Leprosy elimination: are we winning the fight or losing focus?

Despite decades of significant global efforts, leprosy remains persistent a public health challenge, with approximately two million people living with leprosy-related disabilities. This article traces the history of leprosy control, highlights the transformative impact of multidrug therapy (MDT), and warns against the risks of waning global attention. The World Health Organization’s (WHO)’s 1991 elimination target—defined as prevalence below 1 case per 10,000 population—drove a campaign that treated over 13 million cases by 2020. However, this statistical success has fostered a false narrative of eradication, leading to reduced funding, political will, and research investment. This article argues that this premature complacency threatens sustainable leprosy control. Persistent stigma, weak health systems, antimicrobial resistance (AMR), and disparities in gender and child diagnosis. The COVID-19 pandemic exacerbated these issues, causing a 35.9% drop in case detection in the Americas in 2020. We present evidence from in Brazil, India, and Nigeria where community health agents and local leaders have improved early detection and reduced stigma. The risk of losing focus is greatest for marginalized communities, where the disease continues to thrive unnoticed. We conclude that sustaining progress requires a renewed commitment beyond statistical targets, emphasizing continuous surveillance, community-led initiatives, and a focus on social justice and innovative tools like post-exposure prophylaxis (PEP) and AI-based diagnostics to ensure that the gains made are not reversed.