National Leprosy Eradication Programme (NLEP): India?s Journey from Control to Elimination and the Roadmap to End Transmission by 2030

Leprosy or Hansen?s disease is a chronic infectious disease caused by bacteria Mycobacterium leprae. Symptoms include discoloured skin patches, lack of ability to feel touch, pressure, pain, heat and cold, muscle weakness, non-healing ulcers, deformities particularly in hands, feet and face and inability to close eyes and poor vision. The introduction of Multidrug Therapy (MDT) in 1983 in India revolutionized treatment of leprosy. MDT treatment has been provided free of cost to patients through WHO. Since the introduction of MDT, the incidence and prevalence of the disease has remarkably decreased.

The Government of India recognized leprosy as a national health problem in 1954?55 and launched the National Leprosy Control Programme which gained momentum during the Fourth Five Year Plan (1969?74) after becoming a centrally sponsored program. Expanded coverage, NGO involvement, and health education were prioritized. In 1982, WHO endorsed Multi Drug Therapy (MDT) with Rifampicin, clofazimine and dapsone as the standard cure, leading to the launch of the National Leprosy Eradication Programme (NLEP) in 1983. India?s efforts have since focused on early detection, free treatment, and social reintegration of affected individuals to prevent disability.

The NLEP is a centrally sponsored scheme under the National Health Mission (NHM). Funds are allocated to states and UTs based on state/UT specific Programme Implementation Plans, with a focus on local needs, priorities and capacity. Introduction of MDT, strong political commitment, decentralized implementation and a robust Information, Education, and Communication (IEC) strategy brought about tremendous success in leprosy control. In 1981 the leprosy prevalence rate that was 57.2 /10,000 was reduced to 44.8 by March 1984 and to 2.4 per 10,000 population by March 2004. The rate of Grade II deformity (visible deformities) among new patients in 1981 was 20 percent; and by 2004, it was only 1.5 percent.

NLEP embarked upon developing a new strategy document to accelerate the efforts towards leprosy control and overcome the impact of the Covid pandemic. This Strategy is aligned with the Global Leprosy Strategy 2021-2030 and the WHO Roadmap for Neglected Tropical Diseases 2021-2030, aiming to achieve interruption of transmission of leprosy by 2030. The Strategy focuses on interruption of transmission and achieving zero indigenous cases by accelerating case detection activities in high endemic districts and sustaining a strong surveillance system in low endemic districts.

Strategies to be adopted are as follows - acceleration of new case detection by targeted approach, Intensified surveillance systems, digitalization, introduction of advanced tools and techniques for early diagnosis, provide the immediate chemoprophylaxis to all contacts of cases forthwith, introduce a potential safe and effective vaccine, introduction of surveillance of anti-microbial resistance and adverse drug reactions, post treatment surveillance of treated cases and provide them care after cure, sustain leprosy expertise and move towards multi-disease service integration, improved treatment outcomes by introduction of new treatment regimes and widespread awareness with impactful behavioural change communication methods.

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