Health is a cornerstone of societal well-being and neglected tropical diseases (NTDs) continue to pose a significant health burden on India. With over 1.62 billion people globally affected by NTDs, India shoulders a significant burden being home to 12 NTDs. Among all the NTDs, lymphatic filariasis (filaria), or hathi paon as it is called in India, affects an estimated 670 million people in 16 States and five Union Territories, which is 40 per cent of the global burden of LF.

Imposing a substantial financial burden of ₹2,060 crore and $33 billion in out-of-expenses, this stands as a formidable barrier contributing to economic setbacks, healthcare costs, and disability. Although most of eastern, central, and southern India is affected, eight States contribute to 90 per cent of the caseload, among which Bihar, Uttar Pradesh, Jharkhand, Odisha, and Chhattisgarh account for 75 per cent of the cases, indicating a disproportionately high prevalence.

A beacon of hope

Drawing from India’s success in eradicating polio, we recognise the potency of collective action. The government’s nationwide Mass Drug Administration (MDA) aims to eliminate filariasis by 2027, three years ahead of the global target. For MDA to work, it is essential to implement this through targeted efforts focusing on door-to-door administration of anti-filarial drugs, especially in 10 filaria-affected States. Observed over two cycles spanning 17 days each (February 10 and August 10), MDA provides a critical window of opportunity to administer drug treatment for filaria in mission mode in order to ensure its efficacy.

Despite significant efforts by MDA since 2004, challenges persist in addressing drug intake in communities. The silent nature of the disease leads people to believe they’re healthy, neglecting medication despite carrying the infection.

Side-effects and stigma further deter treatment, causing physical, mental, and economic hardships, with some patients resorting to extreme measures like limb amputation to alleviate pain. Awareness of symptoms, treatment, and medical care is crucial for successful drug administration.

ASHA workers are already playing a critical role in generating awareness and breaking down barriers to drug intake. With their proximity to communities they can build trust and urge necessary action. However, filaria eradication needs a comprehensive three-pronged approach of ‘Jan Andolan’ (campaigns), ‘Jan Bhagidari’ (involvement of local governance) and ‘Jan Zimedari’ (individual ownership). The need of the hour is to run campaigns with active participation of Panchayati Raj

Institutions, hyper-local NGOs, self-help groups and local media, which can bring the desired snowball impact of mass mobilisation and action.

Community efforts in Jharkhand’s Akdonikala and Mahuar Panchayats exemplify the synergy of community mobilisation and government commitment to make their gram panchayat LF free.

Aspirational Bharat Collaborative, an initiative to enable last mile convergence and hyperlocal collaboration in India’s most backward districts, is working with the governments of Bihar and Jharkhand to build community ownership, while strengthening the capability of front-line workers to heighten awareness and administer drugs. But what this issue needs is urgency of action in a timely mode, and commitment to eradicate this debilitating disease.

Tackling NTDs requires strong political leadership, akin to campaigns like Swachh Bharat and TB elimination. Leaders can mobilise resources, drive awareness, and create commitment towards LF-free India. Eliminating filaria alone can greatly boost the economy, as demonstrated in Odisha’s Khurda district, with benefits outweighing costs by 130 times.

Piramal is Vice-Chairperson of Piramal Group, and Singh is Head – Aspirational Bharat Collaborative, Piramal Foundation