Bhupendra Tripathi | Targeting Lymphatic Filariasis: Mission To Overcome a Lifetime of Disability in India

On February 10 morning each year, in select villages and urban settlements across India, frontline health workers walk door to door carrying blister packs of medicines and a simple message, that these tablets can prevent a lifetime of disability. For many, the Mass Drug Administration (MDA) campaign against lymphatic filariasis (LF), known as “haathipaon”, is a short, yearly interaction with the public health system. For public health professionals everywhere, it represents one of the world’s largest coordinated public health efforts, requiring trust, precision, and systems that work at scale.

India’s progress against Neglected Tropical Diseases (NTDs) such as filaria, Visceral Leishmaniasis (VL), leprosy, etc, reminds us that elimination is not a short-term goal, but the steady strengthening of health systems that place the most vulnerable at the heart of the mission. As a country bearing one of the highest global burdens of NTDs, India’s journey has been complex. However, sustained leadership by the Union health ministry has transformed diseases once considered “neglected” into national priorities.

Filaria remains endemic in 348 districts across 20 states and Union territories. However, consistent programmatic efforts have ensured that 41% of previously endemic districts (143) have stopped MDA after clearing Transmission Assessment Survey-1 (TAS-1), signalling interruption of transmission. This progress is mirrored at the sub-district level as well, where there has been a 32% decrease in the number of blocks conducting MDA from 2023 to 2025 alone, reflecting sharper targeting, improved coverage, and better community participation.

For the remaining areas, the health ministry’s National Centre for Vector Borne Disease Control is launching the 2026 Mass Drug Administration (MDA) round across 124 endemic districts in 12 states.

This MDA round is not merely about distributing anti-filarial tablets, but employing sophisticated programmatic architecture designed to end a disease that has significantly impacted the health landscape of our most vulnerable regions.

At the heart of India’s filaria elimination efforts is a mission-mode, systems-led strategy. Through a unified nationwide round each year, India now runs one of the largest MDA campaigns globally, supported by an enhanced five-pronged approach integrating administration of preventive medicines, surveillance, morbidity management and disability prevention (MMDP), vector control, and community engagement. In recent years, the Government of India has also expanded the use of triple-drug therapy across 98 endemic districts, accelerating progress toward elimination and reducing the number of rounds required to break transmission.

Digital transformation has further strengthened the programme approach. The integration of the filaria programme within the government’s Integrated Health Information Platform (IHIP) allows near real-time monitoring of MDA coverage, line-listing of patients, and identification of cases positive for carrying the filarial parasite. During recent MDA rounds, over 95 per cent of blocks reported data digitally, enabling rapid identification of gaps and course correction. Modelling support from the National Disease Modelling Consortium (NDMC) at IIT Bombay has helped the national elimination programme to understand emerging transmission aspects, optimise MDA approach, and plan next steps more precisely. Complementing this, the induction of Filariasis Test Strips, now made in India and available through the Government e-Marketplace (GeM) portal, has not only streamlined procurement, but it is also strengthening field-level investigation capacity.

In addition to halting transmission, the elimination programme also focuses on those already affected. India has scaled up MMDP services, including care for those with lymphedema (swelling in the limbs) and hydrocele surgeries (for scrotal swelling), supported through the Ayushman Bharat (PMJAY) scheme. Between 2021 and 2024, the number of MMDP kits distributed and hydrocele surgeries conducted more than doubled, reflecting a stronger focus on patient-centred care. Several states have taken the lead in ensuring patients have access to these care services, including UP, which is ensuring affected filaria patients have access to disability certification for social protections, Bihar, which under state health minister Mangal Pandey has nearly completed the full backlog of hydrocele surgeries, ensuring that elimination leaves no one behind.

Another critical pillar of this progress has been the expanded role of medical colleges. From supporting in evaluating the impact of MDA rounds and microscopy training to strengthen diagnostics and patient care, medical colleges now serve as district-level partners in elimination.

Their participation has grown dramatically, with nearly all filaria-endemic districts supported by academic institutions, embedding the disease elimination within the broader health system.

To ensure the “last mile” is covered and elimination endures we require a shift from a government-run programme to what is known as Jan Bhagidari, true community ownership. In this context, Jan Bhagidari means that the local residents’ welfare associations in urban areas, school principals and village panchayats take responsibility, neighbours encourage neighbours, everyone understands they have a role to play, to ensure not a single eligible individual is missed.

The goal set by the government to eliminate LF by 2027, three years ahead of the global target, is ambitious. Achieving this requires us to treat this February 10 launch with the same war-footing urgency we once reserved for polio.

The main thing to remember is that the anti-filarial medicines are safe. Millions have consumed them globally with no to minimal side effects, which, when they occur, are a sign that the body is reacting to the death of the parasite. Treatment is vital for every eligible individual because even if you feel perfectly healthy, you may be carrying the parasite. Consuming the medicines protects your family and your community from future transmission. Finally, consumption is the only metric of success. Please do not just accept the tablets, consume them in the presence of the health worker.

India has the technical expertise, the frontline workforce, and the programmatic resolve to end this disease. We must now provide the collective will. Let us use this February MDA round to demonstrate to the world India’s collective resolve, showing that we are not only overcoming neglected tropical diseases but leading the way in eliminating them.

Dr Bhupendra Tripathi is the deputy director, infectious diseases and vaccine delivery, at the Gates Foundation’s India Country Office