According to recent WHO report, India accounts for 60% of the new Leprosy cases detected in the world in 2017.
• As per WHO and National Leprosy Eradication Programme data, India accounts for 60% of new cases detected in 2017, i.e., 1.26 lakh out of 2.10 lakh.
• The country’s numbers have consistently been more than half the world figures since 2008.
• Though, the number of serious afflictions in leprosy cases are steadily reducing as per data from Ministry of Health and Family Welfare.
• The state wise Leprosy burden in India is presented below:
Key Challenges in Tackling Leprosy in India
• Undetected new cases: As per the report published in Down to Earth magazine, the reporting of new cases of Leprosy has been made voluntary after 2005.
• Government’s negligence in monitoring the spread: Post-2005, the Indian government became lax in terms of policies and funding once the leprosy free status was achieved. It led to re-emergence of leprosy in India.
• State National Leprosy Eradication Programme units have become diluted with the inclusion of leprosy into the public health programme.
• Use of the term “elimination” also leads to confusion with “eradication” among general public and even among the medical practitioners.
• Social and Psychological: Early detection and early cure can help in eradication but cases are unreported due to fear and stigma associated with Leprosy. Thus, it is also a human
• Economic: Discrimination due to myths and misunderstanding that the disease is highly contagious. E.g. employment.
• Medical: Lack of awareness about its cure and since 1982, same 3 drugs used in therapy for leprosy which increase the chances of emerge of resistance against the disease.
• Legal challenges: Existence of more than 250 obsolete health related laws in central and state level. E.g. The 1898 Lepers Act that was recently repealed. Many States in India prohibit
leprosy patients from running in local elections and deny them employment privileges and benefits.
• United Nations General Assembly adopted Resolution on the Elimination of Discrimination against Persons affected by Leprosy in 2010.
• WHO’s Global Strategy to End Leprosy (2016-20) titled ‘acceleration towards a leprosy free world’ aims to achieve below stated goals by 2020:
– Reduce to zero the number of children diagnosed with leprosy and related physical deformities;
– Reduce the rate of newly-diagnosed leprosy patients with visible deformities to less than one per million;
– Ensure that all legislation that allows for discrimination on the basis of leprosy is overturned;
– The new global strategy is guided by the principles of initiating action, ensuring accountability and promoting inclusivity.
• World Leprosy Day, which focuses on the target of zero cases of leprosy-related disabilities in children, was observed globally on January 27 (the last Sunday of January) and in India on January 30. It helps in awareness generation.
• Leprosy, also known as Hansen’s disease, is a chronic infectious disease caused by Mycobacterium leprae and Mycobacterium lepromatosis.
• Affected Organs: Skin, the peripheral nerves, mucosal surfaces of the upper respiratory tract and the eyes. Leprosy is known to occur at all ages.
• Leprosy is curable and early treatment averts most disabilities. But if left untreated, leprosy can cause progressive and permanent damage to the skin, nerves, limbs and eyes.
• Transmission: The exact mechanism is not known. It is transmitted via droplets, from the nose and mouth.
• India was officially declared to have eliminated leprosy in 2005 when new cases fell to less than 1 per 10,000 (as per WHO criteria), yet India still accounts for the largest number of leprosy affected people in the world (60 per cent).
• India, Indonesia, Brazil are among the main countries where leprosy is prevalent.
• Pre-Independence: Lepers Act, 1898 provided legal provision for forcible confinement of leprosy sufferers in India, but the Act was not enforced.
• Gandhiji worked for leprosy elimination and Baba Amte did the same after independence.
• Post-Independence launches:
– 1955 – National Leprosy Control Programme (NLCP)
– 1982 – Introduction of Multidrug therapy (MDT) in Phases
– 1983 – National Leprosy Eradication Programme (NLEP)
– 2005 – Elimination (not eradication) of Leprosy at National Level achieved by India.
– 2012 – Special action plan for 209 high endemic districts in 16 States/UTs.
– 2012 – Under the 12th five-year plan, India intends to start WHO child-to-child policy under which school students will be taught to identify patches on the skin of their classmates.
• In 2016, government passed the Repealing and Amending Act to repeal Lepers Act 1898.
• The SPARSH Leprosy Awareness Campaign (SLAC) launched to promote awareness and address the issues of stigma and discrimination.
• Government brought Personal Law Bills 2018 to remove leprosy as a ground for divorce or separation amending acts like:
– the Divorce Act, 1869,
– the Hindu Adoptions and
– Maintenance Act, 1956.
– Bill is also meant to provide for the integration of leprosy patients into the mainstream.
• Door-to-door ‘Leprosy case detection campaign’ to uncover hidden cases under NLEP programme.
• Introduction of Made-in-India Leprosy Vaccine on a pilot basis.
• The present government announcement to “eradicate” leprosy from India by 2030.
• Universal detection mechanism: Access all parts of the country for detection of new cases so as to put them under medication for 6-10 months and cure them.
• Leprosy is one of the oldest diseases known to man, yet it is one of the most misunderstood diseases thus it has unique challenges. Thus, a holistic and multi-pronged approach is needed that includes:
– Identifying interventions to dispel stigma and mainstream the affected people,
– Public education campaign,
– Sustainable livelihood programmes, skill training workshops to give them rightful place in society,
– Provide training to dermatologists to diagnose and treat especially early stage leprosy,
– Strict monitoring of drug resistance in leprosy patients.
• Law Enforcement: The government should enact and enforce Eliminating Discrimination against Persons Affected by Leprosy (EDPAL) Bill drafted by Law Commission which has main features like:
– Repeal and amendment of certain laws (e.g. persons eligible for legal aid under the Legal Services Act, 1987),
– Right to Employment,
– Right to Freedom of Movement.
• After achieving the target of elimination at all levels, the emphasis must shift to more policy level changes and sustaining quality of services.