leprosy cases; Indian children accounted for around 46% of all cases reported among children globally in 2025.
- Therefore, childhood case detection and transmission-control programmes must operate together, as cases among children indicate relatively recent transmission within communities.
Recent Government Measures
- During 2025–26, more than 70 crore people were screened in highly endemic areas, detecting 24,367 cases; ASHA workers identified nearly 40 lakh suspected cases, of which 48,027 were confirmed.
- Single-dose rifampicin (SDR) was provided as post-exposure prophylaxis (PEP) to 91.1% of the 16.9 lakh identified contacts, helping prevent infection among people exposed to confirmed cases.
- The government has also operationalised digital surveillance to improve tracking of cases, contacts and transmission patterns.
- It is considering the use of the MIP vaccine to accelerate pathogen clearance among patients considered highly infectious.
Major Gaps: Late Diagnosis and Stigma
- Stigma surrounding leprosy remains a major barrier to early diagnosis, resulting in many patients developing nerve damage before seeking medical care.
- Many healthcare practitioners remain insufficiently familiar with leprosy pathology and may misdiagnose it as an ordinary skin disorder, delaying treatment.
- Thus, transmission control requires not only surveillance but also community awareness, stigma reduction, early diagnosis and better clinical capacity.
Important Concept: Leprosy and Disability
- Leprosy (Hansen’s disease) is a chronic infectious disease caused mainly by Mycobacterium leprae and primarily affects the skin and peripheral nerves.
- Grade-2 disability refers to visible or significant disability resulting from leprosy, such as deformities of the hands, feet or eyes; its presence is an important indicator of late detection.
- Multidrug therapy (MDT) is the standard treatment for leprosy and has been central to reducing the disease burden.
Why Prevalence Alone Can Be Misleading
- The article highlights that falling prevalence does not necessarily mean that transmission has been interrupted because prevalence is influenced by the duration for which cases remain registered.
- Therefore, incidence, childhood cases, contact tracing, Grade-2 disability and transmission interruption provide a more meaningful picture of programme performance.
Need for Course Correction
- India should treat interruption of transmission as the primary outcome, with prevalence reduction becoming a secondary indicator.
- The government should avoid weakening detection mechanisms or lowering elimination targets merely because actual disease levels exceed projections.
- The 2025–26 report shows that overall incidence was 41% above projections, childhood incidence 91.6% above projections, and the Grade-2 disability rate 34% above projections.
- Instead, investments should be strengthened to achieve the existing 2026–27 targets, with intensified efforts in geographical and social settings where late diagnosis and transmission remain concentrated.
Way Forward
- Strengthen active surveillance: Sustain door-to-door screening and digital surveillance in high-endemic districts.
- Prioritise children and contacts: Integrate childhood case detection, contact tracing and post-exposure prophylaxis to identify recent transmission.
- Improve frontline capacity: Train doctors, nurses and community health workers to recognise early skin and nerve manifestations of leprosy.
- Address stigma: Community-level awareness and anti-discrimination measures are essential for encouraging early treatment.
- Target high-burden pockets: Concentrate resources in districts and social groups showing persistent transmission and late diagnosis.
- Measure what matters: Use transmission interruption and early detection, alongside prevalence, to assess progress towards leprosy elimination.
