Leprosy in the post-elimination phase: so near and yet so far

Leprosy is a chronic infectious disease affecting primarily the skin and peripheral nerves. WHO multi-drug therapy launched in 1982 revolutionized the treatment of this old age scourge, paving the way for leprosy elimination at global and national level. The global prevalence came down from over 5 million cases in the 1980s to less than 200,000 at the end of 2016. At present, India, Brazil and Indonesia are the top three countries with maximum leprosy load. The Indian national leprosy programme achieved the prevalence rate of less than 1/10,000 in the year 2005 but even after decade of attaining the WHO elimination target, India still contributes over 50% of the cases to the global leprosy burden leading the pack. Despite achieving the elimination target, the incidence of the disease has not come down as new cases continue to be reported or have plateaued worldwide. Adding to the boil is the persistence of social disparity and shadow of discriminatory laws in the statute books of many countries. Although significant success has been achieved in leprosy control over the years, but as the old adage goes, 'the last lap is the hardest and requires special efforts'. WHO global leprosy strategy 2016-2020 has a vision to achieve "the three zeros": zero disease, zero disability and zero discrimination. The present review focuses on the global and national leprosy scenario, changes made in the leprosy programme in the post-elimination phase and its consequences particularly in India, new scientific advances/insights and global and national strategies to deal with the hurdles in the road towards a "leprosy free world".