One of the world's most dreaded diseases – leprosy – which has caused stigma and social ostracism for millennia, is nearing elimination worldwide as a public health problem, according to the World Health Organization (WHO). However, at the end of 2000, there may still be about 10 countries where the leprosy burden is greater than WHO's target level of less than one case per 10 000 population(1). Since 1985, the use of multidrug therapy (MDT) to treat and cure patients has already reduced the global prevalence of the disease by 85%, and the number of countries with more than one case per 10 000 has dropped from 122 to only 28 at the start of this year.

Today, over 9 million leprosy patients have been cured, with extremely low relapse rates, and some 800 000 patients are registered for treatment globally, compared to more than five million in 1985. Since 1995, WHO has distributed the three MDT drugs, now available in blister packs, to more than 4 million patients living in 71 endemic countries. Between two and three million people have been saved from the irreversible disablement that can result from untreated leprosy.

While welcoming these achievements, WHO and its partners in leprosy work have no intention of resting on their laurels. On the contrary, the Leprosy Elimination Advisory Group (LEAG) met at WHO headquarters on 12 and 13 April to thrash out new ways to bring the leprosy cure to patients wherever they live and to ensure that the level of leprosy prevalence in all countries continues to decline.

With a view to bringing this goal nearer, the LEAG -- which brings together leprosy experts from many countries and representatives of the nongovernmental organizations working in the field -- drew up a focused strategy with the twofold aim:

• In each of the countries which have not yet attained the target level, to review the situation urgently so as to determine what additional resources they will need to reach it by the year 2000 or shortly thereafter.

• In those countries that have achieved the goal nationally, to ensure that the gains made can be sustained, and to aim for less than 1 case per 10 000 target at the level of a district or a province.

In a message to the LEAG, WHO's Director-General Dr Gro Harlem Brundtland said: "We are very close to the leprosy elimination target and this disease remains high on our agenda. We have every confidence that even closer collaboration with our partners in the coming months will ensure that the target is reached in all but perhaps ten countries by the end of the year 2000."

Leprosy is often confined to quite limited areas of endemic countries, and these are frequently areas where for geographic or other reasons it is very hard to bring the MDT drugs to where the patients live. Besides the problems of physical access to patients in remote areas, there are often bureaucratic delays in distributing the drugs and a lack of human resources to diagnose and treat the remaining cases.

WHO estimates that nearly 2 million patients have yet to be detected over the next two to three years. Of these, 90% live in 13 countries of Africa, the Americas and Asia, and in those countries the prevalence rate was still 4.4 per 10 000 population at the start of 1999. The 13 recognized at present as "top endemic countries" are, in order of prevalence, India, Brazil, Indonesia, Myanmar, Madagascar, Nigeria, Mozambique, Nepal, Ethiopia, Democratic Republic of Congo, Niger, Guinea and Cambodia.

The LEAG meeting stressed that the renewed efforts towards elimination will call for existing partnerships with NGOs and other bodies to be strengthened and for new partnerships to be forged. The member bodies of the International Federation of Antileprosy Associations (ILEP) and the Nippon Foundation in particular have long been WHO's allies in the elimination drive. In addition, the Nippon Foundation of Japan has for five years donated funds which permitted the MDT drugs to be made available free of charge to all leprosy patients.

Dr Maria Neira, WHO's Director of Communicable Diseases Eradication and Elimination, said today: "We must not let slip this window of opportunity which will enable us to curb a disease that has filled humanity with dread since time immemorial. Provided we keep up the political commitment to this struggle against leprosy and provided we muster still more effort and resources, we can foresee that, not too far into the new millennium, the world will finally be rid of yet another scourge of humanity."

For further information please contact Gregory Hartl, Health Communications and Public Relations, WHO, Geneva, telephone: (41 22) 791 4458, fax: (41 22) 791 4858. E-mail: hartlg@who.ch or John Bland, Information Officer, CDS/CEE/LEP, telephone (41 22) 791 3891, fax (41 22) 791 4850. E-mail: blandj@who.ch