Despite achieving elimination of leprosy as a public health problem at the national level, India continues to report high new and child cases. Examine the gaps and suggest measures to achieve zero transmission by 2027.

India met the leprosy elimination threshold (prevalence below 1 per 10,000) nationally in 2005. By March 2026 its prevalence rate (PR) was 0.56 [1]. Yet 2025-26 recorded 91,783 new cases, 41.2% above projection. New child cases were 91.6% above projection, which shows the infection is still spreading [1]. Meeting a prevalence target has not stopped transmission.

Gaps

• Metric illusion: The national average hides 114 districts still above the PR target [1]. The national PR has barely moved from 0.57 in 2020 [2]. MoHFW itself lists the "misinterpretation on elimination and eradication" as a challenge [2].
• Late detection: The rate of Grade-2 disability (G2D), meaning visible deformity at diagnosis, is 1.34 per million against a target of 1 [1]. The house-to-house LCDC campaign found 27,428 hidden cases in 2024-25 [3]. That shows a large undetected backlog that periodic campaigns miss.
• Transmission not interrupted: Only 148 of a projected 300 districts have provisionally interrupted transmission [1]. Interruption means zero new child cases for 5 consecutive years [4].
• Uneven burden: PR is highest in tribal belts such as Chhattisgarh (1.66) and Jharkhand (1.51). G2D rates are highest among urban migrants in Chandigarh (13.54 per million) and Delhi (11.53) [1].
• Capacity: MoHFW flags weak human-resource capacity and motivation and poor referral linkages [2].

Measures

• Protect contacts: Give Single-Dose Rifampicin as post-exposure prophylaxis to the household of every new case [4].
• Continuous screening: Use the existing RBSK/RKSK child screening, Ayushman Bharat screening of adults over 30 and NUHM screening of slums [2].
• Outcome metrics: Rank districts by child cases and G2D rate, not PR. This matches the WHO Global Leprosy Strategy 2021-2030 goal of zero locally acquired cases [5].
• Accountability: Investigate every G2D case in detail [2]. Use Nikusth 2.0 to track patients who migrate mid-treatment [4].
• Stigma: Expand the Sparsh campaign and Gram Sabhas on 30 January [2] to support the NSP's "zero stigma" pillar [4].

The gap is not in medicines but in how progress is measured, how early cases are found and whether contacts are protected. If the NSP 2023-27 tracks child cases, protects every contact and screens people routinely, India can reach zero transmission by 2027. That would put it ahead of the SDG 3.3 deadline and would uphold the dignity guaranteed by Article 21.