Zero leprosy is within reach: eliminating leprosy in low-endemic settings demands political will

Pakistan's trajectory offers a critical proof of Zero Leprosy concept for South and Southeast Asia: the last mile of leprosy elimination is technically achievable, but it will not be reached through medical solutions alone. The country has reduced new leprosy case numbers from 971 in 2001 to just 236 in 2023, despite immense health system pressures, humanitarian crisis spillover, and shifting political priorities. According to national surveillance data, the number of new leprosy cases has declined steadily over the past 20 years, with adult cases declining by 75%, from 878 cases in 2001 to 220 cases in 2023. The number of child cases (younger than 15 years) has declined by 83%, from 93 cases in 2001 to 16 cases in 2023. This decline is not a passive epidemiological trend. It reflects deliberate, long-term investments in community engagement, data-driven targeted active case finding and sustained NGO-government collaboration. Pakistan now sits at a strategic tipping point, either to cross the final threshold of transmission interruption or to plateau like several low-endemic countries did before it.