Why in the News
Leprosy was declared “eliminated as a public health problem” in India two decades ago, yet only 148 districts have stopped its spread against a projected 300. The 2025-26 National Leprosy Elimination Programme (NLEP) report shows new cases running well above projections, which puts the targets of the National Strategic Plan (NSP) and Roadmap for Leprosy 2023-2027 at risk.
What does “elimination” mean, and why did leprosy persist?
- What it is: Leprosy is a slow bacterial disease that damages the skin and nerves. “Elimination” meant fewer than 1 registered patient per 10,000 people, a measure called prevalence.
- Elimination milestone: India crossed that mark by 2005. The World Health Organization (WHO) then declared that India had eliminated leprosy “as a public health problem”.
- Complacency followed: The government folded the dedicated leprosy surveillance programme into the general health system. Rising disability in the early 2010s forced a return to door-to-door screening.
- Shorter treatment: Newer multi-drug therapy (MDT) regimens let patients finish treatment and leave the register sooner. As a result, recorded prevalence fell even as infection kept spreading.
- The takeaway: India met a target that counted patients on registers, so the disease kept spreading unseen in the community.
What did the 2025-26 programme achieve?
- Mass screening: Health workers screened over 70 crore people in highly endemic areas and detected 24,367 cases.
- ASHA workers: Accredited Social Health Activists (ASHAs), the village-level community health workers, flagged nearly 40 lakh suspected cases. Of these, 48,027 were confirmed.
- Preventive drug: A single dose of rifampicin, an antibiotic that stops infection turning into disease, reached 91.1% of 16.9 lakh likely contacts.
- New tools: The government has started digital surveillance. It is also considering the Mycobacterium indicus pranii (MIP) vaccine to clear the bacteria faster in highly infectious patients.
Where and why does transmission persist?
- Child cases: Indian children made up around 46% of all child leprosy cases reported worldwide in 2025. Cases in children signal recent, ongoing infection.
- Uneven burden: Chhattisgarh, Jharkhand, Odisha and Maharashtra carry a disproportionate share of the national burden.
- Late care-seeking: Stigma keeps patients away from clinics, so many already have nerve damage when they first seek care.
- Misdiagnosis: Many doctors are unfamiliar with leprosy and mistake it for an ordinary skin condition, which delays treatment.
Why do falling prevalence figures mislead?
- Mixed record: Prevalence and the grade-2 disability rate (visible deformity of hands, feet or eyes) have fallen over the decade, but transmission to new people continues in many pockets.
- Verification pending: Districts reporting “interruption of transmission” still await field verification, so even that count is unconfirmed.
- Projections overshot: New cases, called incidence, ran 41% above projections overall and 91.6% above among children.
- Disability overshoot: The grade-2 disability rate overshot its projection by 34%, a sign that cases are still found late.
- Transmission goal: The NSP makes cutting transmission its main aim, in line with the WHO’s approach.
Challenges
- Long incubation: Leprosy takes about five years, sometimes 20, to show symptoms, so infection spreads before diagnosis.
- Stigma in law: Old laws carried discrimination against patients. Eg. Leprosy was a ground for divorce until the Personal Laws (Amendment) Act, 2019.
- Drug resistance risk: Mass use of rifampicin needs monitoring, because resistant bacteria would weaken both treatment and prevention.
- Diluted focus: In the general health system, leprosy competes with many diseases for frontline workers’ time.
Way Forward
- Transmission first: Make interrupting transmission the primary goal and treat prevalence as a secondary outcome.
- Hold the targets: Resist easing detection or revising elimination targets, and raise investment to meet the existing 2026-27 projections.
- Hotspot focus: Concentrate effort where late diagnosis and transmission persist, by place and social setting.
- Doctor training: Train primary-care doctors to recognise leprosy’s nerve signs and refer suspected cases early.
Conclusion
India’s leprosy record has been judged by patients on registers, which can fall while the disease keeps spreading. Whether the next programme report shows new cases falling, not just registers shrinking, is the test to watch.
Back2Basics: National Leprosy Elimination Programme (NLEP)
- Origin: It began as the National Leprosy Control Programme in 1955 and became the NLEP in 1983, when multi-drug therapy was introduced.
- Structure: It is a Centrally Sponsored Scheme under the National Health Mission, offering free diagnosis and free MDT.
- Current goal: The NSP aims for zero transmission by 2027, ahead of the Sustainable Development Goals deadline of 2030.
- Awareness: The Sparsh Leprosy Awareness Campaign runs each year from Anti-Leprosy Day, 30 January.
Matching Previous Year Question
“[2024, GS2, 15 marks] In a crucial domain like the public healthcare system, the Indian State should play a vital role to contain the adverse impact of marketisation of the system. Suggest some measures through which the State can enhance the reach of public healthcare at the grassroots level.”
