Nepal’s push to eliminate lymphatic filariasis by 2030

Nepal is closing in on a major public health goal: eliminating lymphatic filariasis, a vector-borne disease that can cause severe disability, as a public health problem by 2030.

Since 2003, the country has implemented mass drug administration (MDA), the WHO-recommended preventive chemotherapy strategy, which involves administering an annual dose of medicines to the entire at-risk population.

Mass drug administration against lymphatic filariasis conducted in Kapilvastu District, Lumbini Province in November 2025. Photo credit: WHO Nepal

Today, MDA has been successfully stopped in 57 out of Nepal’s 64 endemic districts, reflecting years of sustained national commitment, backed by strong technical and operational support from WHO Nepal and close collaboration with development partners.

With elimination in sight, the priority is to identify areas where transmission has ended and areas where it persists. According to WHO guidelines, districts that complete two rounds of IDA*-based MDA should carry out an Epidemiological Monitoring Survey (EMS) nine months after campaign completion. This survey is the first critical step in determining whether MDA can be safely discontinued, followed by IDA Impact Surveys (IIS).  

In 2025, after unexpected funding gaps threatened post-MDA assessments, WHO Nepal stepped in to mobilize resources and, with financial support from Glaxo Smith Kline (GSK), was able to ensure that surveillance activities continued and the 2030 LF elimination roadmap stayed on track.

Rapid Diagnostic Testing (RDT) carried out during the Epidemiological Monitoring Survey (EMS) in Rautahat District, Madhesh Province, Nepal. Photo credit: WHO Nepal

Under the leadership of the Epidemiology and Disease Control Division (EDCD), the Epidemiological Monitoring Survey (EMS) was conducted in September 2025 in 12 Evaluation Units** across six districts: Jhapa, Dhanusha, Mahottari, Sarlahi, Rautahat and Rasuwa. Earlier in the year, the government implemented EMS in two Evaluation Units of Kapilvastu District, with technical guidance from WHO, demonstrating strong national ownership.

Results showed that four Evaluation Units in Jhapa, Sarlahi, Rautahat, and Kapilvastu exceeded the WHO microfilaria threshold of less than 1%, indicating ongoing transmission and the need for additional IDA-MDA rounds. All other Evaluation Units passed this first MDA stop assessment and advanced to the next monitoring phase, the IDA Impact Survey-1 (IIS-1).

Following endorsement of EMS results in October 2025, WHO Nepal supported the government to conduct IDA Impact Survey–1 (IIS-1) in 3 Evaluation Units in Dhanusha and Rautahat. The findings were encouraging: antigen positivity stood at just 0.45% and microfilaria prevalence at 0.05%. These extremely low rates confirmed interruption of transmission. All three units passed the second MDA stop assessment and progressed to IDA Impact Survey-2 (IIS-2), bringing them closer to sustained elimination.

In Kapilvastu, where EMS indicated ongoing transmission, WHO Nepal supported an MDA in one Evaluation Unit covering six municipalities in November 2025. The campaign was launched by the Health Minister Dr Sudha Gautam, demonstrating strong political commitment to reach every remaining at-risk community.

Honourable Minister of Health and Population inaugurating the mass drug administration campaign against lymphatic filariasis in Lumbini Province in November 2025. Photo credit: WHO Nepal

Pre-campaign planning and advocacy, media engagement, district coordination and community sensitization ensured effective implementation. To reach migrant populations, cross-border communities and other hard-to-reach groups,  innovative interventions were introduced, including evening sessions, engagement of trusted local influencers, and joint monitoring.

By the end of the campaign, 295 305 of 389 502 eligible individuals had been treated, achieving 76% epidemiological coverage. While absenteeism and concerns about side effects remain challenges, strengthened risk communication and targeted engagement significantly improved uptake compared to previous rounds.

Ward-level coordination meeting conducted as part of the IDA Impact Survey-1 in Dhanusha District, Madhesh Province, Nepal. Photo credit: WHO Nepal

In January 2026, the government launched LF MDA campaigns in Jhapa, Sarlahi, Rautahat, and Banke, the districts showing ongoing transmission, with resources mobilized from WHO and partners. Coverage is expected to reach 80%.

The WHO-supported continuum of evidence generation and action, from EMS to MDA, demonstrates Nepal’s strong commitment to data-driven decision-making and government leadership in the elimination of lymphatic filariasis. Timely surveillance through EMS and IIS, combined with flexible WHO support during funding gaps, enabled decisive and targeted responses to residual transmission. High-quality campaign implementation, community-focused approaches, and engagement of frontline health workers strengthened coverage and protected hard-won gains.

Together, these efforts are accelerating Nepal’s progress toward eliminating lymphatic filariasis as a public health problem by 2030.

Notes

* Ivermectin, Di-ethyl Carbamazine and Albendazole

**  Evaluation units (EU) are subdivisions of the districts with less than 500 000 population in each EU, for LF survey implementation.