Break the chain: On leprosy in India

Source: The post “Break the chain: On leprosy in India” has been created based on “Break the chain: On leprosy in India” published in “The Hindu” on 7th October 2026.

UPSC Syllabus: GS-2-Governance

Context: India brought the prevalence of leprosy below 1 case per 10,000 population by 2005, after which the WHO declared it eliminated as a public health problem. However, continued transmission, childhood cases and disability show that elimination at the national level has not meant complete interruption of transmission.

About Leprosy

1. Leprosy is a chronic neuro-muscular disorder.
2. It is also known as Hansen’s disease.
3. It is caused by several strains of Mycobacterium leprae.
4. It primarily affects the skin and peripheral nerves (the nerves outside the brain and spinal cord).
5. It has a long incubation period which makes detection difficult.
6. It can be cured with Multi-Drug Therapy(MDT).

Present Status

1. The prevalence of leprosy among adults and children and the Grade-2 Disability (G2D) rate have declined over the last decade, but transmission continues in several pockets.
2. India accounted for around 46% of all leprosy cases reported among children globally in 2025, making childhood transmission a major concern.
3. Only 148 districts have achieved ‘interruption of transmission’, against the projected 300 districts.
4. The disease burden is unevenly distributed, with Chhattisgarh, Jharkhand, Odisha and Maharashtra accounting for disproportionate shares.
5. In 2025–26, more than 70 crore people were screened in highly endemic areas. Around 24,367 cases were detected through this exercise, while ASHA workers identified nearly 40 lakh suspected cases and 48,027 cases were confirmed.
6. Single-dose rifampicin post-exposure prophylaxis was administered to 91.1% of the 16.9 lakh eligible contacts.
7. Despite these efforts, the 2025–26 report showed that overall incidence was 41% above projections, childhood incidence was 91.6% above projections, and the G2D rate was 34% above projections.

Reasons for Persistent Transmission

1. Complacency after elimination: After WHO recognised India as having eliminated leprosy as a public health problem in 2005, surveillance was integrated into the general health system, weakening focused leprosy surveillance.
2. Prevalence masking transmission: Multi-drug treatment shortened the period for which patients remained officially registered. Consequently, prevalence declined even while transmission continued.
3. Delayed diagnosis: Stigma surrounding leprosy discourages people from seeking timely medical care, resulting in nerve damage and disability before treatment.
4. Misdiagnosis: Many healthcare practitioners are unfamiliar with leprosy pathology and may incorrectly treat it as an ordinary skin condition.
5. Persistent stigma: Social stigma contributes to concealment of disease and delays in diagnosis, thereby allowing transmission to continue.
6. Geographical concentration: Endemic pockets, particularly in certain States and districts, continue to sustain transmission.
7. Inadequate focus on interruption of transmission: A reduction in prevalence alone can give a misleading picture of progress if new infections continue to emerge.

Government Initiatives and Progress

1. Door-to-door screening: Rising disability in the early 2010s prompted intensified household-level screening.
2. Post-exposure prophylaxis: Single-dose rifampicin was administered to 91.1% of the 16.9 lakh people identified as likely contacts in 2025–26.
3. ASHA-based surveillance: ASHA workers identified nearly 40 lakh suspected cases, strengthening community-level detection.
4. Digital surveillance: The government has operationalised digital systems for better tracking and surveillance.
5. Possible use of MIP vaccine: The government is considering the use of the MIP vaccine to accelerate pathogen clearance in highly infectious patients.
6. National Strategic Plan: The National Strategic Plan (NSP) and Roadmap for Leprosy 2023–2027 appropriately focuses on interrupting transmission, in line with the WHO approach.

Way Forward

1. Prioritise interruption of transmission: The government should treat interruption of transmission as the primary objective, rather than relying mainly on declining prevalence.
2. Strengthen surveillance: Dedicated surveillance should be strengthened in highly endemic districts and vulnerable communities.
3. Ensure early diagnosis: Door-to-door screening and active case detection should be intensified in areas where late diagnosis and transmission remain high.
4. Focus on children: Since childhood cases indicate recent transmission, children should receive special attention through systematic screening and contact tracing.
5. Strengthen contact management: Post-exposure prophylaxis and systematic monitoring of contacts should be expanded to prevent new infections.
6. Improve healthcare capacity: Medical practitioners and frontline health workers should be trained to recognise the clinical manifestations of leprosy and distinguish it from common skin conditions.
7. Combat stigma: Public awareness campaigns should emphasise that leprosy is curable and that early treatment can prevent disability, thereby encouraging people to seek care.
8. Target high-burden areas: Resources should be concentrated in States and social settings where transmission and late diagnosis remain persistent.
9. Maintain ambitious targets: The government should not dilute detection efforts or revise elimination targets merely to improve reported indicators. Instead, investments should be increased to meet the existing 2026–27 projections.
10. Use data-driven surveillance: Digital surveillance should be used to identify transmission hotspots, monitor contacts and assess progress at the district level.

Conclusion: India’s achievement of elimination as a public health problem in 2005 was an important milestone, but it did not mean that transmission had stopped. The reported overshooting of projections in 2025–26 — overall incidence by 41%, childhood incidence by 91.6% and Grade-2 disability by 34% — shows the need for renewed action. India must therefore “break the chain” of transmission through early detection, contact management, stronger surveillance, better clinical capacity and reduction of stigma, with interruption of transmission as the central goal of its leprosy strategy.

Question: Despite India achieving elimination of leprosy as a public health problem in 2005, its continued transmission remains a concern. Discuss the reasons for persistent transmission of leprosy in India and suggest measures to achieve the targets under the National Strategic Plan and Roadmap for Leprosy 2023–2027.

Source: The Hindu