Break the chain: On leprosy in India

While the prevalence of leprosy among adults and children and the grade-2 disability rate have dropped in India over the last decade, its continued transmission in many pockets constrains India’s ability to meet targets outlined in the National Strategic Plan (NSP) and Roadmap for Leprosy 2023-2027. By 2005, the national prevalence had dropped to under 1 case per 10,000 people, prompting the World Health Organization (WHO) to declare that India had “eliminated [leprosy] as a public health problem”. However, the government became complacent and allowed the folding of the leprosy surveillance programme into the general health system. Multi-drug treatment regimens also shortened the time for which patients remained formally registered, allowing prevalence to fall and transmission to continue. Disability due to leprosy began to rise in the early 2010s, prompting door-to-door screening. Today, the NSP is right to focus on cutting transmission, in line with WHO. Since India’s children accounted for around 46% of all cases reported among children in 2025, the two programmes need to move in tandem. The drop in disease burden has also been highly uneven — Chhattisgarh, Jharkhand, Odisha, and Maharashtra bear disproportionate shares of the national burden. According to the 2025-26 National Leprosy Elimination Programme report, only 148 districts have achieved ‘interruption of transmission’ (pending field verification) against the projected 300.

In 2025-26, workers screened more than 70 crore people in highly endemic areas, where 24,367 cases were detected, and ASHA workers flagged nearly 40 lakh suspected cases, with 48,027 cases confirmed. Workers also administered single-dose rifampicin as post-exposure prophylaxis to 91.1% of those 16.9 lakh likely to have come in contact. The government has operationalised digital surveillance and is deliberating on using the MIP vaccine to accelerate pathogen clearance in patients deemed highly infectious. One persistent set of lacunae pertains to care: research has shown nerve damage in many patients by the time they sought care, largely due to the stigma, while many clinical practitioners are unfamiliar with leprosy’s pathology or misdiagnose it as a skin condition. Reading these realities together, the state should double down on interrupting transmission and make prevalence a secondary outcome. It should also resist the temptation to ease detection or revise its elimination targets — the 2025-26 report says the overall incidence overshot projections by 41%, incidence among children by 91.6%, and the grade-2 disability rate by 34% — and instead redouble its investments to meet the extant 2026-27 projections. Finally, it should commit its augmented efforts at locations and social settings where both late diagnosis and transmission remain trenchant.