Leprosy is the oldest disease known to mankind. Despite advances in all spheres of medical science, leprosy continues to be a public health challenges in countries like India, Brazil, Indonesia, Bangladesh. National Leprosy Control Programme (NLCP) was launched by Govt. of India in 1955. Multi Drug Therapy (MDT) came into wide spread use from 1982 and the Leprosy Eradication Programme (NLEP) was introduced in 1983. Since then, remarkable progress has been achieved in reducing the disease burden. In December 2005, India achieved elimination at national level.
India’s fight against leprosy has been long and challenging due to the dominance of stigma and discrimination around the disease. The offensive term ‘lepers’ which was earlier used for leprosy patients is laced with feelings of repulsion and discrimination for the patients who were cast out of their homes due to the disease. Having achieved the target of elimination of leprosy in 2005 as a public health problem at the national level, the next goal to be achieved under NLEP is to make the country leprosy free. This means elimination of leprosy as a disease with zero transmission, and zero new cases of leprosy. In order to achieve the target of Leprosy Free India, it is considered important to first focus on sub-national elimination of the disease. Success at the sub-national level would eventually aggregate to success at the national level.
Currently, India accounts for 54 per cent of the global cases of leprosy (2021-2022). Due to persistent steps by the government and partners, the prevalence of the disease has reduced from 57.8 per 10,000 population in 1883 to 0.45 in 2021 i.e. from total 43.5 lakh new cases (1983) to 75,394 (2021). But more needs to be done to tackle a highly contagious disease like leprosy in a populated country like India. To take India even closer to the eradication of leprosy, many development partners including WHO, Rotary, NLRIF, GLRA, Sawakawa Health Foundation etc. are undertaking active steps to help leprosy patients on four fronts – battling ignorance, training people, active case finding, healthcare and rehabilitation.
The Revised SDG Goal for India is now to make India, leprosy-free with zero transmission and zero new cases by 2027. The country has released National Strategic Plan and Roadmap for Leprosy 2023-2027 to fast-track leprosy elimination efforts through strong partnerships, accelerated case detection, quality of care at every levels, prevention of disease and actions for de-stigmatisation, and digitalisation of registration of leprosy cases with longitudinal follow-up including supply chain management of drugs.
The Indian government collaborates with WHO for community education, supply of MDT drugs, and monitoring and supervision. Organisations like Rotary are actively helping in case detection of leprosy and in supporting the patient’s Right to Life by distributing supporting aids like tricycles, MCR footwear, and installations of solar panels in leprosy colonies. Lack of awareness around treatment accessibility, and fear of stigma and discrimination prevents people with symptoms of leprosy from coming out from their homes and getting diagnosed. The stigma also prevents patients and their families from necessities like food, shelter, and employment opportunities. Early detection is key in preventing disability in patients with leprosy and reducing the risk of transmission. More needs to be done to eliminate stigma and to encourage people to come for disease screening.
India has showcased remarkable improvement in the reduction of leprosy cases, but it still holds the highest burden of the disease globally. The fight against leprosy elimination also includes the elimination of stigma and discrimination associated with the disease. To accomplish the last stretch of eradicating leprosy from India by 2027, there is a need for accelerated steps in awareness, tracking and monitoring of leprosy patients, targeted interventions for interruption of transmission of the disease along with sustained efforts for treatment and rehabilitation.
Though, leprosy was eliminated as a public health problem from the country in 2005, the agenda of eliminating leprosy at the subnational level is still unfinished even after 15 years. There are more than 85 districts (March, 2022 data) still reporting a higher prevalence rate (PR) of leprosy, even though leprosy elimination was expected to be achieved in 100 per cent districts in the country much earlier, may be achieved now at the district level by 2025 and at block level by 2027. India still reports the highest number of leprosy cases in the world. India accounts for more than half (53.6 per cent) of the 1,40,594 new cases detected globally (2021-22), India accounts for 22 per cent in Grade 2 Disability Case globally. It is a clear indication that India is successfully preventing the disability due to leprosy.
With a view to encourage the states and the districts in their local endeavours to achieve the goal of zero leprosy, it has been decided to reward and incentivise the well performing districts. The pre-requisites for claims, verification, certification and awards for efforts towards ‘Leprosy Free’ status, at the district level are well documented in “Guidelines for certification and award at the district level for achieving potential leprosy elimination/ leprosy elimination status”. It is important to generate awareness that leprosy is curable, and treated for free. Also, discrimination should never be tolerated. We may consider elimination of a disease at better level like less than 1 per lakh by eliminating the reservoir of infection, breaking the chain of transmission and increasing the immunity of susceptible hosts. BCG immunisation has been recognised to contribute to protection against leprosy, only one the indigenous vaccine which is a heat-killed species of the bacteria called Mycobacterium Indicus Pranii (MIP) has been recognised as one of the potential immunoprophylaxis vaccine for leprosy contacts but yet to get approval of NTAGI. According to, ICMR and NLEP, the index leprosy patient will receive the MIP vaccine over and above the MDT. His family members and contacts would be immunised with MIP twice with the expectation that their immunity is reinforced to evade leprosy on exposure to M. leprae from a patient.
I would quote the famous saying, “Attitude is a little thing that makes a big difference”. We must make a big difference in our NLEP by changing our attitude and behavior towards work because Knowledge without action is futile.
Dr Mandal is Deputy Director General (Leprosy), Dte. General Health Services, MoHFW
The opinions expressed in this article are those of the author’s and do not purport to reflect the opinions or views of THE WEEK.
