India achieved the 'elimination' of leprosy as a public health problem in 2005, yet transmission persists. Critically examine the gaps and suggest measures to achieve the 2027 zero-transmission goal.

In March 2005, India brought leprosy prevalence below 1 per 10,000 people. That met the yardstick for "elimination as a public health problem" [1]. But prevalence only counts patients currently on the register. It does not count new infections. So the National Strategic Plan (NSP) 2023–27 now aims at interrupting transmission by 2027 [1].

Achievements

• Prevalence fell from 57.2 per 10,000 (1981) to 0.57 (2025). 638 districts are now below the threshold [1].
• Children's share of new cases fell from 9.04% to 4.68% between 2014-15 and 2024-25 [1].
• Single-dose rifampicin post-exposure prophylaxis (SDR-PEP), a preventive dose for contacts, reached 92% of eligible contacts in 2024-25 [1].

Gaps: why transmission persists

• Hidden cases: door-to-door searches under the Leprosy Case Detection Campaign (LCDC) confirmed 27,428 new cases in 2024-25 [1]. These were people the routine system had not found.
• Children still infected: new child cases point to recent spread in the community [1].
• Hotspots: Chhattisgarh (1.80), Jharkhand (1.46), Odisha (1.37) and Maharashtra (1.12) remain above the threshold. 121 districts need special monitoring [1].
• Integration risk: leprosy screening has moved into Ayushman Bharat and child-health screening (RBSK, RKSK). This widens reach but can thin out specialist skills. The NSP itself stresses keeping leprosy expertise [1].
• Stigma written into law: 108 discriminatory laws remain (3 Union, 105 State) [3]. Fear of these consequences delays reporting, so contacts go untraced.
• Measurement risk: a district counts as having stopped transmission after zero new child cases for five consecutive years [1]. Unless this is verified, weak searching can produce a false "zero".

Measures for 2027

• Independent field verification of districts that claim interruption. Districts should report how many people they screened alongside how many cases they found [1].
• Keep active search going through LCDC and ASHA-based surveillance (ABSULS) even in low-burden districts. Enforce the 2025 rule that all health sectors must notify cases [1].
• Trace every contact of every new case and give them SDR-PEP. Add drug-resistance surveillance [1].
• Tribal focus: tag Particularly Vulnerable Tribal Groups (PVTGs) on the Nikusth 2.0 portal under PM-JANMAN [1].
• Legal reform: enact the EDPAL Bill drafted in Law Commission Report No. 256 (2015) and repeal the Lepers Act, 1898 remnants [2][3].

The 2005 milestone was real but only partial. Low prevalence hid ongoing transmission. To break the chain, India must measure transmission, not prevalence, keep up active case-finding, protect every contact, and restore patients' dignity. Doing so would secure the right to health under Article 21, as well as the State's duty to improve public health under Article 47. It would also put India ahead of the SDG 3.3 deadline of 2030.