India has managed to bring down the annual leprosy caseload over time, but marginalised communities still bear a disproportionate burden—revealing stark gaps beneath headline progress.
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Leprosy has not disappeared globally, and India still accounts for the heaviest share of the burden. The World Health Organization’s (WHO) latest global update recorded nearly 182,815 newly detected cases worldwide. India reported 107,851 of these, a 59 percent share of the world’s new cases. Two decades earlier, the global tally stood much higher with 451,325 new cases in 2004. However, India’s share was even more dominant—over 81 percent, with 367,143 cases. The leprosy landscape has improved in India and globally since the early 2000s. Yet, despite significant socio-economic progress, India’s contribution to the global caseload remains sizeable and unrelenting.
The Government of India’s Report of the Expert Committee on Tribal Health (2018) noted that despite constituting a much smaller share of the population, the Scheduled Tribes (STs) accounted for nearly 18.79 percent of India’s leprosy cases in 2015–16. Between 2018 and 2019, the Observer Research Foundation (ORF) published commentaries and a follow-up report presenting a systematic analysis using publicly available government data from 2008–09 to 2016–17, arguing that leprosy was increasingly becoming a disease of the marginalised in India, concentrated among Scheduled Castes (SCs) and STs, and highlighting state-level inequities.
The legacy National Leprosy Eradication Programme (NLEP) website, which contained ready-to-download, disaggregated state-level tables, was widely cited in papers up to late 2019 and eventually fell off the public web.
This line of inquiry resonated with academics, civil society, and clinicians alike and has been cited and reused since. In 2022, an Indian Council of Medical Research (ICMR)- affiliated article of the leprosy situation in the Indian Journal of Medical Research (IJMR) reproduced the ORF thread of analysis but went a step too far: it asserted that data beyond 2017 were not available publicly, and therefore, a more recent trend analysis was not possible. The IJMR article by government-affiliated researchers explicitly states, “data beyond 2017 are not yet available,” citing the ORF report as its only source of data. However, the claim of unavailability of more recent, comparable data does not withstand scrutiny.
Part of the confusion came from a change in public data availability. The legacy National Leprosy Eradication Programme (NLEP) website, which contained ready-to-download, disaggregated state-level tables, was widely cited in papers up to late 2019 and eventually fell off the public web. Some parts of it later reappeared as a Directorate General of Health Services (DGHS) microsite. However, crucially, year-wise national totals and SC/ST disaggregation continued to appear in the Ministry of Health and Family Welfare’s (MoHFW) Annual Reports. Fragmented presentation of data is not the same as the absence of data, even though different verticals within the same Ministry seem unable to access this data. In this context, given India’s ambitious goal of achieving “zero transmission” by 2027—requiring the health system to identify and treat all cases, uncover hidden ones, and provide both chemoprophylaxis and immunoprophylaxis to all contacts—this article seeks to update the earlier analysis with new data.
The official strategy has tightened in the past six years. India launched the National Strategic Plan & Roadmap for Leprosy (NSP) 2023–2027, aligning with WHO’s 2021–2030 neglected tropical diseases (NTD) roadmap, aiming for zero transmission by 2027. The NSP doubles down on early detection, contact tracing, and post-exposure prophylaxis. It also aims to direct step-wise verification of elimination at the state, district, and sub-district levels.
LCDC was designed to surface the latent cases. During its first two years, it detected roughly 67,000 new cases that would have otherwise remained undiagnosed at the time.
At the programme level, India had already reintroduced proactive case-finding through the Leprosy Case Detection Campaign (LCDC) in 2016, scaling in 2017. LCDC was designed to surface the latent cases. During its first two years, it detected roughly 67,000 new cases that would have otherwise remained undiagnosed at the time. The emphasis on active detection, and later the NSP’s contact tracing and chemoprophylaxis, inevitably increased new case detection rates in the short run. COVID-19 further disrupted detection and care: national new detections fell to 65,147 in 2020–21, and eventually rebounded as services restarted.
Currently, 20 years after achieving the national elimination target, only 31 out of India’s 36 States and Union Territories (UTs) have met the leprosy elimination threshold, which is defined as a prevalence rate below 1 case per 10,000 people. Of India’s 759 districts, only 630 (83.0 percent) have reached this benchmark. In comparison, by 2019, 32 States and UTs reached the leprosy elimination threshold. Out of the country’s 708 districts, 588 districts (83.05 percent) had achieved elimination status, signifying stagnation.
A closer look at recent totals shows that new case numbers are not declining in line with the 2027 “zero transmission” ambition. Following the pandemic dip, annual detections have reverted toward their pre-COVID range, reaching 107,851 in 2023–24 (Graph 1). Over the past 15 years, the number of cases has not declined considerably. This does not necessarily indicate worsening transmission; in some districts, more proactive screening may simply be bringing long-overlooked cases to light. Nevertheless, the national signal is clear: the disease is not receding at the pace required. For elimination verification to progress from states to districts and blocks as planned, India must sustain earlier detection while considerably reducing the share of child cases and the incidence of grade-2 disability (a marker of late diagnosis) in high-burden geographies.
Source: Multiple MoHFW Annual Reports, Press Information Bureau (PIB) Releases, and Parliament answers compiled and analysed by the author.
In addition, the underlying equity signal flagged in the earlier ORF analysis in 2018-19 has endured and worsened. In other words, new cases for the year 2023-24 within the SC and ST population groups combined now account for around 37.3 percent, up from 32.7 percent in 2008-09, well above their combined population share of about 25.2 percent . The latest number is consistent with the more detailed, year-wise proportions in MoHFW’s recent annual reports, which show the combined proportion frequently hovering around 36-38 percent in the last several reporting years (Graph 2).
Source: Multiple MoHFW Annual Reports, PIB Releases, and Parliament answers compiled and analysed by the author.
The NSP makes the right suggestions—contact tracing, prophylaxis, and integrated primary-care screening—and it leans on tools that should shrink the pool of undiagnosed infections. Still, structural barriers mapped in the literature, including remoteness, migration, stigma, and delayed care-seeking in tribal belts; workforce inexperience after years of integration; and intermittent, campaign-driven surveillance, can easily blunt these gains. If the national milestones are to be achieved at the state, district, and block levels, accelerants are indispensable. A look at the comparative proportions of SCs, STs and Others (consisting of the rest of the population) tracked over time (Graph 3) paints a distressing picture. Although the share of STs among total new cases has increased steadily from 13.3 percent in 2008–09 to 20.01 percent in 2023–24—despite STs comprising only 8.6 percent of India’s population—the proportions of cases among SCs and Others have declined slightly over the same period.
Source: Multiple MoHFW Annual Reports, PIB Releases, and Parliament answers compiled and analysed by the author.
If there were to be a notable reduction in the leprosy new case numbers in the country over the same time, this could have been seen as an inevitable outcome of distribution dynamics, when active surveillance reaches i remote areas inhabited by marginalised populations, but the overall trend of case numbers suggests otherwise (Graph 1). A look at disaggregated actual case numbers rather than proportions shows that the new cases within the ST population have steadily gone up for the most part between 2008-09 and 2023-24 (Graph 4), starting at 17,846 and currently at 21,582. By contrast, case numbers within SCs and Others have come down considerably in the same period. The SC population, at 16.6 percent of India’s population, now has fewer new leprosy cases than the ST population, which constitutes only 8.6 percent.
Source: Multiple MoHFW Annual Reports, PIB Releases, and Parliament answers compiled and analysed by the author.
For several years, a lot of India’s leprosy-affected districts have also grappled with entrenched Left-Wing Extremism (LWE), where insecurity and hard-to-reach terrain blocked routine outreach, contact tracing, and treatment follow-up. However, over the past decade, LWE has waned drastically (Graph 5), creating space for initiatives such as active case-finding campaigns and contact-based chemoprophylaxis to penetrate deeper than before. Yet the equity signal hasn’t shifted enough: the ST community and, to a lesser extent, the SC community still account for a disproportionate share of new detections, indicating that the gains from improved access are not reaching those who need them most. The policy response now must be deliberately corrective, including equity-weighted micro-planning, trusted local workers and transport in former LWE pockets, enhanced awareness in the private sector, and meticulous contact management to ensure that the security dividend translates into earlier diagnosis and fewer new infections where vulnerability is highest.
Source: Data compiled by the author from a PIB Release.
To make any meaningful progress towards the national goal, India must deploy its health system resources judiciously. First, active case finding can and should be seen as a bridge to lower case load, but only if it is paired with uninterrupted treatment completion, relapse surveillance, and robust post-exposure prophylaxis among contacts. Otherwise, case-finding becomes a treadmill; the more health workers look, the more they find, without bending transmission. Second, data transparency is not a minor administrative detail. The decommissioning of the legacy NLEP site and its thin, inaccessible replacement left even ICMR authors assuming post-2017 data were unavailable.
First, active case finding can and should be seen as a bridge to lower case load, but only if it is paired with uninterrupted treatment completion, relapse surveillance, and robust post-exposure prophylaxis among contacts.
Reinstating a modern, navigable public data portal under NLEP, sharing state-level disaggregated case numbers across socio-economic groups, child and disability indicators, and contact-tracing/ post-exposure prophylaxis (PEP) coverage, would allow researchers, states, and districts to identify slippages early and course-correct. Data transparency becomes even more important as India has, in May 2025, declared leprosy as a notifiable disease, a very important development which got zero media coverage. This paves the way for cases from the private sector entering official data, taking it further up starting 2025-26. Unless there is proactive data-sharing and effective communication, this will trigger panic and sensationalism.
There are green shoots, nonetheless. Professional societies seem to have re-energised leprosy training and discourse, suggesting young dermatologists and physicians are re-engaging with the disease, a clear departure from the trends ORF’s earlier work had identified. Pair that with the NSP’s stronger contact-tracing and PEP architecture, and the system is primed for a real bend in the curve, if implementation keeps pace and if data are proactively shared.
Until then, claims of imminent elimination at sub-national levels will feel wildly aspirational. With restored transparency, relentless focus on early detection and disability prevention, and a frank equity lens on the disproportionate burden imposed on the marginalised populations, the ambition of ‘zero transmission by 2027’ becomes less a slogan and more a plan. When case numbers within marginalised population groups surge, India cannot point towards improved surveillance and keep saying, ‘It gets worse before it gets better’. They have been waiting far too long.
Oommen C. Kurian is Senior Fellow and Head of the Health Initiative at the Inclusive Growth and SDGs Programme, Observer Research Foundation.
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Oommen C. Kurian is Senior Fellow and Head of the Health Initiative at the Inclusive Growth and SDGs Programme, Observer Research Foundation. Trained in economics and ...
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