When a Victory Becomes a Blind Spot: India's Leprosy Paradox

The Milestone That Helped India and Then Hid the Problem In 2005,

India crossed a line that public health officials had worked towards for decades. National prevalence of leprosy fell below one case per 10,000 people and the World Health Organization declared that India had eliminated leprosy as a public health problem.

Twenty years later, the 2025-26 National Leprosy Elimination Programme report shows new cases running 41% above projections, cases in children 91.6% above and visible disabilities 34% above. Only 148 districts have reached interruption of transmission, against a projected 300.

The question is whether the 2005 milestone was a success that later policy failed to build on or whether the milestone itself helped create the failure.

The case that the milestone worked Prevalence targets were useful.

They were simple, measurable and could be tracked across a huge country. Multi-drug therapy made cure possible and the target gave governments a clear goal that mobilised resources and political attention. Without it, India might never have treated the millions it did. Prevalence falling below one in 10,000 was a real achievement.

The case that the milestone misled But prevalence measures how many people are registered as patients at a given time, not how many are being newly infected.

Shorter treatment meant patients left the register faster, so prevalence fell even while transmission continued. Once "elimination" was declared, the dedicated surveillance programme was folded into the general health system and active searching for cases declined.

Hidden transmission surfaced years later as rising disability in the early 2010s, which pushed India back to door-to-door screening. Stigma still delays diagnosis until nerve damage has set in and many practitioners mistake early leprosy for a skin condition.

Where

TAN stands TAN's position is that the 2005 milestone did more harm than good in the form it took. Not because the achievement was false, but because it measured the wrong thing and invited the wrong conclusion. The lesson is to set targets that measure transmission and then to hold them.

That is why the National Strategic Plan's focus on interrupting transmission is right and why the current overshoot should not lead to softer targets. Part of the higher case count reflects better searching: the programme screened over 70 crore people in high-endemic areas and gave single-dose rifampicin to 91.1% of 16.9 lakh close contacts.

Finding more cases is the necessary first step towards ending transmission. Lowering targets now would penalise exactly the active case-finding India needs. The money should follow the transmission: to states such as Chhattisgarh, Jharkhand, Odisha and Maharashtra, to communities where stigma delays care and to tools such as post-exposure prophylaxis and the indigenous MIP vaccine.