India’s long battle with lymphatic filariasis: progress and the path ahead

In many Indian villages, people living with lymphatic filariasis still recall the day their leg began to swell. It starts innocuously, with a slight puffiness around the ankle or knee. Over time, the swelling hardens into something immovable – a weight they carry for life.

Lymphatic filariasis, or haathipaon (“elephant foot”), is one of India’s most persistent diseases. Caused by microscopic worms transmitted by the Culex mosquito, the disease silently invades the lymphatic system, blocking fluid flow and leaving limbs grotesquely swollen. The damage is irreversible.

Unlike malaria or dengue, filariasis does not kill quickly. It disables – stripping away mobility, dignity and income. It is a leading cause of long-term disability worldwide, yet its victims often live unseen, tucked away in villages where the disease is both normalised and stigmatised.

Ancient disease in modern India

Mentions of filariasis date back to ancient Ayurvedic texts, yet the disease continues to remain embedded in India’s public health landscape. India today accounts for approximately 40% of the global burden. An estimated 740 million Indians are at risk, and over 7,00,000 live with its visible effects including limb swelling, scrotal hydrocele or milky white urine.

The numbers are blurry, masked by shame and underreporting. In many rural districts, the disease is so commonplace that people no longer name it; they simply live with it, generation after generation.

Infection begins in childhood. Mosquitoes transfer larvae into the bloodstream, which mature silently in the lymphatic vessels. Years later, irreversible deformity appears. For some, it emerges during adolescence, for others, not until middle age. But by then, the economic and emotional costs are already high.

Filariasis thrives where sanitation fails, among open drains, stagnant water and inadequate healthcare. It also worsens the poverty that sustains it. For labourers and domestic workers, swollen limbs mean the end of livelihoods. Families slip into debt and cycles of dependency begin.

The National Elimination Drive

India’s elimination strategy hinges on annual preventive drugs, through Mass Drug Administration (MDA). The two medicines – diethylcarbamazine (DEC) and albendazole – kill the larvae circulating in the blood, preventing mosquitoes from carrying them to others.

More recently, a triple-drug regimen – Ivermectin + DEC + Albendazole (IDA) – has been introduced in select States. The newer combination shortens the elimination timeline, requiring fewer rounds for impact.

But social hurdles persist; misinformation abounds. Some fear infertility from the pills; others stash them away. Marginalised communities remain mistrustful, haunted by memories of coercive health campaigns.

Awareness campaigns through schools, temples and local radio have helped, but communication remains as critical as medicine. The difference between compliance and failure often comes down to a conversation at a doorstep – one in which fear must be met with empathy, not instruction.

Hidden burden on women

For women, lymphatic filariasis carries a particularly heavy social cost. In patriarchal communities where a woman’s social worth is often tied to her appearance, the disfigurement becomes a source of isolation. Marriage prospects vanish and employment becomes impossible. In some villages, women with visible swelling are barred from cooking for others or participating in community rituals.

The stigma cuts deep. Many women hide their symptoms out of fear, delaying treatment until it’s too late. They bear dual burdens of managing households despite disabilities and enduring recurring infections that leave them bedridden for days.

Yet it is also women – thousands of ASHAs and Anganwadi workers – who are leading India’s elimination efforts. These frontline workers go door-to-door, distributing annual preventive tablets. Their work is physically demanding and emotionally taxing. But their persistence has yielded results. Between 2018 and 2025, India conducted MDA rounds across 328 districts and 143 of these have now achieved elimination thresholds, meaning transmission has dropped below one per 10,000 people.

The success of this effort rests not only on medicine but on persuasion – on the ability of women health workers to translate the suspicion of unknown science into trust.

A disease in transition

Climate change is redrawing the disease’s map. Once confined to coastal belts and river plains, lymphatic filariasis is appearing in upland and semi-urban areas. Longer monsoons, warmer winters and urban flooding are ideal for Culex mosquito breeding.

The National Action Plan on Climate Change and Human Health (NAPCCHH) warns that mosquito density could rise by as much as 20% as rainfall and temperature patterns shift. Every flooded construction site or clogged drain becomes a potential breeding ground.

Filariasis is no longer just a rural affliction: in peri-urban zones, where construction is outpacing sanitation, the disease is finding new ground.

India’s goal is to eliminate lymphatic filariasis by 2027, three years before the global targets. Progress is real, but fragile.

As temperatures rise, mosquitoes adapt. Extended breeding seasons mean longer windows for transmission. Urban flooding turns new neighborhoods into mosquito zones. The epidemiological frontier of LF is shifting – expanding into places where public health systems are unprepared.

The challenge is no longer to end an old disease, but to stop it from finding new life in a warming world. Elimination now requires adaptability, ongoing surveillance, and cross-sector collaboration. The line between success and resurgence is razor thin.

Stigma, long road to care

Even as elimination nears, millions still suffer. For them, “elimination” is a distant concept. Morbidity management and disability prevention (MMDP) are crucial. Patients are taught daily washing, antiseptic use, limb elevation and exercises to prevent flare-ups.

But self-care training rarely reaches those in isolated villages. The psychological toll is immense. Studies show high levels of anxiety and depression among LF patients, compounded by lost income.

The disease becomes a form of social invisibility – one that no drug can fix.

Measured hope

India’s long fight against lymphatic filariasis has been arduous, but it has not been in vain. About 40% of endemic districts have broken the chain of transmission. Millions of lives have been spared from future disability. The disease that once defined regions may soon be confined to history books.

But for that future to arrive, elimination must not be mistaken for the end. The people already living with LF – the women who still wash their swollen limbs in courtyards, the men who limp to work on thickened feet – remain the measure of progress.

The story of LF is, in the end, not just about parasites or pills. It’s about how a country chooses to care for its most invisible citizens.

(Hasina Khatun is an independent communications professional focused on public health and social impact and an Inlaks Shivdasani Foundation Social Engagement 2025 Fellow. connectwithhasina@gmail.com)