Rare diseases—also called orphan diseases—may affect only a small fraction of the population individually, but collectively they pose a massive public health challenge in India. According to estimates from the Foundation for Research on Rare Diseases and Disorders, over 70 million Indians are living with rare genetic conditions. Despite their growing prevalence, patients continue to struggle with limited diagnosis, inadequate treatment options, and high out-of-pocket expenses.A disease is considered rare in India if it affects fewer than one in 2,500 individuals. Globally, more than 7,000 rare diseases have been identified, most of which are genetic and often life-threatening. In the Indian context, conditions like Gaucher’s disease, Duchenne muscular dystrophy, and various lysosomal storage disorders are among the most commonly reported.Key Challenges Facing Rare Disease PatientsDelayed or Missed DiagnosisOne of the most significant hurdles is the lack of awareness and proper diagnostic infrastructure. With overlapping symptoms such as fatigue, muscle weakness, neurological disturbances, and gastrointestinal issues, rare diseases are often misdiagnosed or go undetected for years. This diagnostic delay not only worsens the patient’s condition but can also lead to unnecessary treatments and mounting expenses.High Cost of TreatmentRare diseases typically require long-term and highly specialized care. Therapies like enzyme replacement can cost several lakhs annually, placing a heavy burden on families. Unfortunately, these treatments are often not covered under standard health insurance policies in India.Limited Data and ResearchThe absence of a national registry for rare diseases makes it difficult to accurately track the disease burden or develop targeted interventions. Moreover, limited research funding hampers the development of new treatments, especially when pharmaceutical companies see little commercial incentive to invest in conditions affecting small patient groups.Insufficient Infrastructure and Trained PersonnelThe number of healthcare professionals trained to handle rare diseases remains low. Specialized diagnostic centres and treatment facilities are sparse, especially in rural and semi-urban areas, resulting in inequitable access to care.Policy Responses and Emerging SolutionsNational Policy for Rare Diseases (NPRD) 2021In an effort to streamline care and provide financial assistance, the Indian government introduced the NPRD in 2021. The policy classifies rare diseases into three categories—those that need one-time curative treatment, those requiring long-term therapies, and conditions where definitive treatment is still under research. Under the Rashtriya Arogya Nidhi scheme, financial assistance of up to ₹50 lakh is provided for specific conditions listed in the policy.Encouraging Domestic Drug ManufacturingTo tackle the high costs of imported orphan drugs, the government has been encouraging domestic pharmaceutical companies to manufacture these treatments locally. Incentives, including tax benefits and research grants, are being explored to promote affordable drug development.Newborn Screening and Early DetectionRecognizing the importance of early intervention, efforts are underway to expand newborn screening programs across India. Early diagnosis not only improves survival rates but also reduces the long-term cost and complexity of treatment.Strengthening Public-Private CollaborationsPartnerships among government bodies, research institutions, and private companies are being promoted to advance rare disease research. Initiatives like the ICMR’s Rare Disease Registry aim to generate epidemiological data and facilitate better planning and resource allocation.While recent policy measures have been a step in the right direction, much remains to be done. Strengthening financial support, expanding insurance coverage, increasing public awareness, and scaling up research and diagnostic capabilities are critical to improving the lives of those affected by rare diseases in India.With sustained efforts and inclusive healthcare planning, the country can move toward a future where rare disease patients are no longer sidelined, but receive timely, equitable, and effective care.