Malaria, filaria, and kala-azar, once relentless forces that shaped the health and livelihoods of millions across India, are now poised at the brink of history. What once seemed an unyielding burden is steadily giving way to one of the most remarkable public health turnarounds of our time. Over the past decade, progress has been nothing short of transformative: malaria cases and deaths have dropped by more than 80%, kala-azar has retreated from 633 endemic blocks to the cusp of elimination, and lymphatic filariasis has seen transmission halted in 41% of endemic districts. Between 2023 and 2025 alone, the population at risk fell dramatically by 36%, from 34.1 crore to 21.7 crore.
With the Government of India firmly committed to eliminating all three diseases by 2030, in alignment with the SDGs, the horizon is closer than ever before. For the first time in generations, this hard-won victory feels within our grasp. And yet, it is at this very moment, when success seems certain, that vigilance matters most.
The progress we are seeing today is no accident, it is the result of deliberate vision, sustained effort, and systems built to endure. The National Centre for Vector Borne Diseases Control (NCVBDC), under the ministry of health and family welfare, has quietly engineered a transformation. Through the Integrated Health Information Platform (IHIP), real-time surveillance now follows every case to its conclusion, turning data into decisive action. Meanwhile, the National Reference Laboratory, established in 2022, has become a cornerstone of capacity building, equipping over 400 laboratory professionals across the health system and strengthening both detection and treatment outcomes.
Equally important is the shift in mindset. India has moved beyond fragmented approaches, embracing Integrated Vector Management, where health, sanitation, and urban planning converge in coordinated action. This alignment, complex as it is, has been instrumental in driving measurable change.
Nowhere is this momentum clearer than in the fight against filaria. Drug consumption among eligible populations surged from 82% in 2023 to an impressive 96% in 2025. In February 2026, the mass drug administration campaign reached 124 districts across 12 states. The transition to a once-a-year unified mass drug administration may be operationally demanding, but it is proving far more effective in closing the windows of transmission.
States such as Uttar Pradesh and Odisha stand as powerful examples of what is possible when elimination becomes a true priority, where administrative resolve meets strong frontline delivery, and ambition is matched by execution.
Success in public health carries a quiet, often overlooked risk: as diseases fade from view, so does our sense of urgency, and that is precisely when progress begins to unravel. Lately, I am often asked whether this is the moment to shift focus to other health priorities. It is an understandable question. The numbers are encouraging. The trajectory is promising. But this is exactly the moment when we must resist the temptation to look away.
Polio reminds us why. Despite decades of relentless global effort, eradication remains unfinished, not because we lacked the tools, but because vigilance wavered in the final stretch. Closer to home, India achieved elimination of leprosy as a public health problem years ago, yet it still accounts for the highest number of new cases worldwide. Elimination as a public health problem is not eradication. The distance between the two is bridged only by sustained attention and unwavering effort. History shows us that progress is not lost in dramatic setbacks, but in quiet complacency.
This is where the medical community carries a profound responsibility. As caseloads decline, it is natural to feel that the battle has been won. But it has not. Vigilance must endure, through consistent screening, diligent reporting, and a refusal to lower our guard simply because the numbers appear favourable. Every unreported case is a missed chance to interrupt transmission.
In diseases like malaria, kala-azar, and filaria, what remains is often hidden in the hardest-to-reach places, among communities with the least access to care. These are not just the final cases; they are the most fragile frontlines. And it only takes one untreated case to reopen the door to what we have worked so hard to contain.
Entomological surveillance is the quiet force that shifts public health from chasing outbreaks to staying ahead of them. It is what turns uncertainty into foresight, revealing where vectors take root, how their boundaries are expanding, and how resistance is reshaping the tools we rely on. Without this clarity, disease control remains locked in a cycle of reaction rather than anticipation.
India has laid a strong and enduring foundation in this field; one built through consistent commitment and institutional resolve. The next step is not structural, but human: Filling critical entomology roles at state and district levels. The systems are ready; now they need the people who will bring them to life.
At the same time, climate variability is redrawing the map. Breeding seasons stretch longer, vectors move into unfamiliar terrain, and transmission risks surface where they once seemed unlikely. In this evolving landscape, the need for sharp, dedicated minds has never been greater. For young scientists and public health professionals, this is more than a career path, it is an opportunity to stand at the frontlines of change, where the work is urgent, meaningful, and profoundly impactful.
At the community level, the ask may seem simple, yet its power is profound: Recognise the signs, listen to your body, and seek care without delay. These diseases continue to weigh most heavily on those in remote and underserved regions, where access is limited and awareness can be the difference between risk and recovery. A health system, no matter how strong, can only extend so far, it depends on people reaching back with equal resolve. Personal vigilance–spotting symptoms early, seeking timely care, completing treatment, is not a small act. It is the final, decisive link in a long and intricate chain.
India now stands at the threshold of a historic milestone. Three diseases that have shaped the nation’s health burden for generations are within reach of elimination. This is not a moment to ease our pace, but to intensify it, to push forward with renewed determination and finish what has been set in motion. With continued vigilance from policymakers, implementers, scientists, and communities alike, we can ensure that complacency does not undo the progress we have collectively fought so hard to achieve.
(The views expressed are personal)
This article is authored by Dr Bhupendra Tripathi, deputy director, Infectious Diseases and Vaccine Delivery, Gates Foundation India.
