The last mile in fight against leprosy
In an age of emerging infectious diseases, it is easy to assume that leprosy is a disease of the past. Yet there were more than 232,000 new cases of leprosy reported last year, and the disease continues to cause visible deformities and disabilities in approximately 13,000-15,000 people every year worldwide.
While public health experts continue to work with policymakers, NGOs, partners and donors, the goal of a leprosy-free world is possible only with renewed commitments for resources and trained health workers.
Leprosy is a chronic disease caused by a bacteria called Mycobacterium leprae. The bacterium multiplies very slowly and the incubation period ranges from a few months to as long as 20 years.
It is important to remember that the disease is not highly communicable _ it is transmitted via droplets from the nose and mouth during close and frequent contact with untreated cases.
Untreated, leprosy can cause progressive and permanent damage to the skin, nerves, limbs and eyes. Early diagnosis and treatment with multi-drug therapy are the key elements in eliminating the disease as a public health concern.
While most countries have eliminated leprosy as a public health problem, in Thailand 220 new leprosy cases were reported last year.
The good news is that leprosy is curable. Treatment is available free of charge.
And the social discrimination suffered by persons affected by leprosy is slowly disappearing thanks to tireless efforts by governments and public health experts.
The advent of multi-drug therapy has been a major breakthrough in the management of leprosy. This drug combination kills the bacteria and fully cures the patient. Since 1995, the World Health Organisation (WHO) has been providing free multi-drug therapy for patients worldwide, initially through a drug fund from the Nippon Foundation and, since 2000, through donations provided by Novartis and the Novartis Foundation for Sustainable Development.
Nearly 16 million people have been cured of leprosy using multi-drug therapy over the past 30 years. More than 10 million were prevented from developing visible deformities.
Leprosy programmes have improved significantly due to national and subnational campaigns in most endemic countries. In 1991, the WHO's governing body, the World Health Assembly, passed a resolution to attain global elimination of leprosy as a public health problem by the year 2000.
Elimination of leprosy is defined as a prevalence rate of less than 1 case per 10,000 persons at the national level. The target was achieved on time and the widespread use of multi-drug therapy reduced the disease burden dramatically.
In 1985, 122 countries were identified as highly endemic for leprosy and were reporting a high number of cases. Today the number of endemic countries is less than 20.
Nevertheless, pockets of high endemicity still remain in some areas of a few countries such as Angola, Bangladesh, Brazil, China, Democratic Republic of Congo, Ethiopia, India, Indonesia, Madagascar, Mozambique, Myanmar, Nepal, Nigeria, Philippines, South Sudan, Sri Lanka, Sudan and the United Republic of Tanzania. All of these countries remain committed to further reducing the disease burden and continuing to intensify their leprosy control activities.
However, a lot of work is still needed to cover the last mile in leprosy eradication. There is no room for complacency. A leprosy-free world is within our grasp. This is the time to renew our commitment to detect the disease early, reach the isolated and at-risk populations and tackle the persistent social stigma head on.
In order to reach all patients, leprosy treatment needs to be fully integrated into general health services, which serves to normalise the disease, makes treatment more accessible and removes leprosy's stigma as a "special" or feared entity.
Moreover, political commitment needs to be sustained in countries where leprosy remains a significant health problem. Partners in leprosy programmes also need to continue to ensure that human and financial resources are available.
The increasing number of new cases with visible deformities, also known as Grade 2 disabilities, is a cause for worry.
The age-old stigma associated with the disease remains an obstacle to self-reporting and early treatment. The image of leprosy has to be changed.
A new environment must be created in which patients will not hesitate to come forward for diagnosis and treatment at any health facility.
Political will is the most important ingredient for improving focus on leprosy programmes.
Discriminatory laws and regulations against the people affected continue to exist. These laws deprive the persons affected by leprosy of their legal rights and social entitlements. And some of them in fact jeopardise basic human rights. According to some of these laws, even treated leprosy is a reason for divorce.
Research is another important aspect of leprosy work that needs greater attention. Leprosy research deserves investment of time and money to develop better health-care models, shorter treatment regimens, effective surveillance systems and ultimately a cure to make leprosy history.
National programmes have been successfully involving partners to muster support in further reducing the disease burden. Partnerships with people affected by leprosy have been a great help in reaching isolated people and areas in many leprosy-endemic pockets of some countries.
Our biggest challenges moving forward are garnering greater commitment and resources to sustain the gains achieved, retaining expertise in leprosy, and mobilising communities to respond to the disease as a medical problem.
With continued political commitment, renewed donor commitment and increased public awareness, we can cover the last mile to achieve a world free of leprosy.
Dr Samlee Plianbangchang is regional director, South-East Asia Regional Office, World Health Organisation.